At last, a national health measurement survey program for Australia!

Accurate, timely information about a population’s health, health risks and use of health services and medicines is essential for planning and evaluating health policies and care. Health surveys based on representative probability samples of the population are designed to provide this by collecting data on health behaviours, health determinants such as socioeconomic disadvantage and obesity, prevalence of diseases, need for health care and whether this has been provided, functional capacity, and nutritional status.1

Such surveys can be classified as health interview surveys or health measurement surveys. The former are based on interviews or self-administered questionnaires and rely on a participant’s subjective assessment, while the latter include the addition of anthropometric, physiological and clinical measurements and tests (such as lung volume spirometry) and/or the collection of blood and other biological samples.2 Thus, the health measurement survey generally provides more objective data than the health interview survey; for example, on the prevalence of various diseases and risk factors, where self-reported information is known to be quite inaccurate (sometimes due to the fact that the disease has not yet been diagnosed).1

The recent announcement of a national Australian population health survey program using objective measures3 is therefore a welcome initiative for the community, health practitioners and policymakers alike. National health measurement survey programs have been conducted regularly in other countries for many years. The longest such series is in the United States, where the first national survey was carried out in 1959 — now known as the National Health and Nutrition Examination Survey (NHANES), it celebrated its 50th anniversary in 2009.4-6 European examples include the Finnish surveys from the 1970s, German and Norwegian surveys from the 1980s, and English and Scottish surveys from the 1990s.1 These survey programs have provided their countries with rich and unique national data sources for monitoring important health issues and formulating public health policies.

In the US, for example, federal agencies and other public health organisations use data from NHANES to assess nutritional status and its relationship to health promotion and disease prevention.4,5 Survey findings also serve as the basis for national standard physical measurements like height, weight and blood pressure. Health science researchers use information from the survey to develop public health policy, programs and services, and expand the health knowledge of the nation.4 As a result, numerous advances in public health and nutrition have directly benefited US citizens’ health from the use of survey data to:

• document blood lead levels before and after the removal of lead from gasoline, paint and other household agents;

• quantify second-hand smoke exposure and evaluate the impact of policies to reduce or eliminate this exposure;

• identify low levels of folate in the population and the subsequent increase in these levels after folic acid fortification of foods;

• document the increase in obesity and diabetes in the population, including undiagnosed diabetes; and

• underpin the 1977 and 2000 paediatric growth charts.6

In Australia, there has been investment in collecting health information and concomitant biomedical and other measures in the past, but those studies, conducted through the 1980s and up to the mid 1990s, are no longer current, leaving significant gaps in our knowledge of the health of the population.7 More recent health measurement survey proposals have not proceeded, or have failed to deliver reliable national disease and risk factor prevalence estimates because of problems with study design, sampling and response rates.7-9

Now, the Australian Bureau of Statistics (ABS) is including a health measurement survey as an ongoing element of its Australian Health Survey program.3 This is certainly good news for health researchers, community planners, health practitioners and policymakers, and for the Australian public as a whole. The new survey program offers opportunities to provide an improved information base for national health policy development, health program planning and health research in ways that have not previously been possible.

The Australian Health Survey program will have four components:

• National Health Survey, an existing household interview survey;

• National Aboriginal and Torres Strait Islander Health Survey, an existing household interview survey;

• National Nutrition and Physical Activity Survey, a new household interview survey; and

• National Health Measures Survey, a new health measurement survey.10

Planning is being undertaken by the Australian Government Department of Health and Ageing, in partnership with the ABS and the National Heart Foundation of Australia. Beginning in 2011, a representative sample of 50 000 Australians will be asked to complete the Australian Health Survey, representing “the most comprehensive health survey ever undertaken by the ABS”.3 Participants will also be asked to provide voluntary blood and urine samples to allow testing for nutritional status and early indicators of disease, such as high blood cholesterol or glucose levels.10

The investment in this national health survey program, with its inclusion of objective measures, will provide a firm foundation for health policy development in the 21st century, with undeniable benefits for individuals and the Australian community as a whole.