U3 - Ch2.pdf

Measuring 2 health status LEARNING SEQUENCE 2.1 Overview................................................................................................................................ 61 2.2 Self-assessed health status and life expectancy....................

Measuring 2 health status LEARNING SEQUENCE 2.1 Overview................................................................................................................................ 61 2.2 Self-assessed health status and life expectancy................................................................... 62 2.3 Mortality................................................................................................................................. 68 2.4 Morbidity................................................................................................................................ 76 2.5 Burden of disease.................................................................................................................. 83 2.6 KEY SKILLS........................................................................................................................... 91 2.7 Review................................................................................................................................... 94 2.1 Overview Key knowledge Key skills Indicators used to measure and understand health Describe and apply indicators used to measure health status: incidence, prevalence, morbidity, burden status of disease, disability-adjusted life year (DALY), life expectancy, health-adjusted life expectancy (HALE), Use data to describe and evaluate the health status of mortality (including maternal, infant and under 5) and Australians self-assessed health status Source: VCE Health and Human Development Study Design © VCAA; reproduced by permission. Key terms Asphyxia Maternal mortality ratio Burden of disease Morbidity Congenital malformations Mortality Disability-adjusted life year (DALY) Mortality rate Health-adjusted life expectancy (HALE) Obstetric haemorrhage Health indicators Prevalence Health status Self-assessed health status Hospital separation Trend Incidence Under-five mortality rate (U5MR) Infant mortality rate Years lost due to disability (YLD) Life expectancy Years of life lost (YLL) Maternal mortality Exam terminology Describe Provide a general description Apply Use your knowledge in the given case study/scenario Evaluate Make a judgement, weigh up the pros and cons Resources Digital document Key terms glossary (doc-36124) Exam question booklet Topic 2 Exam question booklet (eqb-0056) TOPIC 2 Measuring health status 61  2.2 Self-assessed health status and life expectancy KEY CONCEPT Exploring the self-assessed health status, life expectancy and health-adjusted life expectancy of Australians In topic 1, the concept of health and wellbeing and FIGURE 2.1 Health statistics are based on large the five dimensions that contribute to overall health groups of people and therefore do not give and wellbeing were examined. As well as exploring information about the health status of individuals. physical, social, mental, emotional and spiritual health and wellbeing, it is useful to be able to measure the level of health and wellbeing experienced by groups or whole populations. Measurable aspects of health and wellbeing provide an ability to make judgements relating to the health status experienced by individuals, groups and countries. For individuals, health status is usually measured by tests conducted by a health professional, including blood, heart rate, blood pressure, eye and urine tests. For populations and whole countries, health status is generally measured using health indicators, which are shown in FIGURE 2.2. FIGURE 2.2 Health status indicators int-8485 Disability Burden Self- Life adjusted of assessed expectancy life years disease health at birth (DALY) status Life Years of Years lost expectancy life lost + due to (YLL) disability (YLD) Health Health- status adjusted life indicators expectancy (HALE) Morbidity Mortality Health status ‘An individual’s Incidence Prevalence Infant Under 5 Maternal or a population’s overall health, mortality mortality mortality taking into account various aspects such as life expectancy, amount of disability and levels of disease risk factors.’ (AIHW, 2008) Health indicators standard statistics that are used to measure and compare health status (e.g. life expectancy, mortality rates, morbidity rates) 62 Jacaranda Key Concepts in VCE Health and Human Development Units 3 and 4 Seventh Edition  EXAM TIP When discussing health and wellbeing, one or more of the dimensions should be the focus. When discussing health status, the health status indicators should be the focus. For example, if discussing how education can influence health and wellbeing and health status, the respective answers could be: Health and wellbeing — educated individuals are more likely to understand the benefits of being socially connected and may therefore invest time in socialising which can enhance the quality of relationships and promote social health and wellbeing [shows link to health and wellbeing]. Health status — education can mean that people have a greater understanding of healthy eating. This can promote healthy food intake, which can promote healthy body weight and reduce the prevalence of cardiovascular disease. In turn, this can decrease rate of premature mortality from causes such as heart attack and increase life expectancy [shows links to health status]. The various statistics give specific information and, when used together, can give accurate information about overall health status. It is useful to look at a range of statistics as quite often one set of statistics will provide only limited information about health status. Examining various health indicators allows governments and other groups to identify trends in health status and, if necessary, assist individuals, groups or populations in achieving optimal health and wellbeing. In this topic, these health indicators and data relating to each will be explored. Although some data exists relating to social, emotional, mental and spiritual health and wellbeing, data relating to physical ill health and wellbeing is generally the easiest to measure and therefore forms the basis of a majority of the health status data available. Where possible, data relating to the other dimensions will also be explored. It is also beneficial to examine statistics relating to different population groups within a country. Statistics are based on averages and do not always accurately reflect the challenges to health and wellbeing faced by different groups. The Aboriginal and Torres Strait Islander population in Australia is an example of this. Their health status is below the rest of the population, but this would not be apparent if only whole population statistics were explored in isolation. Statistics relating to population groups are examined in topic 4. Resources Teacher-led video Measurements of health status (tlvd-0260) 2.2.1 Self-assessed health status Self-assessed health status is a commonly used indicator of health status that reflects a person’s perception of his or her own health and wellbeing at a given point in time. Self-assessed health status data is often collected from population surveys and provides an indication of the overall level being experienced in relation to physical, social, emotional, mental and spiritual health and wellbeing. Trend    a general change or Survey participants are asked to classify their health status according to one of five movement in a particular levels: direction. For example, trends excellent indicate a significant increase in obesity rates over the past very good 20 years. good Self-assessed health status    fair ‘An individual’s own opinion poor. about how they feel about their health, their state of mind and While self-assessed health status is a useful measure of a person’s current health their life in general.’ (AIHW, 2018) It is commonly sourced from status and provides a broad picture of a population’s overall health and wellbeing, it population surveys. is subjective. Health status that one person classifies as ‘excellent’, may be classified TOPIC 2 Measuring health status 63 as ‘very good’ by another person. In 2017–18, over half FIGURE 2.3 Self-assessed health status, by age, (56.4 per cent) of all Australians aged 15 years and over 2017–18 int-8486 considered themselves to have excellent or very good 100 health and wellbeing, while 14.7 per cent rated their health and wellbeing as fair or poor (ABS, 2018). 90 As shown in FIGURE 2.3, the proportion of those assessing their health and wellbeing as excellent or very 80 good decreases with age. 70 A range of factors can influence how an individual assesses their health status, including presence or 60 absence of disease, disability, illness, energy levels, Per cent access to healthcare, social connections, mental state 50 and thought patterns, sense of belonging within the community, and emotional health and wellbeing, 40 including levels of resilience. 30 2.2.2 Life expectancy and health- 20 adjusted life expectancy 10 Life expectancy is defined as ‘the number of years of life, on average, remaining to an individual at a particular 0 15–24 25–44 45–64 65–74 75+ age if death rates do not change. The most commonly Age group used measure is life expectancy at birth’ (AIHW, 2018). Self-assessment health status Although life expectancy figures most commonly relate to Fair/Poor Good Excellent/Very good a baby born at the present time, they can relate to a person Source: https://www.aihw.gov.au/reports/australias-health/ of a different age. If life expectancy data are provided for australias-health-2018/contents/indicators-of-australias-health/ people of different ages, they will be specified in the data. self-assessed-health-status A male born in Australia in 2019 can expect to live (on average) to 80.9 years, whereas Life expectancy    the number a male aged 60 in 2019 can expect to live to 84.1 years. For females, life expectancy at of years of life, on average, remaining to an individual at a birth in 2019 was 85.0 years, while at the same time was 87.1 years for a female aged particular age if death rates do 60. Both males and females in Australia compare well with the global average for life not change. The most commonly expectancy, which was 72.5 years for a baby born in 2019. used measure is life expectancy at birth (AIHW, 2018). As life expectancy is based on the average age at death, life expectancy increases as a person gets older (see FIGURE 2.4 Life expectancy is increasing in Australia. TABLE 2.1). If a person survives the periods of birth, infancy, childhood and youth, their chance of reaching older age increases. Some people will not survive through their infancy, childhood, youth and adulthood stages, which brings the average down for those at birth. Life expectancy has increased by more than 30 years over the last century as indicated in FIGURE 2.5. Life expectancy continues to increase, but due to trends such as increasing rates of obesity, some people question the capacity of Australia to continue making improvements in life expectancy. 64 Jacaranda Key Concepts in VCE Health and Human Development Units 3 and 4 Seventh Edition  TABLE 2.1 Life expectancy for males and females of selected ages in Australia, 2019 Age Males Females 0 (birth) 80.9 85.0 15 81.3 85.4 30 81.8 85.6 45 82.5 86.1 60 84.1 87.1 75 87.4 89.4 90 94.4 95.1 Source: ABS, Life tables, States, Territories and Australia, 2017–19. FIGURE 2.5 Life expectancy of Australians, 1890–2019 90 Females Life expectancy at birth (years) 80 70 Males 60 50 40 30 20 10 0 1886 1896 1906 1916 1926 1936 1946 1956 1966 1976 1986 1996 2006 2016 2017 2018 2019 Year Source: AIHW, Australia’s Health 2018 and ABS, Life tables, various years. Life expectancy is especially useful for comparing different countries and population groups, which can assist governments and non-government organisations in identifying areas for potential improvement. Unlike mortality and morbidity figures, however, life expectancy does not provide information on the health issues facing a country or population groups, such as the leading causes of death or emerging diseases. Although it is an important health status indicator, life expectancy doesn’t give any indication of the quality of life being experienced; it is based purely on the quantity, or length, of life. A measurement that considers life expectancy data and the impact of ill health in a population is health-adjusted life expectancy, or HALE. Health-adjusted life expectancy relates to the average length of time an individual at a specific age can expect to live in full health; that is, time lived without the health consequences of disease or injury. So health- adjusted life expectancy refers to the number of years a person can expect to live without reduced functioning (including decreased mobility and the decline in the functioning of body systems) due to ill health, and is therefore an indicator of both quantity and quality of life. The data in FIGURE 2.6 indicates that the average male born in 2019 can expect to live to 80.9 years of age and spend 11.5 years of those years with ill health, giving a HALE of 69.4. A female born in 2019 can expect to live to 85.0 years of age and spend 13.8 of those years with ill health, meaning a HALE of 71.2 years. Although time with lived ill health is more Health-adjusted life expectancy likely to occur as people get older, it can happen at any age and HALE takes into (HALE)    the average length of time an individual at a specific age can account the average amount of time a person experiences ill health throughout expect to live in full health; that their whole life. is, time lived without the health consequences of disease or injury (AIHW, 2018) TOPIC 2 Measuring health status 65  FIGURE 2.6 Life expectancy at birth in full health (HALE) and ill health, 2019 90 85.0 HALE 80.9 Time lived in ill health 80 11.5 13.8 73.5 70 9.8 60 Life expectancy (years) 50 40 69.4 71.2 63.7 30 20 10 0 Australian Australian Global males females average Source: IHME, GBD Compare, 2020. 2.2 Activity Access the Joy of statistics weblink and worksheet in the Resources tab and then complete the worksheet. Resources Digital document Joy of statistics worksheet (doc-32189) Weblink Joy of statistics 2.2 Exercises To answer questions online and to receive immediate feedback and sample responses for every question, go to your learnON title at www.jacplus.com.au. A downloadable solutions file is also available in the resources tab. 2.2 Quick quiz 2.2 Exercise 2.2 Exam questions Select your pathway LEVEL 1 LEVEL 2 LEVEL 3 1, 2, 3, 5 4, 6, 7, 9 8, 10, 11, 12 Test your knowledge 1. a. What is meant by ‘health status’? b. How is health status measured? 2. Explain what is meant by ‘self-assessed health status’. 3. Explain the difference between life expectancy and health-adjusted life expectancy as health status indicators. 66 Jacaranda Key Concepts in VCE Health and Human Development Units 3 and 4 Seventh Edition  4. a. According to FIGURE 2.6, what was the life expectancy and health-adjusted life expectancy for males and females in Australia respectively? b. What do these numbers mean in relation to quantity and quality of life for males compared to females? 5. a. What is a trend? b. Identify two trends evident in FIGURE 2.5. Apply your knowledge 6. a. Which dimension of health and wellbeing is generally the focus of health statistics? b. Why would this be the case? c. Identify a health status indicator that may reflect multiple dimensions of health and wellbeing and justify your choice. 7. Outline the difference between health and wellbeing and health status. 8. Brainstorm reasons why self-assessed health status may not be completely accurate in measuring the health status of a population. 9. a. Outline the relationship between age and the proportion of those assessing their health and wellbeing as excellent or very good according to FIGURE 2.3. b. Suggest reasons that may account for the relationship outlined in part a. 10. ‘Life expectancy will continue to rise in the future’. To what extent do you agree with this statement? 11. Suggest reasons that might account for the lower life expectancy experienced by men compared with that of women. 12. Explain why life expectancy is higher for those aged 60 compared to those at birth. 2.2 Quick quiz 2.2 Exercise 2.2 Exam questions Question 1 (4 marks) Source: VCE 2010, Health and Human Development Exam, Q.2; © VCAA Briefly outline two indicators that are used to measure the health status of populations. Question 2 (1 mark) Source: VCE 2009, Health and Human Development Exam, Q.3.a; © VCAA Define life expectancy. Question 3 (4 marks) Source: VCE 2009, Health and Human Development Exam, Q.3.b; © VCAA Australian life expectancy at different ages: 1901–10 and 2003–05 for males 1901–1910 2003–2005 From birth 55.2 years 78.5 years From 30 years 66.5 years 79.7 years Source: Adapted from Australian Institute of Health and Welfare, Australia’s Health 2008 p. 27. Explain two reasons why life expectancy has increased since 1901.  Question 4 (2 marks) Source: VCE 2009, Health and Human Development Exam, Q.3.c; © VCAA Australian life expectancy at different ages: 1901–10 and 2003–05 for males 1901–1910 2003–2005 From birth 55.2 years 78.5 years From 30 years 66.5 years 79.7 years Source: Adapted from Australian Institute of Health and Welfare, Australia’s Health 2008 p. 27. Outline why life expectancy from 30 years of age is higher than life expectancy from birth. More exam questions are available in your learnON title. TOPIC 2 Measuring health status 67 2.3 Mortality KEY CONCEPT Exploring mortality and mortality rates of Australians Mortality refers to the number of deaths in a population in a given period (usually Mortality    the number of deaths 12 months). The mortality rate is therefore the number of deaths, usually expressed in a population in a given period per 1000 or 100 000 people in a 12-month period, from a specific cause or from (AIHW, 2018) all causes combined. For example, if the mortality rate for cancer in a population Mortality rate    (sometimes of one million is 50 per 100 000, there would be approximately 500 cancer deaths referred to as ‘death rate’) the measure of the proportion of a during that year. Expressing data ‘per 1000’ or ‘per 100 000’ people allows for population who die in a one-year comparisons to be made between population groups and between countries with period (usually per 100 000) different population sizes. EXAM TIP Ensure the correct unit of measurement is used when analysing health status data. For example, mortality data expressed per 1000 people produces very different figures compared to when it is expressed per 100 000 people. Including the relevant unit is important in ensuring that the discussion is factually correct. Over time, mortality data allows trends in deaths to be identified. These trends can guide governments and other organisations in developing and funding strategies that attempt to reduce mortality rates from the leading causes of death (or those that have an increasing mortality rate). In 2019, the mortality rate for males was 626 per 100 000 and for females was 442 per 100 000. This means that for every 100 000 males in Australia in 2019, 626 died. For females, 442 in every 100 000 died, meaning that males were 1.4 times more likely to die than females. Despite an increase in the total number of deaths, there has been a continuous fall in mortality rates per 100 000 people in Australia. From 1907 to 2019, the age-standardised death rate for males and females fell by 73 per cent and 77 per cent respectively (see FIGURE 2.7). FIGURE 2.7 Age-standardised death rates by sex, Australia, 1907–2019 2500 Females Deaths per 100 000 population Males 2000 1500 1000 500 0 1907 2019 Year Source: AIHW, Australia’s health 2016, p. 10, and AIHW GRIM Books (accessed January 2021). 68 Jacaranda Key Concepts in VCE Health and Human Development Units 3 and 4 Seventh Edition  WHAT ARE AGE-STANDARDISED RATES? Age-standardised rates allow us to compare populations that have a different spread of ages. For example, Australia’s population is ageing and as a result, we would expect more deaths than a country with a younger population, as older people are more likely to die. Age standardising manipulates data to make the age groups of different populations relative so they can be compared more accurately. Analysing the overall trend in the mortality rate is important, but it is also useful to identify the leading causes of death and trends that have occurred in relation to the causes of death over time. These trends give important feedback on the success of current interventions (policies, strategies and campaigns aimed at reducing the impact of health conditions) and allow predictions to be made about the future so relevant interventions can be put into place to improve health status. The leading causes of death in Australia have changed markedly over the past century. Developments have been made with regards to the economy, technology and education. As a result, many diseases that were common causes of death 100 years ago, such as influenza and tuberculosis, cause relatively few deaths these days (see TABLE 2.2). This has helped to prolong life and give most Australians the opportunity to achieve optimal health and wellbeing. TABLE 2.2 Five leading causes of death in 1907 and their contribution to mortality in 2019 1907 2019 Per cent deaths Rank(a) Per cent deaths Rank(a) Cardiovascular diseases 20.0 1 25.5 2 Respiratory diseases 14.3 2 9.6 3 Infectious diseases 12.6 3 1.5 5 Cancer 7.8 4 29.5 1 Injury and poisoning 4.9 5 7.0 4 Other 40.3 26.9 (a) In making these rankings, only the broad causes that were the top five in 1907 are considered. Source: Adapted from AIHW, GRIM books. As people live longer, they are more likely FIGURE 2.8 Although it was not a significant cause of ill health to die from lifestyle-related conditions. 100 years ago, obesity is now a major contributor to ill health. Diseases such as cardiovascular disease, cancers, dementia and respiratory diseases (including chronic obstructive pulmonary diseases) have emerged as the leading causes of death in Australia. Increasing rates of obesity are a significant contributor to these trends. The specific leading causes of death are shown in FIGURE 2.9. When analysing these figures, it is important to remember that they are based on all deaths. As older people account for the majority of deaths in Australia, the causes of their deaths are the ones most likely to appear in these figures. TOPIC 2 Measuring health status 69  FIGURE 2.9 Leading causes of death for males and females, 2019 1 Coronary heart Occurs when the blood vessels feeding the heart with oxygen are damaged or disease 10822 7422 blocked. A heart attack occurs if one of the vessels becomes completely blocked. An umbrella term for over 100 conditions characterised by progressive and 2 Dementia and irreversible loss of brain function. As brain function deteriorates, dementia Alzheimers disease 5424 9592 interferes with normal behaviour patterns and affects memory, language, speech, attention and personality. As brain cells continue to die, dementia will eventually lead to complete dependency on other people and ultimately death. 3 Cerebrovascular disease (including 4089 5802 Occurs when the blood vessels feeding the brain with oxygen become damaged stroke) or blocked. A stroke occurs if one of the vessels becomes completely blocked. Caused by the uncontrolled growth of abnormal cells in the lungs. These cells can 4 Lung cancer 5188 3625 eventually prevent the healthy cells from transferring oxygen to blood cells. 5 Chronic obstructive COPD is an umbrella term for a number of conditions that restrict the airways and 4242 4130 pulmonary disease therefore make breathing difficult. The two most common forms are emphysema and bronchitis. Source: Adapted from ABS, 3303.0 Causes of death, Australia, 2019. Other key trends in mortality figures FIGURE 2.10 Safety features, such as airbags, have reported by the Australian Institute of contributed to the decline in mortality rates from motor vehicle Health and Welfare (AIHW) are listed accidents over the past few decades. here. There has been a 95 per cent drop in deaths from infectious diseases (from around 140 per 100 000 in the early 1920s to 7.6 per 100 000 in 2018). Mortality rates from colorectal cancer have fallen by about 40 per cent since the 1980s. Cervical cancer deaths have fallen by about 75 per cent since the 1960s. Mortality rates due to dementia have increased by around 75 per cent since 2000. Male mortality rates from lung cancer are still higher than for females, but the mortality rate from lung cancer has fallen steadily for males since the 1980s. The rates for females have risen steadily since the 1960s. Mortality rates have fallen for cancer, cardiovascular disease, strokes, injury and asthma. Heart attack rates have fallen and survival rates have improved. The rate of type 2 diabetes is rising, with prevalence doubling in the past 20 years. Deaths from motor vehicle accidents have fallen by almost 80 per cent since the 1970s. 70 Jacaranda Key Concepts in VCE Health and Human Development Units 3 and 4 Seventh Edition  In addition to data covering the whole population, mortality data can also be collected for particular age or population groups. Examples include: infant mortality rate — measures the rate of deaths of infants before their first birthday, usually expressed per 1000 live births under-five mortality rate (U5MR) — measures the number of children that die before their fifth birthday, usually expressed per 1000 live births maternal mortality ratio — the number of mothers who die as a result of pregnancy, childbirth or associated treatment per 100 000 live births. 2.3.1 Infant mortality rates The mortality rate for infants and children are key indicators of the general health and wellbeing of a population and the social and economic resources available. Infants and children rely on others to meet their needs for food, water, shelter and healthcare, and they often have underdeveloped immune and other body systems, which make them Infant mortality rate    the rate of deaths of infants before their first birthday, usually particularly susceptible to premature mortality. Mortality rates for infants expressed per 1000 live births and children therefore reflect the ability of a society to provide the Under-five mortality rate (U5MR)    the resources required to sustain human life. number of deaths of children under five years of age per 1000 live births (WHO, Infant and under-five deaths are often preventable, so exploring the causes 2008) and rates of these deaths can help to improve the health status of children. Maternal mortality ratio    the number of mothers who die as a result of pregnancy, Infant mortality rates are low in Australia compared to other countries. Infant childbirth or associated treatment per mortality rates have decreased over time for both males and females, and the 100 000 women who give birth (or per 100 000 live births) difference between males and females has also narrowed (see FIGURE 2.11). FIGURE 2.11 Infant mortality rates in Australia and the global average over time int-8487 45.0 Australian females Australian males 40.0 Global average Infant mortality rate (per 1000 live births) 35.0 30.0 5.5 5.0 4.5 4.0 3.5 3.0 2.5 2.0 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Year Source: Adapted from AIHW Children’s headline indicators, WHO GHO and https://unstats.un.org/sdgs/indicators/database/ Much of the decrease in infant mortality has been due to reductions in deaths from sudden infant death syndrome (SIDS). SIDS is the unexplained death of an apparently healthy infant. It is only diagnosed when other causes are ruled out. Although the exact causes of SIDS are unknown, there are a number of factors that increase the risk of SIDS for an infant. These include being male (70 per cent of SIDS deaths are usually males) and sleeping on the stomach. TOPIC 2 Measuring health status 71  FIGURE 2.12 Infant mortality is decreasing in part due to reductions in deaths from sudden infant death syndrome (SIDS). Most cases of infant mortality arise from problems associated with the birth or pregnancy itself. As a result of this, a majority of infant deaths occur in the period directly after birth. As infants and children get older, the risk of death decreases. Specific causes of death in the first year of life are outlined in FIGURE 2.13. Conditions originating in the perinatal period, congenital malformations and chromosomal abnormalities account for around 75 per cent of all infant deaths. Conditions originating in the perinatal period relate to conditions that cause death in the first 28 days of life. These include complications of the placenta or umbilical cord, infections, birth injury, asphyxia and problems relating to premature births. Congenital malformations, sometimes referred to as ‘birth defects’, often result from missing Congenital malformations    refers to physical defects developing or ill-formed body structures. They may have a genetic, infectious or environmental either in the uterus or dating from origin, although in most cases it is difficult to identify their cause. Chromosomal birth abnormalities during the creation of sperm and ova can cause a range of conditions Asphyxia    interrupted breathing in the developing baby. Most often, these conditions arise as a result of too many or leading to low levels of oxygen in the body, unconsciousness and too few chromosomes. Some chromosomal abnormalities lead to physical defects that often death result in death. FIGURE 2.13 Causes of infant mortality in Australia, 2016–18 Other causes 11% Sudden infant death syndrome (SIDS) and other ill‐defined causes 9.1% Certain conditions originating in the perinatal period, congenital malformations and chromosomal abnormalities 79.9% Source: Adapted from ABS, Deaths web report, 2020. 72 Jacaranda Key Concepts in VCE Health and Human Development Units 3 and 4 Seventh Edition  2.3.2 Under-five mortality rate Like the infant mortality rate, the under-five mortality rate has decreased over time in Australia (see FIGURE 2.14) and is low compared to most other countries. The reduction in infant mortality is partially responsible for the decrease in under-five mortality rate in Australia. Other contributing factors include greater awareness of risk factors for illness and injury, national childhood vaccination programs, and improved health services and technology. Although the overall rate of under-five mortality has decreased, child mortality rates for Aboriginal and Torres Strait Islander peoples, those living outside of Australia’s major cities, and low socioeconomic groups remain higher than for the rest of the population. FIGURE 2.14 Under-five mortality rate in Australia over time 10.00 9.00 Under 5 mortality rate (per 1000 live births) 8.00 7.00 6.00 5.00 4.00 3.00 2.00 1.00 0.00 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Year Source: Adapted from WHO GHO. The significant proportion of causes of mortality for those under five are termed ‘injuries’ and are accidental in nature (see FIGURE 2.15). Injuries include falls, drowning, suffocation, poisoning, transport accidents and burns. FIGURE 2.15 Leading causes of death for those aged 1–4 in Australia, 2019 int-8488 Females Males 0 2 4 6 8 10 12 14 16 18 Injuries Other causes All cancers All congenital malformations, deformations and chromosomal abnormalities All diseases of the nervous system All diseases of the circulatory system Source: Adapted from: https://vizhub.healthdata.org/gbd-compare/ (accessed January 2021). TOPIC 2 Measuring health status 73 2.3.3 Maternal mortality rate Maternal mortality relates to the deaths of mothers as a result of pregnancy or childbirth, up to six weeks after delivery and the maternal mortality ratio (or rate) relates to the number of mothers who die as a result of pregnancy, childbirth or associated treatment, usually measured per 100 000 women who give birth or per 100 000 live births. Analysing maternal mortality rates allows trends to be identified so interventions can be put in place to reduce the risk of death as a result of pregnancy or childbirth. Pregnant women in Australia experience low maternal mortality rates compared to most other countries, although there is some variation among population groups within Australia, with Aboriginal and Torres Strait Islander mothers experiencing a maternal mortality ratio three times higher than the rest of the population. Although maternal deaths in Australia are relatively rare, both the number and rate of maternal mortality fluctuate over time (see FIGURE 2.16). A range of factors contribute to these changes including technological developments, improvements in the identification and reporting of maternal deaths, increasing rates of obesity (contributing to higher rates of cardiovascular disease among pregnant women) and increases in the average age of women giving birth. FIGURE 2.16 Number and rate of maternal deaths in Australia over time Maternal deaths in Australia 20 100 Total maternal deaths 18 90 Maternal mortality ratio Maternal mortality ratio (per 100 000 women 16 80 Total number of maternal deaths 14 70 who gave birth) 12 60 10 50 8 40 6 30 4 20 2 10 0 0 5 8 81 4 7 0 3 6 9 2 5 08 1 4 7 97 97 98 98 99 99 99 99 00 00 01 01 01 9 0 –1 –1 –1 –1 –1 –1 –1 –1 –1 –2 –2 –2 –2 –2 –2 73 76 79 82 85 88 91 94 97 00 03 06 09 12 15 19 19 19 19 19 19 19 19 19 20 20 20 20 20 20 Year Source: Adapted from AIHW 2020, Maternal deaths in Australia 2015–17. Leading causes of maternal mortality in Australia include: cardiovascular disease — the increased demands on the heart and blood Maternal mortality    death of a mother vessels that occurs during pregnancy can contribute to cardiovascular during pregnancy, childbirth or within six diseases that were not present prior to pregnancy. Cardiovascular diseases weeks of delivery are the most common cause of maternal deaths in Australia. Obstetric haemorrhage    heavy bleeding occurring as a result of pregnancy or obstetric haemorrhage — excessive bleeding during pregnancy, labour childbirth or after birth can lead to maternal death. 74 Jacaranda Key Concepts in VCE Health and Human Development Units 3 and 4 Seventh Edition  Resources Weblink Interactive data on mortality in Australia 2.3 Exercises To answer questions online and to receive immediate feedback and sample responses for every question, go to your learnON title at www.jacplus.com.au. A downloadable solutions file is also available in the resources tab. 2.3 Quick quiz 2.3 Exercise 2.3 Exam questions Select your pathway LEVEL 1 LEVEL 2 LEVEL 3 1, 2, 3, 5, 7 4, 6, 8, 9, 11, 12, 13 6, 10, 14 Test your knowledge 1. Define the following: a. mortality b. infant mortality c. infant mortality rate d. maternal mortality e. maternal mortality ratio f. mortality rate g. under-five mortality rate. 2. List the top three causes of death for men and women. 3. a. How have the causes of death changed over the past century in Australia? b. Brainstorm factors that may have contributed the change outlined in part a. 4. Explain why the mortality rates for infants and children are key indicators of the general health and wellbeing of the population. 5. Outline the difference in causes of mortality for infants compared to 1–4 year olds. Apply your knowledge 6. Discuss the advantages of using mortality data in addition to life expectancy data when making judgements about the health status of a population. 7. Explain what a mortality rate of 150 per 100 000 people means for a population. 8. If a population has 1 000 000 people and the mortality rate is 500 per 100 000 people, how many people on average would die each year? 9. Outline two trends as shown in FIGURE 2.7. 10. Brainstorm factors that may have contributed to the trends in mortality identified at the end of subtopic 2.3. 11. Outline the change in infant mortality rates for males and females that occurred between 2006 and 2019 in Australia according to FIGURE 2.11. 12. Outline the change in the under-five mortality rate over time according to FIGURE 2.14. 13. a. Approximately how many maternal deaths were there in 2015–17 according to FIGURE 2.16? b. Approximately what was the maternal mortality ratio in 2015–17 according to FIGURE 2.16? 14. Dementia is a condition that has seen significant increases over time in Australia. Including references to changes in life expectancy and mortality rates, explain possible reasons for this change. TOPIC 2 Measuring health status 75  2.3 Quick quiz 2.3 Exercise 2.3 Exam questions Question 1 (1 mark) Briefly explain the difference between ‘mortality’ and ‘the mortality rate’. Question 2 (1 mark) Identify the indicator that focusses on the mortality of children under the age of 1. Question 3 (4 marks) Identify and briefly describe two causes of maternal mortality in Australia. Question 4 (4 marks) Identify and briefly describe two causes of infant mortality in Australia. Question 5 (2 marks) Outline two reasons why identifying trends in mortality date over time is important. More exam questions are available in your learnON title. 2.4 Morbidity KEY CONCEPT Exploring morbidity in Australia Mortality rates were examined in subtopic 2.3. Although these are important FIGURE 2.17 Morbidity statistics, they tell only part of the story. Many people experience conditions includes both incidence that impact significantly on health and wellbeing but do not lead to death. and prevalence rates. Many causes of mortality also contribute to significant illness prior to causing Incidence death. Looking at levels of ill health and disability is therefore important in making judgements about overall health status. Morbidity refers to ‘ill health in an individual and levels of ill health within a population (often expressed through incidence, prevalence)’ (AIHW 2018). Therefore, the morbidity rate is a measure of how many people suffer from a particular condition during a given period of time. As stated in the AIHW Prevalence definition, morbidity rates can look at incidence (the number or rate of new cases of a disease during a specified time, usually a 12-month period) or prevalence (the total number or proportion of cases of a particular disease or condition present in a population at a given time). Incidence and prevalence provide two ways of looking at the impact of diseases. Unlike most infectious diseases, many chronic conditions, such as cardiovascular disease and cancer, are long lasting and may have effects that may never be cured completely. As a result, they may require long-term care. People generally only receive a Cure/Death diagnosis for these conditions once; this represents their ‘incident year’. As these conditions can be long lasting, prevalence data provides information Morbidity    ill health in an about the total number of people with a particular condition at a given time, not just individual and levels of ill health those who have been newly diagnosed. Prevalence data provides valuable information within a population (often relating to the healthcare required to treat all people experiencing particular expressed through incidence and conditions. prevalence) (AIHW, 2018) Incidence    refers to the number As mortality rates have fallen, morbidity rates for many causes have increased. As people (or rate) of new cases of a disease/condition in a population are living longer, there is more time for a range of factors to have a negative impact on during a given period health and wellbeing. There have also been increases in conditions such as obesity that Prevalence    the total number or result in an increased rate of associated conditions, such as type 2 diabetes, cardiovascular proportion of cases of a particular disease and some cancers. Even though the rates of some of these conditions have disease or condition present in a population at a given time (AIHW, increased, there are other, non-life-threatening conditions that affect many more people, 2008) such as arthritis and osteoporosis. 76 Jacaranda Key Concepts in VCE Health and Human Development Units 3 and 4 Seventh Edition  FIGURE 2.18 As well as disease, morbidity includes injuries and disabilities. According to the Australian Institute of Health and Welfare estimates, around 75 per cent of Australians experience a long-term health condition. The proportion of people experiencing one or more long-term conditions increases with age. The most commonly reported conditions are outlined in TABLE 2.3. Many of the causes shown do not contribute to death, but they may reduce the quality of life over a long period. TABLE 2.3 The most commonly reported long-term conditions, 2017–18 Males Females Condition Per cent Rank Per cent Rank Long-sighted 27.4 1 32 1 Short-sighted 22.5 2 29.7 2 Hay fever and allergic rhinitis 18.9 3 19.7 3 Back problems 16.5 4 16.3 4 Deafness 12.8 5 8 12 Anxiety-related disorders 10.6 8 15.7 5 Hypertension 10.5 6 10.7 10 Asthma 10.2 7 12.3 7 Depression and mood (affective) disorders 9.5 9 12 8 Allergies 9.4 10 15.1 6 Osteoarthritis 6.8 12 11.2 9 Source: Adapted from ABS, National health survey 2017–18. TOPIC 2 Measuring health status 77 Morbidity figures represent a snapshot of the FIGURE 2.19 Vision problems are among the most whole population. Australians are living longer common health conditions in Australia. than ever, so some of these conditions are very common in the older population, but virtually non-existent in the younger population. As a result, it is also useful to examine the most reported long-term conditions for different age groups (see TABLE 2.4). This allows government and non-government organisations to develop appropriate strategies and allocate funds to address the most common conditions in each age group. TABLE 2.4 Five most common conditions by age group, 2017–18 Age group Condition Per cent Age group Condition Per cent Mental and behavioural 11.1 Long-sightedness 53.2 problems Asthma 10.1 Short-sightedness 34.2 Mental and behavioural 0–14 Hay fever 10.0 45–54 23.8 problems Food allergy 5.5 Hay fever and allergic rhinitis 22.5 Short-sightedness 4.5 Back problems 23.2 Mental and behavioural 25.6 Long-sightedness 62.1 problems Hay fever and allergic rhinitis 21.4 Short-sightedness 41.9 15–24 Short-sightedness 19.4 55–64 Arthritis 34.0 Long-sightedness 12.9 Cardiovascular disease 31.9 Asthma 10.2 Back problems 28.0 Short-sightedness 25.9 Long-sightedness 61.7 Hay fever and allergic rhinitis 22.8 65+ Arthritis 49.0 Mental and behavioural 21.2 Short-sightedness 40.7 25–34 problems Endocrine diseases including Back problems 14.6 39.1 diabetes Asthma 10.7 Short-sightedness 25.6 Hay fever and allergic rhinitis 23.8 Back problems 20.9 35–44 Mental and behavioural 20.6 problems Long-sightedness 17.3 Source: ABS, National health survey 2017–18. 78 Jacaranda Key Concepts in VCE Health and Human Development Units 3 and 4 Seventh Edition 2.4.1 Morbidity requiring care Illnesses and disabilities vary in their severity and many people will require professional care in order to improve health and wellbeing. As a result, morbidity data from doctors and hospitals can be used to make judgements about health status. GP visits According to Department of Health data (2020), around 163 million visits to general practitioners (GPs) were made in 2019–20, which is around 6.5 visits per person each year. Females are more likely to visit doctors than males. This does not mean that they are more likely to be ill, but that they are more likely to visit a doctor when symptoms or concerns arise. GP visits often involve a range of interventions such as prescribing medicines, ordering pathology such as urine and blood tests, administering vaccinations and discussing test results. The table shows prescriptions and check-ups were the leading reason for GP visits in 2016. However, data from the report General Practice: Health of the Nation 2020 revealed the impact of the COVID-19 pandemic with psychological (64 per cent), preventative (56 per cent) and respiratory (45 per cent) causes becoming the leading three causes of visits to the GP in this year. TABLE 2.5 Principle reason of GP visits, 2015–16 Percentage of Percentage of Principal reason visits Principal reason visits Prescription 8.8 Fever 1.4 Check-up 8.1 Depression 1.3 Test results 6.7 Abdominal pain 1.2 Cough 4.1 Upper respiratory tract infection 1.1 Immunisation/vaccination 3.3 Headache 1.1 Administrative procedure 2.5 Skin symptom/complaint 1.1 Back complaint 2.0 Sneezing/nasal congestion 1.0 Rash 1.8 Hypertension/high blood pressure 1.0 Throat symptom/complaint 1.8 Anxiety 1.0 Blood test 1.5 All other reasons 49.2 Source: Adapted from Britt, H, et al. 2015, ‘General practice activity in Australia 2015–16’, General practice series no. 40, Sydney University Press. Hospitals Hospital care encompasses care for chronic conditions, where the patient is admitted to receive treatment, and emergency care that involves unforeseen events that end up requiring medical care, such as car accidents, sporting accidents and premature births. In 2018–19 there were 11.5 million hospitalisations in Australia with around 60 per cent of these being in public hospitals and around 40 per cent in private hospitals. FIGURE 2.20 shows the major causes of hospital separations. Hospital separations are episodes of hospital care that start with admission and end at transfer, discharge or death. Hospital separation    episodes of hospital care that start with admission and end at transfer, discharge or death TOPIC 2 Measuring health status 79  FIGURE 2.20 Major causes of hospital separations, Australia, 2017–18 An artificial method of removing waste substances from the blood and 1 Dialysis for kidney disease 1 500 000 regulating levels of circulating chemicals (functions usually performed by the kidneys) 2 Cancer 1 500 000 Including skin, lung, breast and prostate cancers 3 Diseases of the digestive system 1 100 000 Including intestinal diseases, hernia and dental issues 4 Diseases of the musculoskeletal 795 000 Including arthritis, back pain and shoulder pain system 5 Injuries and poisoning 782 000 Including fractures, dislocations and open wounds 6 Diseases of the circulatory system 584 000 Including heart attack and stroke 7 Diseases of the respiratory system 508 000 Including pneumonia, chronic obstructive pulmonary disease and asthma 8 Pregnancy and childbirth 290 000 Including childbirth and IVF treatment Source: Adapted from AIHW 2018, Australia’s hospitals 2017–18 at a glance. Trends in morbidity A number of morbidity trends are emerging that are worth considering. The long-term effects of some of these trends will influence future mortality and morbidity rates, but this takes time. Some of the key trends identified by the Australian Institute of Health and Welfare include: a significant increase in the prevalence of overweight and obese people over the past 20–30 years (see FIGURE 2.21) increased rates of impaired glucose regulation (a precursor to type 2 diabetes) since 1980 trebled rates of diabetes in the past two decades increased rates of kidney disease (attributed to the increased rates of diabetes). 80 Jacaranda Key Concepts in VCE Health and Human Development Units 3 and 4 Seventh Edition  FIGURE 2.21 Trends in overweight and obesity prevalence, 1995–2018 int-8490 80 1995 2011–12 70 2001 2014–15 2004–05 2017–18 60 50 Per cent 40 30 20 10 0 18–24 25–34 35–44 45–54 55–64 65–74 75 and over Age 2.4 Exercises To answer questions online and to receive immediate feedback and sample responses for every question, go to your learnON title at www.jacplus.com.au. A downloadable solutions file is also available in the resources tab. 2.4 Quick quiz 2.4 Exercise 2.4 Exam questions Select your pathway LEVEL 1 LEVEL 2 LEVEL 3 1, 2, 4, 5, 9 3, 6, 7, 8, 10, 13, 15 11, 12, 14, 16 Test your knowledge 1. Explain what is meant by ‘morbidity’. 2. Explain the difference between incidence and prevalence. 3. Explain why morbidity rates have increased as mortality rates have decreased. 4. a. Briefly outline the overall change in rates of overweight and obesity between 1995 and 2017–18 according to FIGURE 2.21. b. Suggest factors that may have led to these trends. c. Which age groups are most likely to be overweight or obese according to this figure? 5. a. List one difference between the long-term conditions of males and females as shown in TABLE 2.3. b. Suggest factors that may have led to this difference. 6. How do the causes of morbidity change over the lifespan as shown in TABLE 2.4? 7. a. What are the most reported conditions in the 15–24 age group as shown in TABLE 2.4? b. Which of these conditions could be considered life threatening? 8. Which causes from FIGURE 2.20 do you think would be responsible for the most hospitalisations of people your age? 9. According to FIGURE 2.20 approximately how many hospitalisations were there in 2017–18 for: a. dialysis for kidney disease b. diseases of the musculoskeletal system c. diseases of the respiratory system? Apply your knowledge 10. When looking at morbidity rates, why is it important to consider both incidence and prevalence rates? 11. ‘Breast cancer — incidence up, death rate down, survival rates improve’. Is this headline possible? Explain your response. TOPIC 2 Measuring health status 81  12. Look at FIGURE 2.18. This person’s physical health and wellbeing has been affected. How might their social, emotional, mental and spiritual health and wellbeing be affected? Are they all negative effects? 13. a. Why might females be more likely to visit doctors? b. What consequences does this have on the health status of males versus females? 14. Are hospital and GP data completely accurate in indicating the level of morbidity in the population? Why or why not? 15. Describe how increasing rates of obesity could have a large impact on mortality and morbidity statistics in the future. 16. How could living with cancer affect mental and spiritual health and wellbeing? 2.4 Quick quiz 2.4 Exercise 2.4 Exam questions Question 1 (1 mark) Source: VCE 2015, Health and Human Development Exam, Q.5.a; © VCAA Define ‘prevalence’. Question 2 (2 marks) Source: VCE 2013, Health and Human Development Exam, Q.5.c; © VCAA Death rates are one way in which health status can be measured. Incidence and prevalence are other measurements of health status. Outline the difference between incidence and prevalence. Question 3 (2 marks) Source: VCE 2013, Health and Human Development Exam, Q.1.b; © VCAA Outline the difference between mortality and morbidity as measurements of health status. Question 4 (2 marks) Source: VCE 2011, Health and Human Development Exam, Q.6; © VCAA Define the following terms. Under-five mortality rate Morbidity Question 5 (4 marks) ‘Swine flu has been called a pandemic by the World Health Organization because the disease has spread to affect people in 77 countries and has caused 254 206 cases and 2837 deaths. In Victoria, with a population of about 5 million, 2420 people have been diagnosed with the disease, and 30 new cases are being diagnosed each day. Swine flu has killed 24 people in Victoria.’ From the passage above, identify an example of each of incidence, prevalence, mortality and morbidity. More exam questions are available in your learnON title. 82 Jacaranda Key Concepts in VCE Health and Human Development Units 3 and 4 Seventh Edition 2.5 Burden of disease KEY CONCEPT Exploring the burden of disease in Australia Burden of disease statistics take the impact of both FIGURE 2.22 Burden of disease data allow us mortality and morbidity into account and therefore to compare the overall burden of conditions provide a way of examining the total burden that a such as arthritis (which rarely causes death) with condition places on society. Specifically, burden of conditions that lead to many deaths. disease measures the gap between current health status and an ideal situation where everyone lives to an old age free of disease and disability. In the past, if someone wanted to examine mortality and morbidity data to compare the effect that asthma has on Australians compared to the impact cancer has, it would have been difficult. How could a comparison be made between asthma (which affects more people than cancer, can last a lifetime, but causes relatively few deaths) and cancer (which causes thousands of deaths per year)? To overcome this problem, scientists and health professionals devised a system that allows Burden of disease    a measure a comparison of conditions that cause death, conditions that cause illness or of the impact of diseases and injuries, specifically it measures disability, and those that cause both. the gap between current health status and an ideal situation Burden of disease is measured in a unit called disability-adjusted life year or where everyone lives to an old DALY (pronounced ‘dally’), where one DALY is the equivalent of one year of age free of disease and disability. life lost due to premature death or the equivalent time of healthy years lost as a Burden of disease is measured in a unit called the DALY (VCAA). result of living with a disease or disability. If 1000 DALY were lost due to asthma Disability-adjusted life year in a population, it means that 1000 years of healthy life have been lost as a result (DALY)    a measure of burden of of premature death or by people suffering from the condition who experienced a disease. One DALY is equal to reduced quality of life. If 2000 DALY were lost due to mental illness in the same one year of healthy life lost due to illness and/or death. DALYs are population, it means that mental illness was twice the burden of asthma. calculated as the sum of the years of life lost due to premature death DALY are useful for comparing population groups and can provide valuable