Australia has achieved excellent health outcomes and is one of the best performing nations when comparing OECD health outcomes data. In 2005 Australian males had the highest life expectancy along with Japanese males. Australian women had the second highest life expectancy, along with French women.1
Australia can be justly proud of the reductions achieved in mortality from CVD and the fact that Australia has improved its ranking amongst OECD countries for mortality rates from CVD.2 Between 1991 and 2002, mortality rates for CVD in Australia fell by 36.3% for males and 33.7% for females, which in the main can be attributed to a combination of reductions in some risk factors and improved treatments.3
Nevertheless cardiovascular disease (CVD) remains a major health issue for Australia. While mortality rates for CVD have fallen significantly, disability associated with CVD has increased (an estimated 18.2% increase in disability the last decade).4 CVD is a significant contributor to our overall burden of disease, and the major cause of mortality in Indigenous Australians.
In addition, CVD mortality rates have not improved uniformly across all socioeconomic groups, with people from lower socioeconomic groups bearing a proportionately higher burden of disease and Indigenous Australians bearing the greatest burden of disease. The average life expectancy for Indigenous Australians is 17 years less than non-Indigenous Australians, and rates of heart attack in Indigenous Australians are three times higher than for other Australians. The AIHW quotes data from Vos et al. (2007) that indicates that the burden of disease and injury among Indigenous Australians in 2003 represented 3.6% of the total burden of disease in Australia, whereas Indigenous Australians comprise only 2.5% of the total Australian population.5
In response to the continuing gap in health outcomes for Indigenous Australians, the Commonwealth and the States have agreed to an Indigenous Health National Plan worth $1.6 billion over four years, with the Commonwealth contributing $806 million and the States $772 million. This proposal will contribute to addressing the COAG-agreed Closing the Gap targets for Indigenous Australians, closing the life expectancy gap within a generation and halving the mortality gap for children under five within a decade. The proposal includes expanded primary health care and targeted prevention activities to reduce the burden of chronic disease.6
A study of inequalities and socioeconomic disadvantage in relation to Coronary Heart Disease (CHD) was undertaken by the AIHW and found:
“Over the 10-year period from 1992 to 2002, excess CHD mortality in males aged 25–74 years and excess stroke mortality in females of the same age increased steadily. For all CVD and stroke in males, and for CHD in females, the proportion of excess deaths due to socioeconomic inequality among people aged 25–74 increased between 1992 and 1997 but then remained stable.”7
Further this study found that:
If all people aged 25–74 years had experienced the same age-specific rate of CVD mortality in 2002 as those living in the least disadvantaged areas of Australia, approximately 27% of CVD deaths in males (2,278 deaths) and 31% of CVD deaths in females (1,149 deaths) could have been avoided. More than one-third of the excess CVD mortality in males (838 deaths) and almost 40% in females (439 deaths) occurred among the most disadvantaged (quintile 1).8
Discussions about CVD should be undertaken in the context of Australia’s high overall health status and the range of services and programs that already exist to support improvement and prevention of other chronic diseases, while giving due consideration to the existing health gaps between socioeconomic groups and particularly the impact of CVD on Indigenous Australians.
1 Australian Institute of Health and Welfare, Australia’s Health 2008, Australian Government, Canberra: AIHW
3 National Health Priority Action Council (NHPAC) (2006), National Service Improvement Framework for Heart, Stroke and Vascular Disease, Australian Government Department of Health and Ageing, Canberra
5 AIHW, Australia’s Health 2008, Australian Government, Canberra
6 Council of Australian Governments Meeting Communique, 29 November 2008, Canberra
7 AIHW Bulletin 37, Socioeconomic Inequalities in Cardiovascular Disease in Australia – Current Picture and Trends Since 1992, August 2006, Canberra