ABC Updated 1 May 2013, 15:20 AEST
Australians live longer and are healthier than the people of almost every other nation based on the findings of global report detailing health trends for almost 200 countries.
The Global Burden of Disease report says Australia is enjoying the fruits of more than two decades of bold public health interventions.
But it warns that a range of lifestyle choices, particularly poor diet, obesity and rising levels of alcohol and drug use, could undermine the progress that's been made.
The findings for the Asia-Pacific are set to be presented at a national health symposium at the University of Melbourne tomorrow.
Presenter: Richard Ewart
Speaker: Professor Alan Lopez, co-author of report, Laureate Professor at the University of Melbourne and Affiliate Professor of Global Health at the Institute for Health Metrics and Evaluation
LOPEZ: It was funded by the Gates Foundation in part because there's a great demand for sort of information about the relative and comparative importance of different diseases and injuries and how they're changing worldwide.
EWART: So is there a particular pattern or are there patterns that have emerged over the last five years?
LOPEZ: I think what we're seeing is a few very important transitions, particularly a much greater increase across the globe in the importance of non-communicable diseases progressively replacing communicable infectious diseases. We're also seeing a steady increase in disability as a cause of disease burden as opposed to premature mortality.
EWART: So timely I guess that today the Australian government has taken moves to increase the Medicare levy which will raise money for a National Disability Insurance Scheme?
LOPEZ: I think that's an absolutely timely move by the Australian government. Australia is certainly at the vanguard of countries in terms of that transition towards more disability than premature mortality due to the success of policies in Australia to control avoidable death.
EWART: Now in terms of Australia as a whole as I mentioned in the introduction, we're told that Australians are living longer, they're healthier than most people at least in the 200 countries that you looked at in this report. But we can't afford to rest on our laurels and the obesity issue for one is something which is talked about a lot in Australia and I'd suggest that it's clearly getting worse and we need to do something about it?
LOPEZ: Absolutely, I think this study quite clearly shows that things like high body mass index, obesity, is becoming not only more prevalent in the population, but its health effects are becoming more and more evident and it's rising as a cause of major health loss in Australia. Equally things like tobacco, which have been the focus of Australian public policy for over two decades now, while going down in men we still have one in five Australian adults, almost one in five smoking, and that's simply unacceptable.
EWART: So how do we go about as a nation prioritising, I mean which are the areas that we need to target first?
LOPEZ: Well I think the study that we are going to release tomorrow here in Australia provides a framework for us to do that, to make comparative assessments of the relative importance of different diseases, injuries and risk factors. Without that comparative assessment we all might think well our favourite disease is important, but is it really important compared to other conditions.
EWART: So if we look at for example the various cancer campaigns that we see in a country like Australia over the year, there are regular campaigns now that raise money for particular forms of cancer. Are we perhaps putting too much emphasis on those diseases rather than looking at the bigger picture and looking at something like poor diet which may be much more important to address?
LOPEZ: Well it's a very important question and the framework that we're putting forward in the global burden of disease allows us some insight into that. The answer of course is that it's complex, and that one needs to do all of those things. We certainly would not want to take our eye off the focus on preventing cancer. There are many, many cancers that Australians die of and suffer from that are preventable, and we ought to keep public policy focussed on those, leading among those of course is lung cancer, but also other cancers such as colorectal are important and are entirely avoidable or largely avoidable through better diet. It brings me to your broader point there that we cannot just focus on the outcomes of some of our behaviours, we need to focus on changing behaviour, particularly diet, obesity and physical inactivity, which underlie many of these conditions.
EWART: And how would that strategy if you like play out in some of the other countries across the Asia Pacific? Are there particular problems within particular countries, or is there a pattern across the region?
LOPEZ: Asia Pacific is a very complex region but it's a region characterised by what we call very rapid demographic and epidemiological change, perhaps more so than any other part of the world where we are seeing a very rapid move towards what we call non-communicable diseases; cancers, heart disease, chronic lung disease and so on. And this is happening very rapidly here, and it's happening in part because we've had very poor control of some of the leading risk factors in these populations. For example half of Chinese men smoke, two-thirds of men in Indonesia smoke, these patterns of behaviour will lead very massive changes in disease burden in the next ten or 20 years. And if they get fatter, we'll see the same effect on heart disease and stroke.
EWART: So it seems almost as though we have a group of countries who are striving to reach the point that Australia is at now, but if Australia doesn't heed the warnings that come out of this report, we could go into reverse and meet in the middle as it were?
LOPEZ: I think there's a real risk that over the next decade or so, unless Australia takes the rising obesity epidemic more seriously and it is difficult to control. Tobacco there are known work measures that work, but obesity we're still in the infancy, we know some of what to do, but we haven't yet seen population level effects where it's worked. Australians are still getting fatter, as are Americans. And so unless we're able to control some of these important new emerging dietary risk factors, we will in my view begin to lose that favoured position, and indeed perhaps could well be overtaken by some East Asian countries.
EWART: Now you raised the issue of smoking and how that could happen on a number of Asian countries. You mentioned Indonesia where of course it's one of the few countries in the world where tobacco advertising is still legal and extraordinarily prevalent, it seems to be everywhere. Do you think governments, including the Australian government who are essentially rather hypocritical about this issue, because on the one hand they beat the drum over the health education message on smoking, but on the other hand they continue to rake in massive amounts of tax revenue from tobacco?
LOPEZ: I wouldn't necessarily call it hypocritical, but I say it's a challenge for governments to get that balance right. A very good public policy is to raise the price of cigarettes to the point where the demand for cigarettes will decline simply because the cost is so high. And the Australian government have done that and it's worked very well here. Yes they make revenue from what they sell, but more importantly they're focussed on the public health consequences of tobacco use. And high cigarette price is a very good way of controlling those consequences. We're not seeing that in developing countries like Indonesia or China where cigarettes are still very affordable and as a result the disincentives are not near as powerful as they are in Australia.
EWART: Is it too simplistic to suggest that because we know of the obvious and documented dangers of tobacco, that simply there should be a move to stop the manufacture altogether, or is that a bridge too far for a number of reasons?
LOPEZ: Probably a bridge too far, there would be massive legal action as we would expect, and that would probably tie up the public health movement unnecessarily. I think what the public health movement, appropriate public policy should focus much more on reducing demand on the kind of education programs that we know work, on reducing access, particularly for minors, on taxing cigarettes so that the price of the commodity is very high. These are known interventions that work and they work very well as a package, and Australia has implemented those packages for decades now and we've seen the gains. I think this is where the focus of public policy ought to be, rather than on trying to limit supply.
EWART: So what sense do you get of governments in countries like China, like Indonesia being aware of these what would seem to be very obvious threats to national health? I mean are they looking for example at what Australia does and saying we need to aspire to that? Or is it just not on their agenda at all?
LOPEZ: Well many questions there, I think they are aware of what Australia and countries like Australia, the United Kingdom, Finland are other examples, perhaps the United States but a little less powerfully than Australia. They're aware of it, no one cannot be aware of that in the global health movement. Whether they aspire to those sorts of interventions and those sorts of health gains is another matter. And there are clearly forces in these populations that are working against the implementation of these interventions. There's simply not enough popular support and indeed government support for their implementation. So while I think knowledge about these interventions and how they work and the necessity of them is high, I think it's early days yet in terms of the implementation unfortunately in these countries.