Australia’s health – our current arrangements and challenges Presentation to: Academy of the Social Sciences in Australia: Health Roundtable 1 December 2014 David W Kalisch Director (CEO) AIHW

National Health Performance Framework

Health status

Life expectancy at birth Health status

More disability free years Living longer with more disability free years Influenced by lifestyle factors Advances in screening, primary prevention and therapeutic interventions Health status

Experiences/views of community about their health Health status

Health disparities

Indigenous health Lower life expectancy Some improvements Higher proportion report their health as poor Greater impact of risk factors, higher incidence of many diseases at younger ages Health disparities

Socio-demographic Health disparities Clear social gradient of health, with riskier behaviours more prevalent in more disadvantaged areas of Australia

Cancer death/ survival Rate of new cases increasing, with population ageing Cancer deaths falling 16% of total disease burden Greater focus on survivorship Health disparities

Fewer heart attacks/strokes Health disparities

Burden of disease Global Burden of Disease Study 2010: largest contributors to total burden (Australasia): cancer 16% musculoskeletal disorders 15% cardiovascular diseases 14% mental and behavioural disorders 13% AIHW is updating this for Australia – to be released later in 2015 Health disparities

Contributors to the health gap Health disparities

Health risks

Overweight/obesity 26% of children (5–17) overweight or obese 63% of adults overweight or obese - 70% males - 56% females More common in lowest SES areas Health risks

Smoking 12.8% of adults smoke daily Smoking rates low by international standards Downward trend over last 50 years Fewer young people taking up smoking Indigenous Australians 2.5 times more likely to smoke daily Lowest SES 3 times more likely to smoke daily Health risks Source: AIHW 2014 Smoking status in 2013

Alcohol risks Health risks Volume of alcohol drunk per year/per person declined 6.5% of people drank on a daily basis 1 in 5 adults exceeded ‘lifetime risk’ ‘levels 49% of drinkers reduced their alcohol intake Increase in % of people abstaining from drinking alcohol

Exercise - insufficient physical activity Health risks

Nutrition 92% of adults did not eat 5 serves of vegetables 52% did not eat 2 serves of fruit On average, ‘treat’ foods contributed 36% of energy intake for adults and 41% for children Health risks

Rise of chronic disease Leading cause of illness, disability and death in Australia Accounts for 90% of all deaths Share common risk factors Global BOD Australasian region findings, leading risk factors: Dietary 11% High BMI 9% Smoking 8% Health risks

Health system performance

Complexity of our health system Health system performance

Health expenditure to GDP Health system performance

Health expenditure to revenue Health system performance

International comparison

What is driving health costs? 1.6% growth per year Upwards pressure on costs Population growth New diagnostic and treatments New pharmaceuticals New technologies Costs increase in older ages 20 times higher per person Population ageing Health system performance

Current policy challenges How our “system” can best work as a system Improving value from our health spending Reducing health inequalities – socio-demographic and regional Contributions of social determinants and “health in all policies” Role of stakeholders, information and analysis in the health sector Current policy challenges

Efficiency of health services Governments, NGOs and individuals spend a lot on health services Should deliver value for money to taxpayers, shareholders, households and patients Some attention to the efficient price of hospital services, Could also progress opportunities to asses and improve both technical and allocative efficiency across the broader health system Current policy challenges

Reducing health inequalities While overall health outcomes are very good for Australia as a whole, there are significant health inequalities Considerable scope to improve health outcomes for indigenous Australians, those with lower socio- demographic status, those residing in regional/remote areas of Australia, etc Health system is only part of the solution Current policy challenges

Comprehensive strategies – beyond the health system Analyse the impact that education, employment, housing, community, etc. has on health outcomes Considerable attention to social determinants of health following the Marmott Committee report Should prompt greater engagement with other economic, social and environmental sectors, to better understand and exploit the shared interests Mutual dependancies? Current policy challenges

Engaging with clinicians and consumers as the change agents Lot of information is collected about our health system and health services. Opportunity to liberate and use this information in more productive ways Conversation developing around options to move beyond current largely aggregated public reporting to information that can better inform and empower consumers and clinicians as change agents Current policy challenges

The latest Australia’s health 2014 report is available from our website at: A comprehensive chapter is dedicated to the National Health Performance Framework indicators that shows how we compare with OECD countries on a range of measures. Want more information?