Health is a state of complete physical, mental, and social wellbeing. The World Health Organisation states that it’s not merely the absence of disease or infirmity. Health is inextricably linked to all other domains, such as employment1, living standards2 , housing & homelessness3, disability4, and life satisfaction5.
Population health and wellbeing is considered to be one of the top five challenges for Australia. Improving the nation’s health is a national research priority. In order to address the burden of ill-health in both social and economic terms, it is essential to monitor the nation’s changes to health over time, and to identify contributors to both good and poor health.
Overall Self-Rated Health
Self-rated health is a measure of how people
assess their own health and is a subjective indicator of their health status6. Although it can
differ from a professional medical diagnostic, self-rated health captures how
people perceive their health and studies have shown that it can predict the
presence of illness7. Thus, taken
together with objective measures of health, it gives a more complete picture of
an individual’s health.
Self-rated health was measured on the Household, Income and Labour Dynamics in Australia Survey (HILDA) with a 5-point scale, from poor to excellent. In 2013, according to the HILDA data, just under half (49%) the Australian population aged 15 and over assessed their own health as being very good or excellent. This proportion was significantly lower compared with 2001, where 51.3% self-assessed their health as very good or excellent.
Obesity is a significant health challenge we face as a society. In 2013, according to data from HILDA, 56.5% of people aged 15 and over were overweight or obese, approximately 40% were a normal weight and 3% were underweight.
Between 2006 and 2013, there was a significant decrease in the proportion of the population who were a normal weight, from 42% to 40% (HILDA data). Correspondingly there was a significant increase in the proportion who were obese between 2006 (21.3%) and 2013 (22.9%).
Excessive alcohol consumption has many negative health and social consequences for both the individual and society8.
In 2013, HILDA data show that just over one third (36%) of people reported drinking alcohol above the recommended threshold of two standard alcoholic drinks per day. There was also a significant decrease in the proportion of people drinking within the recommended guidelines between 2001 and 2013, from 47% to 42%.
However, the good news is that there were small but significant increases in the proportion of people reporting never or no longer drinking alcohol between 2001-06, 2006-11 and 2011-13. Overall, the proportion of people reporting never or no longer drinking alcohol significantly increased from 16% in 2001 to 22% in 2013.
According to our analysis of 2013 HILDA data, young people aged 15-24 were more likely than 25-64 year olds to exceed the alcohol consumption guidelines, as were males when compared to females, Indigenous people when compared to non-Indigenous people, and people suffering from a high level of psychological distress when compared to people with low levels of psychological distress. However, people with a disability were less likely to exceed the guidelines when compared to people with no disability.
In 2013, 16.6% of people aged 15 and over reported being a smoker, according to the HILDA survey, representing a significant decline (p < 0.01) from 22.5% in 2001.
The likelihood of being a smoker varied across different population groups. We found that younger people aged 15 to 24 and older people aged 65 and over were less likely to be smokers than those in the 25-64 age group.
Gender, disability status, and Indigenous status were also significantly associated with smoking, according to our analysis of HILDA data. Women were significantly less likely to smoke than men, while people with a disability and Indigenous people were more likely to be smokers compared to people with no disability and non-Indigenous people respectively.
The likelihood of smoking increased with psychological distress; people with higher levels of psychological distress were significantly more likely to smoke compared to people with a low level of psychological distress. The predicted probabilities of being a smoker for those experiencing moderate, high and very high psychological distress were 20%, 20% and 31% respectively, compared to 13% for people with a low level of psychological distress.
People living in remote or inner regional areas were significantly more likely to smoke than those living in a major city. Likewise, people living in the most disadvantaged areas had a significantly higher likelihood of smoking compared to people in median areas of disadvantage. Conversely, people living in the least disadvantage areas were significantly less likely to be smokers compared to people living in median areas of disadvantage.
The World Health Organisation (2014) asserts that mental health refers to “a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community”. Mental health is not simply the absence of mental illness9. Mental health is critical to an individual’s wellbeing and quality of life; poor mental health is associated with many negative social outcomes including poverty, unemployment and homelessness, social isolation and discrimination10.
One in five Australians will experience a mental health problem in their lifetime, with anxiety and depression among the most commonly experienced11. In population studies, the Kessler 10 (K10) is a widely used measure of mental health to determine the level of non-specific psychological distress of an individual. It measures the likelihood of having experienced anxiety and/or depression in the past four weeks12.
According to findings from the HILDA survey, nearly 16% of the population 15 years and over were experiencing high or very high levels of psychological distress in 2013. In the same year, 62.7% and 21.4% of the population reported a low and moderate level of psychological distress respectively. These proportions did not significantly change between 2011 and 2013.
In our analysis of HILDA data, we found that young people aged 15 to 24 years were significantly more likely to experience psychological distress than 25 to 64 year olds, while people aged 65 and over were significantly less likely to experience psychological distress.
Females were also more likely to experience psychological distress than males. Similarly, people with a disability and Indigenous people were more likely to experience psychological distress than people with no disability and non-Indigenous people respectively.
People living in the most disadvantaged areas also had a higher likelihood of experiencing psychological distress compared to people in areas of median disadvantage, while people in least disadvantaged areas were less likely of being psychologically distressed.
Access to services
Governments around Australia wrestle with the challenges of hospital and specialist waiting lists, and inadequate access in some areas to GPs and other health services. Access to health services is exacerbated in some areas of Australia by geographical remoteness13. Indeed, 5.4% of the Australian population aged 15 years and over reported not being able to access and use health related services at times in 200914.
In 2013, according to data from HILDA, 45% of people 15 and over reported that they had not been to a dentist in the last year. Specifically, 17% had not been to the dentist in one to less than two years, more than a quarter (27%) had not been to a dentist for two or more years, and 1% had never been to a dentist.
Despite significant investment in health, there has been little progress made in improving the health of Australians. Shifts of less than 2% were evident for the proportion of the population aged 15 and over meeting physical activity guidelines; having a healthy weight; and drinking alcohol at or below recommended daily limits. Encouragingly, there have been reductions in proportions of those that smoke tobacco.
Some population groups experienced poorer health outcomes and unhealthy behaviours including Indigenous people; people with a disability; people experiencing high psychological distress; and people living in the most socio-economically disadvantaged areas. The need to focus on prevention and early intervention is further reinforced.
- WANBERG, C. R. 2011. The Individual Experience of Unemployment. Annual Review of Psychology, 63, 369-396.
- SAUNDERS, P., NAIDOO, Y. & GRIFFITHS, M. 2007. Towards New Indicators of Disadvantage: Deprivation and Social Exclusion in Australia. Sydney: Social Policy Research Centre. MUIR, K., MARJOLIN, A. & ADAMS, S. 2015. Eight Years on the Fringe: What has it meant to be severely or fully financially excluded in Australia? Sydney, Australia: Centre for Social Impact for the National Australia Bank.
- MUIR, K., MARJOLIN, A. & ADAMS, S. 2015. Eight Years on the Fringe: What has it meant to be severely or fully financially excluded in Australia? Sydney, Australia: Centre for Social Impact for the National Australia Bank.
- COMMONWEALTH OF AUSTRALIA 2009a. Shut Out: The Experience of People with Disabilities and their Families in Australia. National Disability Strategy Consultation Report prepared by the National People with Disabilities and Carer Council.
- DIENER, E. & CHAN, M. Y. 2011. Happy people live longer: Subjective well-being contributes to health and longevity. Applied Psychology: Health and Well-Being, 3, 1-43.
- WU, S., WANG, R., ZHAO, Y., MA, X., WU, M., YAN, X. & HE, J. 2013. The relationship between self-rated health and objective health status: A population-based study. BMC Public Health, 13, 320-328.
- AUSTRALIAN BUREAU OF STATISTICS. 2007. Notes [Online]. Available: http://www.abs.gov.au/ausstats/abs@.nsf/mf/4828.0.55.001 [Accessed January 2016].
- NATIONAL HEALTH AND MEDICAL RESEARCH COUNCIL. 2015. Alcohol and Health in Australia [Online]. Available: http://www.nhmrc.gov.au/health-topics/alcohol-guidelines/alcohol-and-health-australia [Accessed January 2016].
- KEYES, C. L. & SIMOES, E. J. 2012. To flourish or not: Positive mental health and all-cause mortality. American Journal of Public Health, 102, 2164-2172.
- AUSTRALIAN INSTITUTE OF HEALTH AND WELFARE. n.d. Mental health services in Australia [Online]. Available: http://mhsa.aihw.gov.au/home/ [Accessed January 2016].
- AIHW 2014a. Australia's health 2014. Canberra: AIHW.
- DRUG AND ALCOHOL CLINICAL ADVISORY SERVICE n.d. The Kessler 10 - Information for health professionals. Screening and Assessment. DACAS.
MCGRAIL, M. R. & HUMPHREYS, J. S. 2015. Spatial access disparities to primary health care in rural and remote Australia. Geospatial health, 10.
- AUSTRALIAN BUREAU OF STATISTICS. 2011a. Health services: Use and patient experience [Online]. Available: http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4102.0Main+Features20Mar+2011 [Accessed January 2016].