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Liveability: human well-being (continued)

Environmental health

Human health is influenced by many different factors, including genetic inheritance, biomedical processes and environment, as well as economic, social and behavioural determinants. Delineating the role of environmental factors in health is complex, and needs to be studied in different dimensions. Prominent among these dimensions is the pattern of human settlements. Human settlements generate a range of environmental settings and situations which affect human health.

Industrial bases, labour markets and housing markets provide the mechanisms - employment and income - by which individuals and households gain access to particular geographic spaces for work, recreation and residence. The locales in which different groups work, live and travel also vary by their physical amenity (quality of air, water) and their social amenity (quality of housing, indoor environments, access to health and community services). Employment, income, quality of living and working environment, and access to services all affect health outcomes.

The environment in which people live in remote areas differs in many ways to the metropolitan environment. There are issues such as fewer services, longer distances to travel for those out of town or those needing to travel between towns, diminished access to public transport, poorer road conditions, and environmental issues related to agricultural and mining occupations. The socio-economic disadvantage also tends to increase with increasing remoteness (Australian Institute of Health and Welfare (AIHW) 1998a).

This section discusses the health of Australians living in various types of settlements, in terms of environmental factors and determinants such as service accessibility and use, exposure to health risks and outcomes across the spectrum of human settlements.

Mortality

The most common and useful measure of a population's health is its death rate, since mortality statistics are the most widely available source of information on health and health problems. There are around 127 000 deaths in Australia each year. Deaths of persons aged 70 years and over accounted for 70% of all deaths, 20% occurred at ages 50-69 years, 8% at ages 20-49 years, and 2% at ages less than 20 years (AIHW 2000a).

Australia has experienced a considerable reduction in the death rate over the past century (Figure 62). Death rates are now less than half what they were in the early 1900s. Improvements in social and environmental conditions such as sanitation, health education, the quality of food and water supply, and better housing, contributed to the decrease in mortality in the early part of the century, particularly deaths from infectious diseases. In the later half of the century, behavioural or lifestyle changes such as decreased smoking and improved diet have contributed significantly to the reduction in death rates. Advances in medical technology (including mass immunisation and antibiotics), improved medical care and the development of surgical interventions (e.g. coronary bypass operations) are also believed to have had a significant impact on death rates.

These mortality reductions, however, have not occurred uniformly among all population groups. The death rate among males, for example, has remained consistently above that among females, with the male rate ranging from 1.2 to 1.7 times the female rate (AIHW 2000b). Life expectancy, a measure based on age-specific mortality patterns, also varies considerably among population groups. The life expectancy of Indigenous Australians born in the 21st century is similar to that for non-Indigenous Australians born at the beginning of the 20th century.

Three major trends are apparent:

1. The death rate in Australia is lower than the average for 28 other OECD countries (AIHW 1998b, 2000a). Australia ranked seventh lowest after Japan, Iceland, Canada, Switzerland, France and Sweden in 1997 (WHO 1998a).
2. The age-standardised death rate varies considerably across the different categories of settlement, increasing consistently with rurality and remoteness of the population. For example, the death rate in 'remote centres' was 29% higher than that in capital cities in 1994-1998. In the rural zone, the rate was around 7% higher (Table 41).
3. Death rates decreased in all settlement categories over the period 1986-1998 (AIHW 2000b). Among males, the greatest decreases were generally observed in capital cities and other metropolitan areas, while for females the decreases were greatest in large and small rural centres and in other remote areas.

Table 41: Deaths in Australia by class of settlement, 1994-1998.

Indicator	Metropolitan zone		Rural zone			Remote zone		Total
	M1	M2	R1	R2	R3	Rem1	Rem2
Average annual number of deaths	77 548	10 336	8 295	9 756	18 494	1 007	1 983	127 419
All causes, age-standardised death rateA	618.2	641.2	659.3	663.8	658.6	794.6	767.6	635.1

^ANumber of deaths per 100 000 persons, age-standardised to the Australian population at 30 June 1991. Note that values for all other zones vary significantly from M1 ('capital cities') at the 5% level.
M1 - capital cities.
M2 - other metropolitan areas (urban centre population 100 000 or more).
R1 - large rural centres (urban centre population 25 000-99 000).
R2 - small rural centres (urban centre population 10 000-24 999).
R3 - other rural areas (urban centre population less than 10 000).
Rem1 - remote areas (urban centre population 5000 or more).
Rem2 - other remote areas (urban centre population less than 5000).

Source: AIHW(2000b).

Major causes of mortality in Australia are circulatory system diseases, cancers, respiratory diseases and injuries (Figure 63). Diseases of the digestive system are also large contributors to deaths. While a relatively consistent rise in death rates with rurality and remoteness is noted for circulatory, respiratory and digestive system diseases, as well as injury and poisoning, no consistent pattern emerges for cancer deaths. The pattern for deaths from infectious diseases was also not clearly associated with rurality.

[HS Indicator 8.9] The major factors contributing to these differences are the significantly higher proportions of Indigenous people, who have a much higher death rates than their non-Indigenous counterparts, living in rural and especially remote areas. In the remote zones, the much larger proportion of males, who have a much higher death rates than females, further adds to these differentials. Death rates for males are 1.5 times those for females, while the death rate for Indigenous people is almost 2.5 times the rate for non-Indigenous people.

Indigenous people are more likely than their non-Indigenous counterparts to be exposed to poor living conditions, including living in improvised or overcrowded dwellings, poor nutrition, smoking, consumption of dangerous amounts of alcohol, the use of illicit drugs and other harmful substances, and exposure to violence (ABS and AIHW 1999). These poor conditions contribute to high rates of infectious, rheumatic heart, respiratory and genito-urinary diseases (State of the Environment Advisory Council 1996).

Skin cancers in Australia

Australians have the highest rate of skin cancers in the world (DHFS and AIHW 1998). Each year, approximately 345 000 new cases of cancers are diagnosed in Australia. About 78% of cases are non-melanocytic skin cancers (NMSCs). Melanoma, the other major form of skin cancer, is one of the most commonly diagnosed cancers in Australia, and has a significant impact on morbidity, mortality and health service use. Queensland has the highest incidence of melanoma in Australia (53.5 per 100 000 population). About 10 775 potential years of life would be lost to Australia each year as a result of people dying of melanoma before the age of 75.

The incidence of melanoma has increased considerably since the early 1980s (Figure 64). Overall there was an 87% increase in the incidence of melanoma among males and a 34% increase among females between 1983 and 1996. The largest increase among both sexes was in the 60 and over age group. Much of the increase in incidence rates is likely to be due to better detection and improved registration for this type of cancer. However, increases in UV exposure are also likely to play a large role (see the Atmosphere theme report). By comparison, age-standardised death rates for melanoma have changed little since 1983. Death rates have remained relatively low partly because the melanoma survival rate is high (South Australian Cancer Registry 1996; Supramaniam et al. 1999). In terms of settlement type, no consistent pattern emerges in the death rate for melanoma.

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