Life expectancy at birth for men and women continued to increase throughout the 1990s, and Australians are now among the longest-lived people in the world. But substantial differences remain among certain parts of the population; Indigenous Australians in particular have much lower life expectancy than other Australians.

People hope to have a long life, free from pain, illness or disability. Good health for all brings social and economic benefits to individuals, their families and the wider community.

An indicator describing how long Australians live while simultaneously taking into account the full burden of illness and disability, would be a desirable summary measure of progress. But although such indicators have been developed they are not available as a time series (discussed in the commentary Health: Looking more closely). Life expectancy at birth is one of the most widely used indicators of population health. It focusses on length of life rather than its quality, but it usefully summarises the health of the population.

Australian life expectancy improved during the 1990s. A boy born in 1999 could expect to live to be almost 77, while a girl could expect to reach 82 - increases since 1990 of close to 3 and 2 years respectively.


LONGER TERM VIEW

Increases in life expectancy occurred over most of the twentieth century, and resulted in an increase of 20 years of life for both men and women. Much of the improvement in the first part of the century was because of a decline in deaths from infectious diseases. This was associated with improvements in living conditions, such as cleaner water, better sewerage systems and improved housing, coupled with rising incomes and improved public health care, including initiatives like mass immunisation. (SEE FOOTNOTE 1) These changes were particularly beneficial to infants, women who were pregnant or in childbirth, and older people; official statistics show that rapid declines in deaths among infants were the main reason that life expectancy increased in the first half of the century. (SEE FOOTNOTE 2) Increases in life expectancy slowed in the middle of the twentieth century, and then plateaued in the 1960s, largely because of increases in cardiovascular disease. (SEE FOOTNOTE 1)

Substantial improvements in the life expectancy of older people have been a feature of the second half of the twentieth century, particularly since the 1970s. Between 1980 and 1999, life expectancy at age 65 increased by just over 3 years for men and 2.5 years for women. Life expectancy at birth over the same period increased by over 5.5 years for men and just under 4 years for women.

Progress has been associated with a decline in deaths from degenerative diseases, such as heart disease, cancer and strokes (these have replaced infectious diseases as the main causes of death). Greater attention to living healthier lifestyles, continued improvements in living standards, together with ongoing medical advances, including improvement in treatments, illness prevention and diagnosis and screening, have supported this transition.

INTERNATIONAL COMPARISONS The Population Reference Bureau ranks Australian life expectancy among the highest in the world. (SEE FOOTNOTE 3) Total life expectancy (men and women combined) in Australia is 79 years, alongside France, Italy and Canada. It falls below Japan (81 years), Hong Kong, San Marino, Sweden and Switzerland (all 80 years), but is above countries such as Greece and Spain (both 78 years), and New Zealand, the UK and the USA (all 77 years).

SOME DIFFERENCES WITHIN AUSTRALIA

Despite continued improvement in the population's health, there are significant disparities between different groups. Women tend to live longer than men, and this is reflected in the differences in life expectancy throughout the twentieth century. But during the 1990s, life expectancy at birth for men increased more quickly than for women, although a girl born in 1999 could still expect to live over 5 years longer than a boy. There are a number of reasons why women live longer than men; these are discussed in the commentary Health: Looking more closely.

The health of many Aboriginal and Torres Strait Islanders is poor. It is difficult to assess national trends in Indigenous life expectancy because many of the historical data are of poor quality. What is known is that Indigenous Australians do not live as long: recent data estimate their life expectancy at birth to be about 20 years less than for other Australians. (SEE FOOTNOTE 4) At the end of the 1990s Indigenous life expectancy at birth (56 years for men and 63 years for women) stood at levels similar to those of the general population close to the beginning of the twentieth century.

A substantial body of evidence shows that lower socioeconomic status and less education contributes to poorer health. Likewise, poor health, particularly in childhood, can impair education and thus affect socioeconomic success in later life. (SEE FOOTNOTE 4)

Older people are much more likely to experience ill health and disability. However, while Australians are living longer than ever before, there are concerns about whether the general health of older people (whether or not they are afflicted by disabilities or chronic illnesses associated with ageing) is also improving. Recent evidence is not conclusive, but it appears that the length of time people are living without a disability is not increasing as quickly as overall life expectancy. (SEE FOOTNOTE 5)


FACTORS INFLUENCING CHANGE

Historical studies of health improvement, as well as comparisons of health between developing and developed countries, provide ample evidence that many factors have helped to improve health. In developed countries, improvements in nutrition, sanitation, water supplies, hygiene, and living and working conditions, brought major improvements in health and life expectancy, particularly before the 1950s. Advances in medical technology have also been important, especially in the past 50 years. These advances have been supported by further improvements in lifestyle such as better diet.

There is a good deal of debate about whether life expectancy will continue to increase, and there are two opposing schools of thought. Some analysts believe that there is a biological limit to an average life of around 85 years which has nearly been reached; others believe that life expectancy will continue to increase as a result of further medical advances and better lifestyles. (SEE FOOTNOTE 1) There is no doubt that there is more room for improvement among some groups of the population than among others.


LINKS TO OTHER DIMENSIONS OF PROGRESS

Improvements in health may assist progress in other areas and vice versa.

For instance, a healthy population stimulates economic growth: with fewer sick people to care for, more money is available for other things, while Australian business benefits from a healthy workforce taking fewer days off sick. Conversely the growth of the economy can help to provide funds, either to governments or individuals, to pay for better hospitals and health care, and to maintain suitable sanitation and housing services. Moreover, the health industry is a very significant employer and total health expenditure was over 8% of GDP at the end of the 1990s.

Various types of economic activity also affect human health. The burning of fossil fuels, for example, is linked to types of air pollution and a variety of health concerns. The changing make-up of the Australian economy is having an effect too: a shift to more office-based work with proportionally fewer people employed in more dangerous occupations like mining has helped, (SEE FOOTNOTE 6) along with other factors, to reduce the incidence of fatal accidents at work, although more sedentary occupations have some adverse health effects.

ABS population projections indicate that the proportion of the population aged 65 years or more will rise. This has prompted concerns about future health care costs. The incidence of disability is strongly linked to a person's age, and increases in life expectancy among older people have been accompanied by increases in the numbers of disabled. Not only does a disability detract from the quality of life of those it afflicts; it can also create pressures on the families and carers of people with disabilities.

See also the commentaries National income, Air quality, Atmosphere, Work, and Economic disadvantage and inequality. Improvements in health may assist progress in other areas and vice versa.


FOOTNOTES

1 Mathers, C. and Douglas, B. 1997, "Measuring Progress: is life getting better", in Measuring Progress, p.131, CSIRO Publishing, Melbourne.

2 Australian Bureau of Statistics 1995, "Life expectancy trends", in Australian Social Trends 1995, Cat. no. 4102.0, ABS, Canberra.

3 Population Reference Bureau 2001, World Population Data Sheet, PRB, Washington D.C.

4 Australian Bureau of Statistics 2001, Deaths Australia, 2000, Cat. no. 3302.0, ABS, Canberra.

5 Australian Bureau of Statistics 2000, "Health . National Summary Tables", in Australian Social Trends 2000, Cat. no. 4102.0, ABS, Canberra; and de Looper, M. and Bhatia, K. 2001, Australian Health Trends 2001, AIHW Cat. no. PHE 24, AIHW, Canberra.

6 National Occupation Health and Safety Commission, Work-related Traumatic Fatalities in Australia 1989-92, NOHSC, Canberra.

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