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INTRODUCTION

This article summarises some key changes in health and related characteristics of the Australian population over the ten years 1995 to 2004-05, as measured by the National Health Survey (NHS). Changes in the prevalence of selected long-term medical conditions, health-related lifestyle behaviours and changes in use of selected health services are discussed for broad age groups and by sex.


DATA SOURCES

The article uses selected health indicators from the 1995, 2001 and 2004-05 National Health Surveys conducted by the ABS. Only those indicators which were collected in all or most of these surveys are included.

Direct comparability of data between surveys for some indicators may be affected by changes in the content of the NHSs over this period, and in survey methodologies, data definitions and classifications (footnote 1). In general, the indicators selected for inclusion in this article are those where data are considered sufficiently comparable to indicate the broad trends in health. Major breaks in comparability are noted where applicable.

Data are age standardised or presented by age to take account of changes in the age structure of the population over time (footnote 2). Changes in age standardised rates between 1995 and 2004-05 are expressed as rate ratios (footnote 3).

More detailed information about most of the topics covered in this article has been separately published in a series of snapshot articles which are available from the ABS website via the ABS health theme page. Papers on the comparability of NHS data over time for long-term medical conditions and health risk behaviours are also available; See List of References for further details.


INQUIRIES

For further information about these and related statistics, contact the National Information and Referral Service on 1300 135 070 or email <client.services@abs.gov.au>.


CHANGES IN HEALTH OVER TIME

Health information is fundamental to developing effective health policies and programs, to ensuring quality provision of services, to coordinating treatment and care and to empowering consumers (AIHW 2006).

The NHS provides regular national benchmarks on a wide range of health issues and enables changes in health to be monitored over time.

NHSs have been conducted in 1989-90, 1995, 2001 and 2004-05, and prior to this similar surveys known as Australian Health Surveys were conducted by the ABS in 1977-78 and 1983. This publication uses selected indicators from the last three NHSs to illustrate recent trends in health over the ten year period 1995 to 2004-05.


SELF ASSESSED HEALTH STATUS

• An individual's rating of their own health is often used as one of the indicators of health status and is sometimes used as a predictor of health care use and mortality (AIHW 2006).
• The majority of Australians aged 15 years and over consider themselves to be in very good or excellent health. There has been little variation in the proportion of people reporting against each category of self-assessed health status over the period 1995 to 2004-05.

	1995 %(a)	2001 %(a)	2004-05 %(a)	Rate ratio 1995 to 2004-05
Excellent/ very good	54.3	51.5	56.4	1.0
Good	28.5	30.3	27.8	1.0(b)
Fair/poor	17.2	18.2	15.8	0.9
Total	100.0	100.0	100.0	na
Source: National Health Survey, 1995, 2001, 2004-05

• The proportion of people with one or more long-term medical condition (footnote 5) rises sharply with age, so that almost all persons aged 65 years and over reported at least one condition in 2004-05. The proportion with a long-term condition has remained steady over the period, (76% in both 1995 and 2004-05) (after adjusting for age differences).
• Long and short sightedness were the long-term conditions most commonly reported in the 1995, 2001 and 2004-05 NHSs, followed by hayfever and arthritis.
• For National Health Priority Areas, the survey results show the proportions of the population reporting arthritis, asthma and hypertension (high blood pressure) have remained steady over the period 1995 to 2004-05, while the proportions reporting diabetes mellitus and osteoporosis have increased. Reported mental and behavioural problems increased between 1995 and 2001 but were steady between 2001 and 2004-05. These conditions are discussed below.
• High cholesterol and hayfever also increased between 1995 and 2004-05 (rate ratios of 1.3 and 1.2 respectively).

Chart 1: Selected long term conditions 1995, 2001, 2004-05

	1995 (a)(b) %	2001 (a) %	2004-05 (a) %	Rate ratio 1995 to 2004-05
Arthritis	15.6 (c)	13.9 (c)	14.9	1.0
Asthma	10.9 (c)	11.6	10.2	0.9
Back pain/problems, disc disorders	(d)	(d)	15.1	-
Deafness complete/partial	10.1	10.8	10.1	1.0(e)
Diabetes mellitus	2.4	3.0	3.5	1.5
Hayfever	13.6	15.5	16.1	1.2
Heart, stroke and vascular diseases	(d)	4.3	3.8	-
High cholesterol	5.2	6.1	6.6	1.3
Hypertension	10.9 (c)	10.3	10.4	1.0
Long sightedness	22.0	22.4	26.3	1.2
Malignant neoplasms (cancers)	1.9 (f)	1.4	1.7	0.9
Mental and behavioural problems	4.1	9.6	10.7	2.6
Osteoporosis	1.5	1.6	2.9	1.9
Short sightedness	20.9	20.9	21.8	1.0
Sinusitis	10.1	10.7	9.2	0.9
Source: National Health Survey, 1995, 2001, 2004-05

• Musculoskeletal conditions are defined as conditions of the bones, muscles and their attachments, and include joint problems such as arthritis. Although there are more than one hundred musculoskeletal conditions the most common are arthritis (including osteoarthritis and rheumatoid arthritis), osteoporosis and back pain (AIHW 2004).
• Arthritis was the most prevalent long-term musculoskeletal condition in 2004-05. Half (50%) of those reporting a musculoskeletal condition reported arthritis. The type of arthritis most commonly reported in the 2004-05 NHS was osteoarthritis (51% of those reporting arthritis).
• The proportion reporting arthritis has remained steady overall between 1995 and 2004-05 (after adjusting for age differences), and there has been little change in the reported prevalence of arthritis in different age groups (footnote 6).

Chart 2: Persons with arthritis

• There has been little change between 1995 and 2004-05 in the proportion of the population reporting asthma (rate ratio of 0.9).
• It should be noted that the NHS data reflects the views of survey respondents as to whether or not their asthma is current, and therefore the data may differ from other sources which use different criteria to establish the prevalence of the condition.
• Although the overall level of asthma in the population has changed little, the reported prevalence of asthma in children has decreased, from 16% of children aged less than 15 years in 1995 to 12% in 2004-05, with a small rise in prevalence in older age groups.

Chart 3: Persons with asthma

• The proportion of the population reporting diabetes mellitus has increased between 1995 and 2004-05 (rate ratio of 1.5) (after adjusting for age differences). Most (83%) people reporting diabetes in the 2004-05 NHS reported that they had Type 2 diabetes.
• Estimates for diabetes from the NHS may understate the true prevalence of the condition in the community as they exclude those cases which have remained undetected (footnote 7) .
• The prevalence of diabetes has increased in all age groups above 44 years, and was highest in the 65-74 year age group (14%). The number of people aged 65 years or more reporting Type 2 diabetes has more than trebled between 1995 to 2004-05. As a result, the proportion aged 65 years and over reporting diabetes increased from 9% in 1995 to 14% in 2004-05.

Chart 4: Persons with diabetes

• Diseases of the circulatory system include all diseases of the heart and blood vessels, including high blood pressure, ischaemic and other heart disease, cerebrovascular disease (including stroke) and diseases of the veins and arteries.
• In 2004-05 high blood pressure (hypertension) was the most commonly reported disease of the circulatory system. An estimated 59% of those reporting a disease of the circulatory system reported high blood pressure (footnote 8).
• The proportion reporting high blood pressure has remained steady over the period 1995 to 2004-05 (rate ratio of 1.0) and there has also been little change in reported levels across age groups.
• When all other diseases of the circulatory system (comprising ischaemic heart disease, stroke and other heart and vascular disorders) are considered as a group, there has been a decrease in the reported prevalence of these conditions between 1995 and 2004-05 across all but the 75 years and over age group.

• The proportion reporting long-term mental and behavioural problems more than doubled between 1995 and 2001 (rate ratio of 2.4) (after adjusting for age differences) but has remained steady between 2001 and 2004-05 (rate ratio of 1.1). The overall increase between 1995 and 2004-05 should be interpreted with care, as it may in part be due to a greater knowledge of and willingness by respondents to report mental problems in the surveys.
• The most commonly reported mental and behavioural problems reported in 2004-05 were mood (affective) problems including depression (reported by 46% of those reporting a mental problem) and anxiety related problems (44%) (after adjusting for age differences).
• Increases in the reported prevalence of mental problems between 1995 and 2004-05 were highest in the 35-44 (5% to 14%) and 45-54 (4% to 13%) year age groups. Rates were higher among females than males.

• In 2004-05 13% of adults were classified to a high/very high level of psychological distress (footnote 9). This was similar to the proportion recorded in 2001.

• Compared with results of the 1995 NHS, the 2004-05 survey showed that more adults are drinking alcohol at risky or high risk levels (rate ratio of 1.6), and more are overweight or obese (rate ratio of 1.2) (after adjusting for age differences).
• In contrast, the proportion of adults reporting that they smoked decreased slightly (rate ratio of 0.9) and there was little change in the proportion reporting they did no exercise or had exercised at a very low exercise level (rate ratio of 1.0).
• While the proportions of adult males who smoked, drank alcohol at risky or high risk levels, or who were classified as overweight or obese (as measured by their body mass index (BMI) derived from reported height and weight (footnote 10) are higher than females, the overall rates of change between 1995 and 2004-05 for smoking and overweight/obesity were similar for both sexes. The rate of increase in the proportion of females who consumed alcohol at risky or high risk levels was higher for females than males (rate ratio of 1.9 compared to 1.5).

	% Males (b)					% Females (b)				% Persons(b)
	1995(c)	2001	2004-05	Rate ratio 1995 to 2004-05		1995(c)	2001	2004-05	Rate ratio 1995 to 2004-05	Rate ratio 1995 to 2004-05
Current smokers	28.4	27.2	26.2	0.9		21.8	21.2	20.4	0.9(d)	0.9(d)
Risky/high alcohol risk	10.3	13.1	15.2	1.5		6.1	8.5	11.7	1.9	1.6
Overweight/ obese BMI	48.8	54.3	58.3	1.2		32.4	38.1	39.9	1.2	1.2
Physically inactive (e)	35.0	30.9	33.6	1.0(d)		35.4	32.2	34.4	1.0(d)	1.0(d)
Source: National Health Survey, 1995, 2001, 2004-05

• The proportion of both men and women who were current smokers (footnote 11) fell between 1995 and 2004-05 (rate ratio of 0.9) (after adjusting for age differences).
• In 2004-05, 92% of current smokers reported that they smoked daily.
• Fewer young women reported smoking in 2004-05 than in 1995. The proportion of women aged 18 to 24 years who smoked was five percentage points lower in 2004-05 than in 1995 (26% compared to 31%). Almost two thirds (64%) of women aged 18-24 and 53% aged 25-34 reported having never smoked, up from 57% and 48% respectively in 1995.
• The proportion of men aged 18-24 years who reported smoking fell one percentage point between 1995 and 2004-05 (35% to 34%), while the proportions of males who reported having never smoked was higher across all age groups in 2004-05 than in 1995, except the 75 and over age group.
• Compared to 1995, smoking was more likely to be reported in 2004-05 by females in the 35-44 and 45-54 year age groups. In all other age groups for women, and across all age groups for men, the proportions who were current smokers were similar or lower in 2004-05 than in 1995.

• The NHS collects information about the types and quantities of alcohol recently consumed. Caution should be used in interpreting these data as the collection of accurate data in recall situations about the quantity of alcohol consumed is difficult.
• The proportion of men and women drinking at risky/high risk levels (footnote 12) increased between 1995 and 2004-05 (rate ratios of 1.5 and 1.9 respectively).
• The proportion of men and women who drank any alcohol in the last week increased between 1995 and 2004-05 in all age groups, with the largest increase in the 55-64 year group (from 62% to 73% for males and 40% to 57% for females).
• Increases between 1995 and 2004-05 in the proportions of men and women drinking at risky/high risk levels were recorded across all age groups. For men the largest increase was in the 55-64 year age group (from 9% to 18%). For women the largest increases were recorded in age groups from 35-44 years through to 55-64 years (from 6-7% to 13%).

• The proportions of men and women whose reported BMI classified them as overweight or obese increased between 1995 and 2004-05 (rate ratio of 1.2) (after adjusting for age differences).
• For both men and women, the increase between 1995 and 2004-05 in the proportion overweight/obese is apparent across all age groups, but the largest increase was in the 35-44 years age group for men (from 52% to 65%), and 25-34 and 65-74 year groups for women (from 26% to 35% and from 40% to 50% respectively).

• The increase between 1995 and 2004-05 in the proportion of men classified as overweight or obese has been higher in the obese group than the overweight group. Men classified as obese increased from 11% to 18% (with the largest increase of 10% in the 35-44 year age group) compared with an increase from 38% to 41% in men classified as overweight. Over this period the proportion of women classified as obese increased from 11% to 15%, and those classified as overweight increased from 21% to 25%.
• Data were also collected in the surveys showing the body mass index of children aged 15-17 years. These data showed that in 2004-05, 15% of boys and 11% of girls aged 15-17 years were categorised as overweight or obese. As the data were obtained from a parent or other adult for the majority of children in this age group, these data should be interpreted with care (footnote 13).

• Based on reported details of exercise undertaken for recreation, sport or fitness the proportion of adults classified as physically inactive (i.e. very little or no exercise) (footnote 14) decreased between 1995 and 2001 (rate ratio 0.9) but increased between 2001 and 2004-05 (rate ratio of 1.1) so that overall the levels recorded in 2004-05 are similar to those in 1995.
• While the overall proportions of adults classified as physically inactive were similar between 1995 and 2004-05 there has been a decrease in the proportion of both men and women classified as physically inactive in all but the youngest (18-24 years) and oldest (75 years and over) age groups.

• Data were also collected in the surveys showing the exercise level of children aged 15-17 years. These data showed that in 2004-05, 19% of boys and 30% of girls aged 15-17 years were reported as doing very little or no exercise. As the data were obtained from a parent or other adult for the majority of children in this age group, these data should be interpreted with care (footnote 13).

• Over the period 1995 to 2004-05, the proportion of persons reporting visiting a doctor in the two weeks prior to interview has remained steady (rate ratio of 1.0).
• In contrast, the proportion consulting a health professional other than a doctor or dentist (footnote 15) increased between 1995 and 2001 (rate ratio of 1.3). Changes to survey methodology from 1995 to 2001 may have contributed to this increase. The proportion of the population consulting a health professional other than a doctor or dentist has remained steady between 2001 and 2004-05 (rate ratio of 1.0).

	1995 %(a)	2001 %(a)	2004-05 %(a)	Rate ratio 1995 to 2004-05
Admission to hospital (b)	na	12.3	14.8	-
Visited casualty/ outpatients/day clinic	4.3	5.2	5.3	1.2
Consulted doctor	23.5	24.5	22.8	1.0
Consulted dentist	5.6	6.1	5.9	1.0(c)
Consulted other health professional	9.9	13.1	13.5	1.3
Source: National Health Survey, 1995, 2001, 2004-05

• The proportion of children consulting doctors was lower in 2004-05 than in 1995, but more people in older age groups reported a recent doctor consultation. In 2004-05 proportionally more people in all age groups reported consulting a health professional (other than a doctor or dentist) than they did in 1995, with the biggest increases in the 75 years and over (from 13% to 20%) and 45-64 years (from 10% to 15%) age groups.

	1995 '000	2001 '000	2004-05 '000
Self-assessed health status (a)
Excellent/ very good	7,799.7	7,737.6	8,864.4
Good	4,035.9	4,526.2	4,384.0
Fair/poor	2,352.7	2,705.1	2,512.6
Selected long-term conditions
Arthritis	2,633.3	2,576.9	3,020.1
Asthma	2,002.6	2,197.3	2,013.5
Deafness complete/partial	1,718.5	2,012.8	2,014.3
Diabetes mellitus	403.9	554.2	699.6
Hayfever	2,469.8	2,935.3	3,165.7
Heart, stroke and vascular diseases	na	782.2	754.7
High cholesterol	881.8	1,131.6	1,339.7
Hypertension	1,839.2	1,909.1	2,100.7
Long sightedness	3,754.1	4,209.7	5,334.1
Malignant neoplasms (cancers)	321.1(c)	261.3	337.8
Mental and behavioural problems	723.3	1,812.6	2,109.5
Osteoporosis	247.7	299.8	585.8
Short sightedness	3,668.6	3,941.2	4,353.0
Sinusitis	1,799.4	2,020.0	1,815.5
Selected risk behaviours
Current smokers (c)	3,423.3	3,449.2	3,462.7
Risky/high alcohol risk (c)	1,108.5	1,536.9	2,020.9
Overweight/ obese (c)	5,363.0	6,551.7	7,366.0
Physically inactive (c)(d)	4,660.3	4,468.2	5,094.5
Actions taken in the previous 2 weeks
Admission to hospital (e )	na	2,304.1	2,913.3
Visited casualty/ outpatients/day clinic	712.0	1,000.6	932.4
Consulted doctor	4,206.6	4,631.2	4,487.6
Consulted dentist	1,006.1	1,155.4	1,158.9
Consulted other heath professional	1,792.6	2,482.7	2,648.5
Days away from work/study	1,358.8	1,568.6	1,531.8
Populations (f)
Persons aged 15 years and over	14,188.4	14,968.9	15,760.9
Persons aged 18 years and over	13,389.9	14,184.7	14,963.1
All persons	18,061.1	18,916.3	19,681.5
Source: National Health Survey 1995, 2001, 2004-05