2015-2018 4-yearly report: At a glance
At a Glance: Health Outcomes and Health Determinants
Understanding how chronic disease and health risks vary depending on where we live, and how these factors change over time, is critical to responding to emerging health trends and our diverse health needs. South Australians in general have access to some of the best healthcare in the world. However, differences in income, employment, education, housing and social environment are leading to inequalities in health outcomes.
One method of assessing the performance of South Australia’s health system is to look at changes and differences in population health outcomes. The Health Performance Council’s State of Our Health resource provides a picture of population health over time in each of the South Australian local health networks, by age and sex, by socio-economic status, and against national and Aboriginal population comparators.
The report contains a mix of good and bad news for South Australians. For this four-yearly report, the Council perused the 166 statistical measures it currently reports for indicators of improvement or challenge. The full ‘State of Our Health’ (SoOH) indicator report is at Appendix Three. The criteria used in short-listing are subjective but include persistent increasing or decreasing trends over a decade, a prevalence of more than 10 per cent, and/or measures where South Australia was ranked first, second, penultimate or last compared to other states and territories. The Council prioritised measures where data was most current.
This process short-listed 20 measures of health outcomes and determinants noted as strengths, which indicated improvements, or that the Council decided presented current or emerging challenges to the health system. The Council has denoted these 20 strengths and challenges below with ticks ✔ and crosses ❌, along with brief context explaining why the selected measure should be brought to the attention of the Minister for Health and Wellbeing. More information is available at State of Our Health.
While the gap between Aboriginal and non-Aboriginal life expectancy is about 10 years, life expectancy across the population in South Australia is rising. The vast majority of South Australians self-report that their general health status is good, very good or excellent — despite around a quarter having disabilities that restrict everyday activities and around one in 20 needing assistance with core activities due to profound or severe disability. Most South Australians do not eat the recommended amounts of fruit and vegetables, or undertake the recommended amount of moderate or vigorous physical activity, including walking.
Approximately two-thirds of South Australians are overweight or obese, around a quarter have high blood pressure, and about one in six has high cholesterol. Approximately one in eight South Australians has recently experienced high or very high levels of psychological distress. One in 10 has been told by a doctor that he or she has or has had cancer.
Around a quarter of South Australians drink at levels on a single occasion that puts them at risk of an alcohol-related injury, and about one in six consumes alcohol at levels that puts them at lifetime risk of alcohol-related harm. One in six is a current smoker. Just under one in six South Australians aged 14 years and older reported using drugs illicitly, including the use of pharmaceuticals for non-medical purposes, in the 12 months before survey.
Living with chronic conditions
Changing lifestyle choices, improved healthcare responses and increased life expectancy mean more South Australians are living with chronic conditions. However, not all South Australians with chronic conditions are older; such conditions may exist at birth or be acquired in childhood or early adulthood.
Looking at chronic conditions in this state from highest prevalence to lowest, approximately one in four South Australians has arthritis, about one in five lives with a doctor-diagnosed mental health condition, around one in seven has asthma, and one in 10 has diabetes. About one in 12 South Australians lives with cardiovascular disease, one in 17 with osteoporosis (with the rate for females four times than that of males), and one in 40 with chronic obstructive pulmonary disease such as bronchitis or emphysema.
Starting well and the early years
✔ Fewer teenaged women are giving birth. The percentage of births to women aged 19 years or less is decreasing in South Australia, from 4.6 per cent in 2006 to 2.4 per cent in 2016. The percentage of births to Aboriginal women aged 19 years or less is also down, from 20.3 per cent to 15.2 per cent in the same time period. These trends are in line with falls in the corresponding Australian rates over the same period. [SoOH §2-2]
✔ More women are starting antenatal visits early in their pregnancy. The percentage of women who had their first antenatal visit within the first 14 weeks of pregnancy increased from 70.8 per cent in 2007 to 78.2 per cent in 2015. However, there is a large gap between the rate for non-Aboriginal women (79.0 per cent) and Aboriginal women (56.5 per cent). [SoOH §2-4]
✔ Fewer women are smoking while pregnant. The smoking rate during pregnancy (recorded at first antenatal visit) decreased from 23.4 per cent in 2005 to 12.5 per cent in 2015. However, there remains a large gap between the rates for non-Aboriginal women (11.2 per cent) and Aboriginal women (48.4 per cent). South Australia is ranked equal third-highest (with Queensland) among the states and territories for smoking rate at first antenatal visit. [SoOH §2-4]
✔ More children are immunised. The percentage of children in South Australia fully immunised by age five years has increased from 80.5 per cent in 2007 to 93.5 per cent in 2017. This is in line with increases in the overall Australian rate over the same time period. The percentage of Aboriginal children in South Australia fully immunised by age five years also increased, from 70.4 per cent in 2007 to 93.0 per cent in 2017. [SoOH §2-10]
✔ Perinatal deaths are down. The rate of perinatal deaths — that is, foetal deaths (at least 20 weeks’ gestation or at least 400 grams birth weight) plus all neonatal deaths — in South Australia dropped from 6.3 perinatal deaths per 1,000 births in 2006 to 5.5 in 2016; South Australia now has the lowest rate of the states and territories. The Aboriginal perinatal death rate is even lower at 4.5 per 1,000 relevant births in 2012-2016. [SoOH §5-3]
❌ Diabetes during pregnancy has more than doubled. The prevalence of gestational diabetes among women who gave birth in South Australia has more than doubled over 10 years, from 4.5 per cent in 2005 to 10.4 per cent in 2015. [SoOH §2-4]
❌ Overweight or obesity rates during pregnancy are high. South Australia ranks highest among the states and territories for the rate of women overweight at their first antenatal consultation (28.0 per cent) and second-highest for obesity in pregnancy (24.4 per cent). National rates have fallen while South Australian rates are relatively steady. [SoOH §2-4]
❌ Rate of caesarean births is high. South Australia, at an overall rate of 35.1 per cent (35.2 per cent for non-Aboriginal women and 32.7 per cent for Aboriginal women), ranks second-highest among the states and territories for births by caesarean section. The overall South Australian rate has been above the national average for 10 years. [SoOH §2-7]
Staying healthy and ageing well
✔ Fewer people are consuming alcohol at risky levels. The percentage of the South Australian population consuming alcohol at risky levels is dropping. The proportion of people at risk of alcohol-related single-occasion injury is down from 26.4 per cent in 2011 to 24.6 per cent in 2017; the percentage at lifetime risk of harm from alcohol-related disease or injury dropped from 19.1 per cent in 2011 to 15.6 per cent in 2017. Fewer than one in 10 (9.6 per cent) Aboriginal people in South Australia exceeds lifetime risk guidelines for alcohol consumption, well below the national average for Aboriginal people of 14.7 per cent. Nationally, South Australia is ranked third-lowest of the states and territories for long-term risk of harm from alcohol. [SoOH §3-8]
✔ Fewer people are smoking. The percentage of the South Australian population that smokes daily, weekly, or less often than weekly, dropped from 20.1 per cent in 2007 to 16.5 per cent in 2017. South Australia is ranked second-lowest of the states and territories in the proportion of current daily smokers. However, more than a third (35.4 per cent) of Aboriginal people in South Australia reported being current daily smokers in 2014-15; this was below the national average for Aboriginal people of 38.9 per cent. [SoOH §3-12]
❌ Fewer people are exercising at healthy levels. The proportion of South Australians undertaking 150 minutes or more per week of walking or other moderate or vigorous physical activity is decreasing, from 53.0 per cent in 2007 to 45.0 per cent in 2017. No directly comparable national figure is available. In 2012, about half (51.6 per cent) of Aboriginal people in South Australia reported undertaking sufficient physical activity. [SoOH §3-5]
❌ The rate of disability is high. The prevalence of disability (22.9 per cent) in the South Australian community and the proportion of those who need assistance with core activities due to profound or severe disability (6.0 per cent) are both second-highest of the states and territories. In South Australia, 7.7 per cent of Aboriginal people require assistance with core activities due to profound or severe disability, which is above the national average of 6.7 per cent. [SoOH §3-6]
❌ More people are living with multiple health risk factors. The percentage of South Australians living with two or more risk factors — current high blood pressure; current high cholesterol; fewer than 150 minutes per week of walking, moderate or vigorous physical activity; overweight or obese; current smoker; long-term alcohol risk; and/or insufficient consumption of fruit and vegetables — is increasing, from 28.5 per cent in 2007 to 32.7 per cent in 2017. No directly comparable national figure is available. [SoOH §3-7]
❌ More people are overweight or obese. The percentage of South Australian adults overweight or obese is increasing, from 56.9 per cent in 2007 to 63.7 per cent in 2017. The South Australian rate is above the national average. In 2012–13, 62.9 per cent of Aboriginal people in South Australia were classified as overweight or obese. [SoOH §3-9]
❌ More people have high blood pressure. The percentage of South Australians living with doctor-diagnosed high blood pressure or on medication for high blood pressure increased from 19.2 per cent in 2007 to 22.3 per cent in 2017. South Australia is ranked second-highest of the states and territories for prevalence of high blood pressure. In 2012, 20.0 per cent of Aboriginal people in South Australia self-reported that they were living with doctor-diagnosed high blood pressure and/or were on medication for high blood pressure. [SoOH §3-10]
❌ More people have high cholesterol. The percentage of South Australians living with doctor-diagnosed high cholesterol or on medication for high cholesterol increased from 15.1 per cent in 2007 to 17.5 per cent in 2017. South Australia is ranked third-highest of the states and territories, and above the national average, for rates of high cholesterol [SoOH §3-11]
Living with chronic conditions
❌ More people are living with multiple chronic and long-term health conditions. The percentage of South Australians living with two or more chronic conditions — diabetes, asthma, cardiovascular disease, arthritis, osteoporosis and/or a mental health condition — is increasing, from 17.8 per cent in 2007 to 21.9 per cent in 2017. (No directly comparable national figure is available.) In 2012–13, 35.7 per cent of Aboriginal people in South Australia reported living with three or more long-term health conditions. [SoOH §4-1]
❌ More people have a mental health condition. The percentage of South Australians living with a doctor-diagnosed mental health condition is increasing, from 16.7 per cent in 2007 to 20.9 per cent in 2017. South Australia is ranked third-highest of the states and territories for population living with a mental or behavioural problem. In 2012, 10.3 per cent of Aboriginal people in South Australia reported living with a doctor-diagnosed mental health problem. [SoOH §4-3]
❌ More people have diabetes. The percentage of South Australians ever told by a doctor that they have diabetes increased from 7.5 per cent in 2007 to 10.1 per cent in 2017. South Australia is slightly under the national average for the rate of the population living with diabetes mellitus. The prevalence of diabetes/high sugar levels in the South Australian Aboriginal population was 8.9 per cent in 2012–13. [SoOH §4-5]
❌ Prevalence of chronic back pain is high. The proportion of South Australians living with a back problem which has lasted, or is expected to last, six months or longer is very high (17.0 per cent) and is ranked highest of the states and territories. [SoOH §4-9]