The burden of disease and injury in Australia: time for action Another report or the beginning of a new era?
MJA 1999; 171: 581-582 | |||
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The purpose of the Australian Institute of Health and Welfare (AIHW)
is to provide authoritative and timely reports on the health and
welfare of Australians to inform community discussion and decision
making. This year alone the AIHW has released more than 30 reports or
documents on topics ranging from aspects of general practice to
specific diseases and disabilities to other, more eclectic
information on health and welfare endeavours.1 Most of the
reports are relatively specialised and are of limited interest
beyond specific echelons of health and welfare enterprises.
However, The burden of disease and injury in
Australia2 is a notable exception. This
report is our first comprehensive national study on the impact of
mortality and disability arising from 176 disease and injury
categories. It also explores the burden associated with a range of
disease risk factors, other health determinants and socioeconomic
gradients. As its numerous categories of disease and injury
encompass a wide spectrum of medical activities, its major findings
are of relevance and interest to doctors. Selected highlights of the
report are shown in the Box.
This Australian study comes hot on the heels of the groundbreaking study of the global burden of disease and injury by researchers from the Harvard School of Public Health and the World Health Organization.3 Indeed, the Australian study used the methods developed by the global initiative,4 but modified for the Australian context. The study's analytical tool is the disability-adjusted life-year, or DALY. This measure extends the concept of potential years lost because of premature death to include equivalent years lost to poor health and disability (effectively the sum of years of life lost [YLL] and years lost due to disability [YLD]). DALYs are intended to be a transparent tool for enhancing dialogue on major health challenges.4 Although the authors of the report have qualified it as "provisional and developmental" and its findings have yet to be widely scrutinised, it should be welcomed. For the first time we have a standard analytical measure that allows comparisons of the health burden by different diseases or health disorders, and produces a picture that differs from traditional mortality analysis. It also allows for comparisons based on geography,5,6 as well as for assessment of interventions and other factors that may influence the burden of disease. In essence, the report has shown that in 1996:
What will be the ramifications of this study? After an initial flurry of interest, will it gather dust in the libraries of academia, health departments, non-profit health agencies, or lie in the "too-hard" baskets of bureaucrats and politicians? This is a pessimistic view, but, unfortunately, it does have precedents. In the past decade there have been many reports urging more effective action to reduce both the burden of disease and inequities in health.7 In 1986, the Better Health Commission's Looking forward to better health8 contained proposals for achieving greater equity in health in Australia, as well as strategies for addressing several major preventable contributors to death and disease. This report was received by the Australian Health Ministers Advisory Council (AHMAC), which responded by establishing the Health Target and Implementation Committee (HTIC) to determine how its recommendations could be implemented. Two years later the HTIC published Health for all Australians.9 This again emphasised equity as the key goal for future health promotion and outlined a comprehensive set of health promotion goals to be achieved by the year 2000. The political response to this report was the establishment of the National Better Health Program (NBHP), which was empowered to pursue these initiatives. Unfortunately, this program went the way of many State-Commonwealth initiatives, and failed to have significant effect. In 1991, the Commonwealth commissioned a major review of the NBHP and its effects on the health goals set in 1988. The outcome of this review, Goals and targets for Australia's health in the year 2000 and beyond,10 was submitted to AHMAC in 1993. It advocated a more radical and comprehensive approach than was politically acceptable, and AHMAC responded by establishing the much more narrowly defined National Health Priority Area (NHPA) program. The NHPA Committee has published a plethora of reports on cancer control,11 injury prevention and control,12 cardiovascular health,13 diabetes mellitus,14 and mental health.15 The diseases targeted by the NHPA are responsible for 70% of the total burden of disease and injury in Australia, comprising 81% of the YLL and 57% of the YLD.2 There is no doubt that disease and injury burdens have decreased since 1981 (see Box). These gratifying advances reflect a combination of different interventions, such as health education, changes in public policy, primary care and treatments. The Burden of disease and injury in Australia2 is a welcomed report, but the time has surely come for less analysis and more concerted action. The continuing role of the NHPA beyond simply generating reports is ripe for review. As there are so many players in the field of addressing Australia's burden of disease and injury, including the community, a national summit for achievable action in health might be a good place to start. Martin B Van Der Weyden
©MJA 1999
Readers may print a single copy for personal use. No further reproduction or distribution of the articles should proceed without the permission of the publisher. For permission, contact the Australasian Medical Publishing Company. Journalists are welcome to write news stories based on what they read here, but should acknowledge their source as "an article published on the Internet by The Medical Journal of Australia <http://www.mja.com.au>". <URL: http://www.mja.com.au/> © 1999 Medical Journal of Australia. We appreciate your comments. | |||||||||
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75 years, and injuries are the main causes of YLL in young adults and children.
