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This Chief Medical Officer’s report looks at some key data, at the quality of health care and at some challenges and opportunities to be faced in coming years.
International comparisons are provided regarding life expectancy and three of the risk factors that have a major impact on life expectancy, being tobacco consumption, alcohol consumption and the prevalence of obesity. Data on national expenditure on health follow.
The second aspect of the Report focusses on key elements of the quality of health care and how, at system, organisation and individual levels our system is responding to the vision of the Australian Safety and Quality Framework for Health Care. This envisages safe and high quality care for all Australians.
Finally, a glimpse is provided into three of the challenges and opportunities we face in coming years in dementia, health technology and genomics.
Australia’s health generally compares well internationally. Our life expectancy is among the highest in the world, and our infant mortality rate is among the lowest.1Death rates are falling for many of our major health problems, such as cancer, cardiovascular disease, chronic obstructive pulmonary disease, asthma and injuries, and survival from these conditions continues to improve.
Most Organisation for Economic Co-operation and Development (OECD) countries have seen substantial gains in life expectancy over past decades, largely due to improvements in living conditions, public health interventions and progress in medical care. These gains in life expectancy reflect large declines in mortality at all ages.
The World Health Organization (WHO) reports that heart disease, stroke, cancer and other noncommunicable diseases pose a looming health burden. While death rates are falling, the incidence of these somewhat preventable diseases is increasing amongst the Australian population.
It has been estimated that almost four in five Australians have at least one long-term or chronic health condition.3 The burden of these chronic illnesses has risen, and is projected to further increase as populations age because these diseases are more common at older ages. Expenditure on chronic disease in Australia already makes up nearly 70% of total health expenditure on disease.4
A small number of risk factors account for much of the morbidity and mortality attributed to noncommunicable and chronic disease. These include: tobacco use, excessive alcohol consumption, being overweight, insufficient physical activity, high blood pressure, high concentrations of cholesterol in the blood and inadequate intake of fruit and vegetables.
Figure 1 Life expectancy, male and female population at birth – OECD countries 2010
The proportion of adults smoking daily has declined markedly over the past two decades in most OECD countries. Australia has achieved remarkable progress in reducing tobacco consumption, cutting by more than half the percentage of adults who smoke (from 35.4% in 1983 to 15.1% in 2010). Much of this decline can be attributed to policies aimed at reducing tobacco consumption through public awareness campaigns, advertising bans and increased taxation.
The smoking rate in Australia is now one of the lowest in OECD countries (among a small group of countries including Sweden, Iceland, and the United States) and is well below the OECD average of 21.1%.
Figure 2 Tobacco consumption, % of population 15+ who are daily smokers
Alcohol consumption in Australia has been estimated at 10.3 litres of pure alcohol per person (aged 15 years and over) per year. Australians consumed more alcohol than the OECD average of 9.6 litres per person per year. As a standard drink consists of 12.5mls of pure alcohol, for Australia, this equates to an average of 2.2 standard drinks per day per person aged 15 years and over.
The ABS National Health Survey shows that the proportion of people aged 15 years and over at risk of health effects, over the long term, from excessive alcohol consumption was 13% in 2007–08.
Figure 3 Alcohol consumption, litres per capita – 2010 (or nearest year)
Figure 4 Increasing obesity rates (% of population) among the adult population in OECD countries – 2010
Risks of developing heart disease, stroke, type 2 diabetes and certain cancers increase steadily with increasing body mass index (BMI). Being overweight or obese also has adverse metabolic effects on blood pressure, cholesterol and insulin resistance.
In Australia, the adult obesity rate, based on measures of height and weight, was 25% in 2010. This is lower than in the United States (35.9%) and Mexico (30%), but higher than the OECD average of 22.2%. Obesity’s growing prevalence foreshadows increases in the occurrence of health problems and higher health care costs in the future.5
In Australia, obesity rates have increased from 11% in 1990 to 25% in 2010.
Figure 5 Health expenditure (%) as a share of GDP, OECD countries – 2010
There has been a steady rise in the health spending across the OECD countries, which has tended to grow faster than GDP. In 1960, health spending accounted for under 4% of GDP on average across OECD countries. By 2010, this had risen to 9.5%.
The Productivity Commission has estimated that, as a proportion of GDP, health spending will increase by 78% between 2009–10 and 2049–50, partly due to the expected rise in preventable conditions. While Australia’s smoking rates are comparatively low, our rates of drinking alcohol, being obese and sedentary are relatively high. Improving on all these risk factors is an important step towards the prevention of potential unnecessary disease and death.
Population growth will create further pressures on our health system. Our population is projected to grow from the current 22 million to 36 million by 2050. Further, the 2010 Intergenerational Report shows that the proportion of our population aged over 65 is forecast to increase from 14% in 2010 to 23% by 2050. This will further increase the need for more health services, as well as new care facilities and an expanded health workforce.7
Another cause of growth in health spending is the growing role of expensive new technologies and pharmaceuticals. Significant increases in labour costs, as well as increasing patient expectations of the health system, are also impacting on health care costs.
To meet the demand for health care in the future, we must examine our health systems and ensure they are effective and efficient. We need to engage people in caring for their own health to prevent disease from occurring, and then better manage treatment when disease does occur.
At the core of an effective and high performing health care system is good access to clinically appropriate services. Essentially this means being able to see the right health professional, at the right time, in the right place, and in a manner that is affordable and culturally appropriate.8
To make sure health services meet the needs of communities, the Commonwealth Government is reshaping health services to be more locally focused by establishing Medicare Locals and Local Hospital Networks under the new National Health Reform.
Local Hospital Networks (LHNs) have been introduced to run small groups of hospitals, so that hospitals better respond to the needs of their local community. Local Hospital Networks will collaborate to provide better coordinated patient care and promote more efficient use of resources.
Medicare Locals have been established to support and enable better integrated and responsive local General Practice (GP) and primary health care services to meet the needs and priorities of patients and communities. In particular Medicare Locals will make it easier for patients to navigate the health system. While GPs remain at the centre of primary health care and responsible for individual patient care, Medicare Locals will develop strategies to meet the overall primary health care needs of their communities, including the availability of after-hours care.
For health care to become truly responsive to the needs of the patient, it is vital that patients feel engaged and empowered to manage their health, are proactive about their health, and are more aware about health care services.
Patient-centred care is health care that is respectful of, and responsive to, the preferences, needs and values of patients and consumers. Research demonstrates that patient-centred care improves patient experience and creates public value for services.
Patient-centred care is particularly important among vulnerable or disadvantaged populations, such as the young, elderly, disabled or mentally ill; those from culturally and linguistically diverse backgrounds, or rural and remote areas; and Aboriginal and Torres Strait Islander peoples. For many of these people, communication and collaboration with health professionals can be difficult and necessarily involves carers, friends, family and the broader community. Patient-centred care principles and approaches are considered to be an opportunity to go some way towards reducing the inequity people in these populations can experience and potentially achieving better health outcomes.
In Australia, a patient-centred approach is supported by the Australian Charter of Healthcare Rights, the Australian Safety and Quality Framework for Health Care, the National Safety and Quality Health Service Standards and a range of jurisdictional and private sector initiatives.
Another driver for improving patient-centred care is the establishment of the National Health Performance Authority to report transparently on a range of performance indicators, including ‘patient satisfaction’ for every Local Hospital Network, public hospital, private hospital and primary health care organisation.
Strategic and planning documents include core principles related to achieving patient-centred care. For example, the National Chronic Disease Strategy lists optimising self‐management so people can take responsibility for their own health, make informed decisions, and maximise their quality of life and wellbeing as one of its overarching principles.
On a smaller scale, individual programs in diverse areas such as medication management and aged care, are also taking a patient-centred approach. Medication management is an increasingly complex issue, particularly in the residential aged care sector. A significant number of people have co-morbidities and take multiple medicines and as such are more prone to adverse events, interactions and other drug related problems. Medication Management Reviews involves collaboration between a patient’s GP and pharmacist, to maximise the patient’s benefit from their medication regime and prevent medication-related problems. The patient is central to the development and implementation of a medication management plan.
The Consumer Directed Care initiative allows older people and their carers to make choices about the types of care services they access and the delivery of those services, including who will deliver the services and when. After a successful pilot project, Consumer Directed Care will be embedded into new Home Care packages from 1 July 2013.
For health care to be sustainable and for patient outcomes to be optimal, care should be provided in accordance with best practice clinical guidance for common conditions endorsed by peak national and professional bodies. Although most health care in Australia is associated with good clinical outcomes, patients still do not always receive all the care that is recommended to them, and preventable adverse events continue to occur across the Australian health care system.
In recent years, there has been a shift in both the awareness of, and investment in, safety and quality by Australian health services. This includes developing and using clinical guidelines that, while set by clinicians and experts nationally, are applied at the local level and contribute to redefining local service mix and approach.
The Australian Commission on Safety and Quality in Health Care developed the National Safety and Quality Health Service Standards, published in June 2011. The Standards provide a nationally consistent and uniform set of measures of safety and quality for application across a wide variety of health care services. They propose evidence-based improvement strategies to deal with gaps between current and best practice outcomes that affect a large number of patients.
Among other things, the Standards include national benchmarks and targets for Staphylococcus aureus bacteraemia and Medication Safety.
Staphylococcus aureus bacteraemia in Australian public hospitals:
Staphylococcus aureus bacteraemia (SAB) associated with hospital care is an important measure of the safety of hospital care. Patients who develop bloodstream infection such as SAB are more likely to suffer complications that result in a longer hospital stay, and serious infections can result in death.
A national benchmark has been set for public hospitals that no more than 2.0 cases of SAB occur for every 10,000 days of patient care. In 2010-11, there were 1,873 cases of SAB reported for Australian public hospitals overall, at a rate of 1.1 per 10,000 patient days.9
Improving hand hygiene among healthcare workers is the single most effective intervention to prevent health care associated infections in Australian hospitals.
The Australian Commission on Quality and Safety in Health Care is implementing a National Hand Hygiene Initiative to improve Australian health care worker hand hygiene practices, by identifying ‘Five Moments’ in patient care during which hand hygiene is critical to stop the spread of harmful microorganisms.
Medication Safety
Over 1.5 million Australians are estimated to experience an adverse event from medicines each year.10 This result in at least 190,000 hospital admissions (2-3% of all admissions), approximately 50% of which are considered potentially avoidable.
A study published in 2009 reported that medicine-related hospital admissions in Australia were estimated to cost $660 million.11
The most common cause of medication error is due to slips in attention that occur during routine prescribing, dispensing and administering. In response to reducing harm to patients from medication errors, the National Inpatient Medication Chart was implemented to standardise communication of medication information between doctors, nurses and pharmacists. The patient charts greatly assisted in reducing the incidents of re-exposure of medications that have previously been identified as causing an adverse drug reaction.
While Australia’s health system serves most Australians well, at a cost to the community that is around the average of other advanced nations, it also faces many challenges. Some of the emerging issues in the health arena include the increasing prevalence of some diseases or conditions, harnessing new technologies such as eHealth, and investing in new scientific developments such as genomics.
Australians continue to live longer lives than at any time in history. This has led to a growing focus on the extent to which these additional years are lived in good health. As at 30 June 2011, 14% of the population were aged 65 or over. By 2031, this figure is projected to grow to 19-21% of the population.12 These projections suggest a steady increase of certain age-related diseases, including neurodegenerative diseases in general, and dementia in particular.
Dementia describes a syndrome associated with a range of diseases which are characterised by the impairment of brain functions, including language, memory, perception, personality and cognitive skills. Dementia is increasingly common with age but it is not an inevitable part of ageing and can affect people as young as 30.
There has been growing recognition that dementia will be a major cause of disability for Australians and presents a significant challenge to health, aged care and social policy. In August 2012, Commonwealth and state and territory Health Ministers agreed to make dementia a National Health Priority Area.
The predicted rise in dementia prevalence can largely be attributed to increasing longevity and the ageing population since the incidence of all dementia nearly doubles with every 5 years of age. There is growing evidence indicating that certain medical conditions, such as hypertension, diabetes and obesity, may increase the risk of dementia whereas a healthy lifestyle may reduce the risk. Furthermore, aggressive management of vascular risk factors may slow the progression of vascular dementia and Alzheimer’s disease.13
People can reduce the risk of developing dementia by up to 20% through lifestyle interventions which include healthy weight, getting regular exercise and managing blood pressure and cholesterol.14
Identification and modification of these risk factors early on remains the basis to delay the onset of dementia and its prevention.
The technology with which we communicate and access information has also changed dramatically in recent times, which has opened up opportunities to deliver health care services in a different, more time-effective way.
Electronic health records enable comprehensive databases of information to be viewed and used by authorised users when they need it and where they need it. eHealth is an important enabler in a patient-centred health system.
All Australians who choose to register for their own personally controlled electronic health record (PCEHR) can now do so. Over time this investment will deliver substantial benefits to consumers and the health system by reducing the potential for medication errors and duplication of tests.
The use of telehealth services will address some of the barriers to accessing medical and specialist services. In particular, this will benefit Australians in remote, regional and outer metropolitan areas.
These investments will begin to enable consumers to be more active in their health care management, regardless of where they live or when they seek care.15
All Australians benefit from the outcomes of health and medical research, as research is translated into improved primary and hospital care, aged care, and better preventative health strategies.
In the coming years, a better understanding of the role of genetics in health care will bring about profound changes to service delivery in the health sector.
Most of the human ailments, except for trauma, have some basis in our genes. Until recently, doctors were able to take the study of genes, or genetics, into consideration only in cases of birth defects and a limited set of other diseases. The completion of the Human Genome Project in 2003 facilitated the complete sequence of the human genome. These advances in health care technology provide new diagnostic approaches for the early detection of many common and chronic conditions such as cancer, diabetes, and cardiovascular disease that constitute the majority of health problems around the world.
Genome-based research is already enabling medical researchers to develop effective medical treatments to better understand the health needs of people based on their individual genetic make-ups, and to design new treatments for disease. Realising this potential will require a population focus, not only for research, but also in designing strategies to interpret and use genetic and genomic information in community and home-based settings.
Importantly, it is hoped that advances in genomics will provide new opportunities for prevention, traditionally at the heart of public health, both at the individual level and through population-wide interventions.16
Professor Chris Baggoley
Chief Medical Officer
September 2012
Produced by the Portfolio Strategies Division, Australian
Government Department of Health and Ageing.
URL: http://www.health.gov.au/internet/annrpt/publishing.nsf/Content/annual-report-1112-toc~11-12overview~11-12cmoreport
If you would like to know more or give us your comments contact: annrep@health.gov.au
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