Editorial
Health and inequity in Australia
In this issue of The Lancet Public Health, Shariful Islam
and colleagues examine the state and trends of disease
burden in Australia from 1990 to 2019. In brief, life
expectancy has increased by 6 years and a major
success has been the drastic decline in age standardised
mortality rates in the top three causes of mortality,
ischemic heart disease, stroke, and tracheal bronchus
and lung cancer. However, to take stock of the health of
Australians the question is not only what is the burden
of disease but also who carries the burden of disease?
Non-communicable diseases remain the main
drivers of disease burden in Australia. Based on Islam
and colleagues’ analyses, their leading risk factor is
high body mass index, which has overtaken smoking
in 2019. This is likely due to Australia’s strict tobacco
control measures, which have coincided with a steady
decline in smoking prevalence down to 11%. But
prevalence of daily smokers remains high in those
with socioeconomic disadvantage and are more than
three times the national average for Aboriginal and
Torres Strait Islander people. Obesity prevalence is
increasing and in unequal rates. 31% Australians live with
obesity, 38% for those who did not complete secondary
education; the proportion reaches 43% for First Nations
peoples. Notably, the distribution of risk factors between
First Nations and Non-Indigenous Australians overlaps
with socioeconomic determinants such as education
or employment, which are also unequally distributed.
In this issue, Kim Kiely and colleagues strengthen
the evidence on inequalities by education in their
longitudinal study on healthy working life expectancy in
the Household Income and Labour Dynamics in Australia
survey. Although total and working life expectancy
at 50 years increased, those who did not complete
secondary schooling mainly gained years working in
poor health and lost overall healthy life expectancy.
The burden of risk factors and distribution of
social determinants in Aboriginal and Torres Strait
Islander peoples is the result of historic policies and
discrimination. These disadvantages feed a cycle of
ongoing discrimination creating further barriers to better
outcomes for physical and mental health. The latest
Closing the Gap report by the Productivity Commission
of the Australian Government, which monitors progress
in reducing inequalities in the Australian First Nations,
www.thelancet.com/public-health Vol 8 August 2023
paints a sobering picture. Although some improvements See Articles page e585
have been observed, the increased proportion of See Articles page e600
Aboriginal and Torres Strait Islander peoples completing See Articles page e610
For data from the National
high school (68%) has been too modest to reach the Drug Strategy Household
national target (96%). There has also been a worsening Survey 2019 see https://viz.
aihw.gov.au/t/Public/views/
in some outcomes, for instance adult suicide, which is PHE270Druguseandpopulation
already twice as common in this population, showed figure/Popgroupchoosedrug
an upward trajectory. A sign of hope is the observed For the National Aboriginal and
Torres Strait Islander Health
reduction in the rate of First Nations young people Survey see https://www.abs.gov.
in detention, which is on track with the target for au/statistics/people/aboriginal-
and-torres-strait-islander-
2031 (30%). The impact of incarceration on young peoples/national-aboriginal-
people‘s health is documented by Lucas Calais-Ferreira and-torres-strait-islander-
health-survey/latest-release
and colleagues also in this issue. Compared with peers For data on obesity and
in the general Australian population, the authors find overweight see https://www.
aihw.gov.au/reports/overweight-
a 4-times higher risk of early mortality and 1·7 times obesity/inequalities-overweight-
higher risk of death from non-communicable diseases in social-determinants-health/
summary
young people with a history of incarceration.
For the Australian Institute of
Overall, the analysis of the Global Burden of Disease Health and Welfare see https://
Study 2019 by Islam and colleagues shows increases www.aihw.gov.au/reports/
australias-health/social-
in life expectancy and reductions in disease burden in determinants-and-indigenous-
Australia. But the burden is disproportionally carried health
For the Closing the Gap report
by people with socioeconomic disadvantage and the see https://www.pc.gov.au/
First Nations peoples—with an 8·6 years shorter life closing-the-gap-data/annual-
data-report
expectancy in men and 7·8 years in women compared
For the statement by the Public
with Non-Indigenous people. Health inequities stem Health Association of Australia
from social, cultural, environmental, and historical see https://www.phaa.net.au/
documents/item/5137
determinants. Targeted public health approaches and
For the statement by the
action are needed to address health inequalities. But Australian Academy of Health
and Medical Sciences see
historically Indigenous populations have been excluded https://aahms.org/news/
from decision making on matters affecting their statement-supporting-the-
voice-to-parliament/
health and wellbeing. Later this year, Australia has the
For the statement by the
opportunity to establish a constitutionally enshrined Australian Medical Association
Voice of Aboriginal and Torres Strait Islander peoples, see https://www.ama.com.au/
articles/ama-statement-voice-
an independent and permanent advisory body that will parliament
have the ability to speak out and advise the Australian
Parliament and Government on matters that affect the
lives of First Nations peoples. We welcome the Public
Health Association Australia, the Australian Academy
of Health and Medical Sciences, and the Australian
Medical Association supporting the constitutional
amendment for Aboriginal and Torres Strait Islander
peoples to be heard to tackle health inequalities.
■ The Lancet Public Health
Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open
Access article under the CC BY 4.0 license.
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