4102.0 - Australian Social Trends, Mar 2011
ARCHIVED ISSUE Released at 11:30 AM (CANBERRA TIME) 23/03/2011
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This document was added or updated on 25/03/2011. HEALTH OUTSIDE MAJOR CITIES
WHO LIVES OUTSIDE MAJOR CITIES? People may live outside Major Cities for a variety of reasons, such as commercial opportunities,(Endnote 1) a preference for living in smaller communities,(Endnote 2) and the different lifestyle which may be found there.(Endnote 3) It is estimated that at 30 June 2009, nearly one third (31% or 6,886,600 people) of the Australian population resided outside Major Cities. The population in these areas grew by 11% (705,300 people) between 2001 and 2009 while the population of Major Cities areas grew by 14% (1,836,700 people).(Endnote 4) It is estimated that in 2009, 5.4% of those who lived outside Major Cities were Indigenous, as were 1.2% of the population who lived in Major Cities.(Endnote 4) (Endnote 5) For information on the health of the Indigenous population see 'The city and the bush: Indigenous wellbeing across remoteness areas', Australian Social Trends, September 2010 (cat. no. 4102.0). The age structure of those living outside and in Major Cities is different. A higher fertility rate outside Major Cities leads to a higher proportion of children living in areas outside Major Cities.(Endnote 6) However, after the completion of school, many young adults move to the city for further education and work opportunities. AGE DISTRIBUTION OUTSIDE AND IN MAJOR CITIES - 30 JUNE 2009 Source: ABS preliminary 2009 estimated resident population SELF- ASSESSED HEALTH Self-assessed health is a good indicator of the overall health of a population, providing some insight into how people perceive their own health at a given point in time. Research has shown that self-assessed health can be a strong predictor of mortality and morbidity for some population groups.(Endnote 7) According to the ABS 2007-08 National Health Survey, people aged 15 years and over who lived outside Major Cities were less likely to think their health was excellent or very good than people who lived in Major Cities (4% less likely), and more likely to think that their health was fair or poor (15% more likely). DISEASES OR CONDITIONS Across Australia, as the number of people with chronic disease increases, more pressure is put on health services as people seek to manage and treat their conditions. Increasingly, emphasis is being placed on disease prevention programs. Prevalence Although there were many long-term health conditions which were more common outside Major Cities than in Major Cities, there were several where there was a marked difference between the two areas. People who lived outside Major Cities in 2007-08 were 23% more likely to have had back pain, 20% more likely to have had asthma, and 27% more likely to have been deaf than people who lived in Major Cities. People who lived outside Major Cities were also 16% more likely to report that they had a mental or behavioural problem. However, there was no significant difference in the prevalence of some other conditions e.g. diabetes, high cholesterol, and hayfever and allergic rhinitis. There was also no significant difference in the prevalence of cancer or ischaemic heart disease between the two areas, but as the two leading causes of the burden of disease and injury in Australia in 2003,(Endnote 7) their treatment and prevention is a priority throughout Australia. People who lived outside Major Cities were 17% less likely to report that they were short sighted than those who lived in Major Cities. PREVALENCE OF BACK PAIN(a) - 2007-08 (a) Back pain/problems not elsewhere classified/disc disorders Source: ABS 2007-08 National Health Survey
(b) Based on age standardised rates. This ratio shows how many times more likely it was to have a condition when living outside Major Cities compared with in Major Cities e.g. 1.13 times (13%) more likely, or 0.83 times (17% less likely). (c) Back pain or problems not elsewhere classified and disc disorders. (d) Malignant neoplasms. Source: ABS 2007-08 National Health Survey
PEOPLE OUTSIDE MAJOR CITIES UNDERTAKING HEALTH RISK BEHAVIOURS(a) - 2007-08
(b) Based on age standardised rates. This ratio shows how many times more likely it was to have this behaviour when living outside Major Cities compared with in Major Cities e.g. 1.30 times (30%) more likely. (c) See the box 'Alcohol guidelines' for more information. (d) Based on measured Body Mass Index. Excludes those for whom height or weight were not measured. (e) Exercise undertaken for fitness, recreation or sport in the two weeks prior to interview. (f) See the box 'Nutrition guidelines' for more information. Source: ABS 2007-08 National Health Survey Daily smoking People aged 15 years and over who lived outside Major Cities in 2007-08 were 30% more likely to be a daily smoker than those in Major Cities. The difference in daily smoking rates for women was greater than for men. Women outside Major Cities were 50% more likely to smoke on a daily basis, while men were 15% more likely. The daily smoking rate for women who lived in Major Cities plateaued around 16% between the 25-34 and 55-64 years age groups. Men and women living outside Major Cities had higher rates of smoking in most age groups. However, from 55 years of age the rates of smoking converged for those in and outside Major Cities. CURRENT DAILY SMOKERS(a) - 2007-08 (a) People aged 15 years and over. Source: ABS 2007-08 National Health Survey
Risky drinking People living outside Major Cities are more likely to experience alcohol-related harm through violence, acute and chronic health problems, and drink driving.(Endnote 8) It has been suggested that the ongoing high levels of risky drinking outside Major Cities may be due to community acceptance of drinking as 'usual' behaviour and limited leisure and social venues.(Endnote 9) In 2007-08, people aged 15 years and over who lived outside Major Cities were 32% more likely than those in Major Cities to drink in the week prior to interview at levels which were risky for their health in the long term (see the box 'Alcohol guidelines' for more information). Men living outside Major Cities were more likely to drink excessively than those in Major Cities (42% more likely), and this was also the case for women who were 20% more likely. One in four men aged 25-34 years (25%) who lived outside Major Cities drank at risky levels in the long term, while nearly one in six men of this age (15%) who lived in Major Cities drank at these levels. In addition to the risk of long term harm from alcohol consumption, excessive drinking can also put the person at risk in the short term (also known as binge drinking - see the box 'Alcohol guidelines' for more information). In 2007-08, people aged 15 years and over who lived outside Major Cities were 24% more likely than those who lived in Major Cities to binge drink at some time in the previous 12 months. Men who lived outside Major Cities were 27% more likely than those in Major Cities to have drunk more than six standard drinks in a day within the previous 12 months, the amount considered to be ‘binge’ drinking for men. The 25-34 year age group had the highest proportion of binge drinkers - seven in ten men (72%) in this age group who lived outside Major Cities drank at risky levels at some time in the previous 12 months, compared with six in ten (61%) in Major Cities. The quality of data on alcohol consumption via recall methodology is known to have limitations, with people underestimating their consumption. This may particularly affect data related to the 15-24 years age group, where under-age drinking may have occurred. ALCOHOL DRINKERS AT RISK OF SHORT TERM HARM(a)(b) - 2007-08 (a) People aged 15 years and over. (b) Risky or high risk drinking in the short term within the last 12 months, based on 2001 NHMRC guidelines. Source: ABS 2007-08 National Health Survey Being overweight or obese Excess body weight contributes to the risk of developing conditions such as diabetes, cardiovascular disease, osteoarthritis and some cancers.(Endnote 10) In 2007-08, people aged 15 years and over who lived outside Major Cities were 13% more likely to be overweight or obese than those in Major Cities. The difference in rates for women living outside Major Cities was more pronounced than for men - women were 19% more likely to be overweight or obese, while men were 8% more likely. PEOPLE WHO WERE OVERWEIGHT OR OBESE(a)(b) - 2007-08 (a) People aged 15 years and over. (b) Based on measured Body Mass Index. Excludes those for whom height or weight were not measured. Source: ABS 2007-08 National Health Survey Inadequate exercise Sporting clubs and facilities such as commercial gymnasiums are less available outside Major Cities, and there may be limited transport to those which are available. There can also be a belief that ‘rural work’ provides sufficient physical activity for a healthy life.(Endnote 11) In 2007-08, the likelihood of people aged 15 years and over who lived outside Major Cities being sedentary or having a low level of exercise when measured by physical activity for fitness, recreation or sport was similar to those in Major Cities. However, occupations which involve physical activity are more common outside Major Cities so physical activity undertaken as part of their work duties may increase the difference in exercise level between the two areas. In 2007-08, 18% of employed people aged 15 years and over who lived outside Major Cities had employment which mainly involved heavy labour or physically demanding work compared with 11% in Major Cities. There was no significant difference for either men or women in the level of exercise for fitness, recreation or sport between those who lived outside Major Cities and in Major Cities. This was also the case for different age groups.
Fruit and vegetable consumption Access to a wide range of fruit and vegetables, and the cost, may make consumption of fruit and vegetables difficult outside Major Cities, particularly as remoteness increases. However, there can also be more opportunities for people to access locally grown produce. In 2007-08, the fruit and vegetable consumption of people aged 15 years and over who lived outside Major Cities was 55% more likely to meet the Nutrition guidelines than those in Major Cities (see the box 'Nutrition guidelines' for more information on guidelines. Men who lived outside Major Cities were 59% more likely to eat fruit and vegetables as advised in the guidelines than those in Major Cities. Similarly, women who lived outside Major Cities were more likely to meet the guidelines than those who lived in Major Cities (54% more). MENTAL WELLBEING Mental wellbeing may be measured by the level of psychological distress a person may suffer. The ABS 2007 Survey of Mental Health and Wellbeing found that 8.3% of people aged 16-85 years who lived outside Major Cities had high or very high levels of psychological distress, not significantly different to those living in Major Cities. However, when very high levels of psychological distress are looked at separately, people who lived outside Major Cities were 34% less likely than those who lived in Major Cities to have this level of distress. While there was no significant difference between men living outside Major Cities and in Major Cities for high or very high levels of psychological distress, men outside Major Cities were half as likely to have very high levels of psychological distress. Women had different results - women who lived outside Major Cities were 22% less likely than those in Major Cities to have high or very high levels of psychological distress, but as likely as women in Major Cities to have very high psychological distress. MEASURES OF MENTAL WELLBEING OUTSIDE MAJOR CITIES - 2007
(b) Based on age standardised rates. This ratio shows how many times more likely it was to have this measure when living outside Major Cities compared with in Major Cities e.g. 1.05 times (5% more likely), or 0.89 times (11% less likely). (c) Difference in rates between outside Major Cities and in Major Cities is not statistically significant. (d) Based on Kessler 10 score. Source: ABS 2007 Survey of Mental Health and Wellbeing Thoughts or plans of suicide In 2007, 14% of 16-85 year olds who lived outside Major Cities had seriously thought about or planned suicide at some time in their life, and 2.0% had seriously thought about or planned it in the last 12 months. In both cases, this was not significantly different to people who lived in Major Cities. There was no significant difference in the rates for either men or women between the two areas for either time frame. Mental disorders Those aged 16-85 years who lived outside Major Cities in 2007 were no more likely to have had a symptom of a mental disorder in the last 12 months than those who lived in Major Cities. However, those who lived outside Major Cities were slightly (8.0%) more likely to have had a mental disorder at some point in their life. There was no significant difference between the two areas in the proportion of men who had a mental disorder at some point in their life, or between the women in the two areas. The age group with the largest difference between the two areas was in the 35-44 years age group - six in every ten people (60%) in this age group who lived outside Major Cities had experienced a mental disorder compared with five in every ten people (51%) who lived in Major Cities. In 2007, people aged 16-85 years who lived outside Major Cities were 25% more likely to have had a substance use disorder in their lifetime compared with people who lived in Major Cities. Men aged 16-85 years who lived outside Major Cities were 28% more likely to have had a substance use disorder, whereas there was no significant difference between areas for women. In both areas, the vast majority of men with a substance use disorder were diagnosed with an alcohol use disorder (96% of those who lived outside Major Cities with a substance use disorder and 92% of those who lived in Major Cities). In contrast to the ABS 2007-08 National Health Survey, where respondents volunteered whether they currently had a mental or behavioural problem, the ABS 2007 Survey of Mental Health and Wellbeing used an internationally recognised questionnaire to determine whether a person had a mental disorder (of which the person may not have been aware). Consequently, data between the two surveys may not be comparable. PEOPLE WHO HAD A MENTAL HEALTH DISORDER(a) AT SOME POINT IN THEIR LIFE - 2007 (a) Persons who met criteria for diagnosis of a lifetime mental disorder (with hierarchy). Source: ABS 2007 Survey of Mental Health and Wellbeing MORTALITY It has been estimated that life expectancy is up to four years lower outside Major Cities than it is in Major Cities.(Endnote 12) In 2008 it was calculated that the number of deaths for every 100,000 people who usually resided outside Major Cities was 42% higher than those who lived in Major Cities. SELECTED CAUSES OF DEATH(a) OUTSIDE MAJOR CITIES - 2008(b)
(b) Causes of death data for 2008 are preliminary and subject to a revisions process. See ABS Causes of Death, 2008: Technical Note 1 (cat. no. 3303.0). (c) Crude death rate. (d) Based on age standardised death rates. This ratio shows how many times more likely it was to have had a particular cause of death when living outside Major Cities compared with in Major Cities e.g. 1.44 times (44%) more likely. (e) High blood pressure. Source: ABS 2008 Causes of Death collection Heart disease For people who usually resided outside Major Cities, the cause of death with the highest death rate was ischaemic heart disease, with 144 deaths per 100,000 people. Although this was also the most common cause of death for people who resided in Major Cities, people outside Major Cities were 44% more likely to have died from this disease than those in Major Cities. Dying from a stroke was the second most common cause of death in those who lived in either area, but was 31% more likely to be a cause of death outside Major Cities. Those who lived outside Major Cities were also nearly twice (1.90 times) as likely to die from hypertensive disease (high blood pressure) and 70% more likely to die from heart failure. Transport accidents People living outside Major Cities may need to travel long distances, at speeds which are often greater than those used in Major Cities. In addition, road conditions may be worse and, in the event of an accident, possibly have longer retrieval times. These factors expose people living outside Major Cities to greater risks when using transport.(Endnote 2) People living outside Major Cities in 2008 were three times (3.08 times) as likely to die because of a transport accident as those living in Major Cities. This was similar for men and women (3.05 times as likely and 3.02 times as likely, respectively). The difference between the two areas is particularly evident in certain age groups. In 2008, men outside Major Cities aged 20-24 years had a death rate due to transport accidents that was four times as high as those in Major Cities (42 per 100,000 men and 10 per 100,000 men respectively). DEATH RATES(a) TRANSPORT ACCIDENTS - 2008 (a) Causes of death data for 2008 are preliminary and subject to a revisions process. See ABS Causes of Death, 2008: Technical Note 1 (cat. no. 3303.0). Source: ABS 2008 Causes of Death collection Suicide In 2008, suicide was ranked the 14th highest leading cause of death in Australia, with 78% (1,709) of these deaths related to men.(Endnote 13) People living outside Major Cities in 2008 were much more likely to die from suicide than those in Major Cities (66% more likely). Overall, death rates from suicide were higher for men than for women. Men who usually resided outside Major Cities were 68% more likely to have committed suicide than those who lived in Major Cities; the likelihood of women who lived outside Major Cities to have committed suicide in 2008 was 51% higher than for women who lived in Major Cities. For men aged 15-29 years, the death rate from suicide for those who lived outside Major Cities was twice as high as that in Major Cities. Unemployment, greater availability of lethal means of self-harm, barriers to mental health care services and loneliness are seen as reasons for suicide in this age group.(Endnote 14) Men aged 85 years and over who lived outside Major Cities had the highest death rate from suicide (40 deaths per 100,000 men). Changes in economic circumstances leading to financial insecurity and vulnerability, which is known to be a reason for suicide in older age groups,14 is also likely to affect this age group. DEATH RATES(a) FROM SUICIDE - 2008 (a) Causes of death data for 2008 are preliminary and subject to a revisions process. See ABS Causes of Death, 2008: Technical Note 1 (cat. no. 3303.0). Source: ABS 2008 Causes of Death collection LOOKING AHEAD The National Healthcare Agreement has stated that all Australians should have timely access to quality health services based on their needs, not ability to pay, regardless of where they live in the country.(Endnote 15) A variety of programs have been implemented under the National Rural and Remote Health Infrastructure Program with the aim of achieving this and consequently improving the health status of those living outside Major Cities. New developments in technology will enable the extension of services such as telemedicine and e-Health which will greatly benefit those living outside Major Cities. ENDNOTES 1. National Rural Health Alliance Inc. May 2009, Fact Sheet 15: Rural Australia, viewed 7 March 2011. <nrha.ruralhealth.org.au>.2. Phillips A, 2009, ‘Health status differentials across rural and remote Australia’, Aust. J. Rural Health 17:2-9.3. Australian Institute of Health and Welfare, 2010, Australia's health 2010. Australia's health series no. 12. Cat. no. AUS 122. Canberra: AIHW. p 246. <www.aihw.gov.au>.4. Australian Bureau of Statistics, 2010, Regional Population Growth, Australia, 2008-09, cat. no. 3218.0 <www.abs.gov.au>.5. Australian Bureau of Statistics, 2009, Experimental Estimates and Projections, Aboriginal and Torres Strait Islander Australians, 1991-2021, cat. no. 3238.0 <www.abs.gov.au>.6. Australian Bureau of Statistics, Dec qtr 2010, ‘One for the country: recent trends in fertility’, Australian Social Trends, cat. no. 4102.0. <www.abs.gov.au>.7. Australian Bureau of Statistics, 2007, ‘Self-assessed health in Australia: A snapshot, 2004-05’, cat. no. 4828.0.55.001. <www.abs.gov.au>.8. Miller PG, Coomber K, Staiger P, Zinkiewicz L and Toumbourow JW, 2010, ’Review of rural and regional alcohol research in Australia’; Aust. J. Rural Health, 18: 110-117.9. Bourke L, Humphreys and Lukaitis F, 2009, ‘Health behaviours of young, rural residents: A case study’, Aust. J. Rural Health, 17: 86-89.10. World Health Organisation, 2011, Obesity and Overweight. Fact Sheet No. 311, Geneva:WHO viewed 7 March 2011. <www.who.int>.11. National Rural Health Alliance Inc, January 2011, Fact Sheet 26: Physical Activity in Rural Australia, viewed 7 March 2011. <nrha.ruralhealth.org.au>.12. National Rural Health Alliance Inc, November 2010, Fact Sheet 23: Measuring the metropolitan-rural inequity, viewed 8 March 2011. <nrha.ruralhealth.org.au>.13. Australian Bureau of Statistics, 2010, Causes of Death, Australia, 2008, cat. no. 3303.0. <www.abs.gov.au>.14. National Rural Health Alliance Inc, May 2009, Fact Sheet 14: Suicide in rural Australia, viewed 7 March 2011. <nrha.ruralhealth.org.au>.15. Ministerial Council for Federal Financial Relations, National Healthcare Agreement, viewed 16 March 2011. <www.federalfinancialrelations.gov.au>. Please direct all statistical enquiries to the National Information and Referral Services (NIRS) by emailing client.services@abs.gov.au Articles in Australian Social Trends are designed to provide an overview of a current social issue. We aim to present an interesting and easy-to-read story, balanced with appropriate statistics. The articles are written as a starting point or summary of the issues, for a wide audience including policy makers, researchers, journalists and people who just want to have a better understanding of a topic. For people who need further information, we provide references to other useful and more detailed sources. Tell us if we are achieving this aim by emailing social.reporting@abs.gov.au Document Selection These documents will be presented in a new window.
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