Reta Rasdien and Marnie McKimmie, The West Australian.
Are you healthy? Take some time to answer, it’s not a straightforward “yes” or “no” based on the absence of disease.
In 2017, our “health” is our physical, mental and social well-being all rolled together. It covers lifestyle, environmental and genetic factors, cultural influences, socio-economic conditions and access to health care and programs.
If we look at the health scorecard for the WA population as a whole, many gains have been made in the 18 years since The West Australian newspaper launched Health+Medicine, combining forces with leading health groups and Healthway to encourage people to embrace a healthier lifestyle and seek out high quality evidence-based advice to overhaul habits.
Back in 1999, West Australians were exercising less, smoking and drinking too much and junk food meals were rising in popularity.
Now we look back at 18 significant gains made in improving our health, as well as looking forward to what remains to be tackled.
There has been progress on many fronts, confirmed by the Australian Institute of Health and Welfare.
Our life expectancy is one of the highest in the world, and there is less chance of heart attack and death from cardiovascular disease. A much smaller proportion of people smoke today than 20 years ago and alcohol consumption has fallen to its lowest level in 50 years.
But there are causes for concern. More than 11 million Australians have at least one of eight chronic conditions and some people are not doing so well in their health and longevity — including those in rural and remote areas, in the lowest socio-economic areas, Aboriginal and Torres Strait Islanders and people with disability.
Looking to the future, Telethon Kids Institute director Professor Jonathan Carapetis urges West Australians to focus efforts on the “very beginning” of our health and prevent rather than wait to address problems.
“We have mountains of evidence to tell us that good health and wellbeing in the womb and in the first few years of life are the best recipe for a healthy, happy and long life,” he said.
Gains: The virtual eradication of serious Haemophilus Influenzae type B infections with vaccination.
To do: The latest national childhood immunisation figures show that while many regions across Australia improved in 2015-16, several in Perth went backwards. Overall, Perth was one of the worst three regions in Australia for unvaccinated five-year-olds.
2. Mental health
Gains: Shift in community attitudes, reduction in stigma and major developments in the “rights, voices and choices” of those experiencing mental health issues. New IT and online resources had the potential to break down access barriers and overcome confidentiality concerns. More precise clinical guidelines resulting in psychiatric diagnoses becoming more transparent and reliable across different cultures and settings.
To do: Address trends showing higher levels of distress in our community – due to financial pressures, family break up, unstable employment, safety and security concerns. And although people are seeking help sooner, there is a struggle to keep up with the demand for services, often due to budgeting and funding constraints. Concerns about the “medicalisation” of normal human behaviour – with proposals to recognise road rage and excessive jogging as diagnosable mental disorders.
Gains: Falls in smoking-related cancers. Outstanding progress in breast cancer screening and treatment leading to survival rates above 90 per cent. The National Bowel Cancer Screening Program could also lead to falling death rates, but will rely on boosting participation. Advances in the precision of treatment and new, better drugs offers great hope, with immunotherapy drugs leading the way. And, theoretically, the eradication of cervical cancer could be seen “within our lifetime” if the HPV vaccine could achieve even better reach.
To do: Keep an eye on as yet “unconfirmed carcinogens” to ensure newer compounds, substances and chemicals, or those not yet adequately examined, are safe so as to avoid creating a new cancer epidemic in the future. Another concern is the capacity to meet the increased volume of demand from the baby boomer generation.
4. Skin cancer
Gains: The WA community has responded to the SunSmart campaign. Melanoma rates have fallen in the under 40s age group.
To do: Recently, New Zealand surpassed Australia as the number one skin cancer nation in the world, but locally there is still much work to be done.
Gains: Two decades ago, the first insulin pump (reducing the need for injections for people with type 1 diabetes) was used at Royal Perth Hospital. Today, thousands of Western Australians use an insulin pump.
To do: Use technology to provide better services and specialist support to people with diabetes – particularly in regional and remote areas – using telehealth and evidence-based management apps.
Gains: An 11 per cent reduction in deaths from heart attacks in WA has been achieved through a big fall in the prevalence of smoking, widespread use of cholesterol lowering medicines and increased availability and success of stent procedures and other advances in medical treatments
To do: Complacency about smoking is a major threat to these gains, as are obesity and diseases related to sedentary living.
7. Physical activity
Gains: Exercise capacity, or fitness, is now recognised as an independent predictor of mortality in healthy individuals: the fitter you are, the lower your risk of premature death, independent of other risk factors such as being overweight, smoking, having high blood pressure or cholesterol. Exercise is also now recognised as medicine in that it can play a role in the prevention and management of a number of chronic health conditions such as obesity, type 2 diabetes, cardiovascular disease, cognitive dysfunction, depression and anxiety, osteoporosis and some cancers.
To do: Despite the well-established benefits of exercise, work on spreading the message is required with most people not reaching the minimum recommended level of physical activity of 150 to 300 minutes of moderate intensity physical activity or 75 to 150 minutes of vigorous intensity physical activity, each week.
8. Sedentary behaviour
Gains: Now recognised as a risk factor independent of your physical activity levels, with the spotlight firmly on sitting, which is associated with poorer health outcomes, including type 2 diabetes.
To do: Aussies are yet to take on board the relatively new lifestyle message that they should minimise the amount of time they spend sitting and that they should break up periods of sitting as often as possible. No recommendations have been set down for a safe amount of sitting yet but this may come as evidence emerges.
Gains: Better access to healthy foods in public places and, in supermarkets, the Health Star Rating on labels provides an opportunity for informed choice. The incredible rise in popularity of cooking shows has generated new interest in cooking, especially among young people. School gardens and cooking programs that focus on developing skills and confidence in producing and preparing fresh foods also appear effective.
To do: Not much has improved over the last two decades in terms of nutrition. While we might be eating more chia, quinoa, coconut oil and gluten-free products, the reality is that most of us are not addressing the fundamentals of healthy eating with diets that emphasise vegetables, fruit, whole grains, nuts, lentils and minimally processed foods. Eating two fruit and five veg a day has been shown to help prevent heart disease, some cancers, obesity and constipation and yet four out of five adults don’t eat enough to meet Australian Dietary Guidelines.
Gains: Sudden Unexpected Deaths in Infancy fell by 80 per cent between 1989-2015, estimated to represent 9450 deaths prevented since the early SIDS campaigns. Over the years, with the benefit of research, new messages have been added to the safe sleeping guidelines of placing baby on their back to sleep, ensuring their head remains uncovered and keeping them away from smoke before and after the birth. These new messages are to maintain a safe sleeping environment during the day and at night, breastfeeding and sleeping baby in a safe cot in the parents’ room.
To do: While great progress has been made, more than 3200 babies and children die suddenly and unexpectedly each year with causes including stillbirth, SIDS and fatal sleep accidents. More research and ongoing education is required.
Gains: Poor sleep is linked to a tendency to obesity and that ongoing poor sleep can affect your metabolism to a point where it might make you more prone to diabetes, as it affects glucose and insulin metabolism. There is also a better understanding of poor sleep and the subsequent development of depression.
To do: The invasion of smart phones, laptops and tablets into the bedroom needs to stop because it delays people going to sleep and the blue light emitted affects the secretion of go-to-sleep hormone melatonin so people are less likely to go to sleep straight away or to get into deep sleep as quickly as they otherwise would. This is particularly a problem for young people. A greater understanding that sleep should be seen as a pillar of good health alongside diet and exercise is required.
Gains: An unexpected reduction in the number of people with dementia in some countries. This could be the result of the lifestyle changes people are making in response to earlier public health campaigns, particularly healthy heart campaigns.
To do: Even if Australia experiences a similar reduction in incidence rates, the number of people living with dementia will continue to rise because of the ageing population. Dementia is WA’s second leading cause of death. There is still no cure.
Gains: There is a downward trend in daily use (from 9 per cent in 1998 to 6 per cent in 2016) and weekly use (from 40 per cent in 1998 to 36 per cent in 2016), mainly driven by younger men improving their drinking habits. More teenagers are now abstaining from alcohol (94 per cent of 12-15 year-olds and 58 per cent of 16-17 year-olds) and the average age of first use has increased from 14 to 16 years.
To do: This is still the most widely used drug in Australia, with about 78 per cent of us aged 14 years or older indulging in the past year and 17 per cent drinking more than the recommended two standard drinks a day, putting ourselves at increased risk of cancer and other alcohol-related disease. One in four consume five or more standard drinks on a single occasion at least once a month, increasing the risk of alcohol-related injury. Latest data also shows a worrying increase in very high risk drinking (11 or more standard drinks on one occasion) among people in their 50s and 60s.
14. Illicit drugs
Gains: Use has fallen from about 22 per cent of Australians aged 14 and older in 1998 to around 16 per cent in 2016. Those under 40 are now less likely to have recently used illicit drugs than in the past.
To do: While methamphetamine use has declined since 1998 from around 3.7 per cent of the population using it in the last 12 months to around 1.4 per cent in 2016, use of the more potent crystal form ice has led to much more regular use with substantial increases in related harms. Those aged over 40 are also more likely than in the past to use illicit drugs.
15. Indigenous health
Gains: Facing up to the need to tackle Indigenous disadvantage seriously, with a Closing the Gap strategy (in its 10th year) with a bipartisan approach to indigenous health and wellbeing and significant funding attached.
To do: Address the worrying trend that only one of these seven targets is on track and that nine successive Prime Minister’s reports have not told a “happy story”. Stop “tinkering at the edges” with the ultimate solutions needing to come through leadership from indigenous communities.
Gains: Greater recognition of obesity as a major public health threat and targeted programs such as LiveLighter.
To do: Only about one-third of Australian adults have a healthy body weight. Achieving progress remains a challenge as the drivers of expanding waistlines are recognised as being a complex web of factors. Hard-nosed policy options such as restricting advertising and marketing of junk food to kids are now being called for.
Gains: National and State commitments to enrich early childhood environments and folate to prevent neural tube defects — important gains the Telethon Kids Institute had contributed to. The institute also conducted the first comprehensive population studies of the prevalence of mental health disorders in Australian children and young people. As a result, there had been increased focus on prevention, less stigma and a more new services.
To do: A worrying trend is the range of societal and environmental “wicked problems” affecting children, youth and their families — inequalities, overweight kids, climate change, overconsumption, the adverse effects of social media, commercialisation of kids. All of which profoundly affect children’s lives and demand whole-of-government/whole-of-society approaches. There is also a need to address the emerging increase in major depressive disorders and anxiety disorders in young people, particularly girls.
Gains: Record lows. In the early 1980s, over 30 per cent of adults were regular smokers and anti-smoking efforts led to a drop to 12.8 per cent by 2013. And by 2014 only three per cent of 12-15 year-olds were smokers, compared to 20 per cent in 1984. Health warnings and plain packaging, severe restrictions on where you can smoke and market products and recognition of the dangers of second-hand smoke.
To do: Australian Council on Smoking and Health urges Federal and State governments to continue to introduce major anti-smoking changes – including banning political donations from the tobacco industry and a ban on all remaining forms of tobacco marketing and promotion. ACOSH says an estimated 1.8 million Australians now alive will die because they smoked.
SOURCES: Telethon Kids Institute’s founding director and patron Professor Fiona Stanley, director Professor Jonathan Carapetis and Professor Stephen Zubrick, WA Association for Mental Health chief executive officer Rod Astbury, Cancer Council WA Terry Slevin, Diabetes WA, Heart Foundation WA chief executive Maurice Swanson, Sleep Health Foundation chair Dorothy Bruck, National Drug Research Institute, Alzheimer’s Australia, Red Nose, ACOSH and the Australian Institute of Health and Welfare, University of WA Winthrop Professor of Psychiatry Aleksander Janca.