Prevention of chronic disease and control of risk factors
Cardiovascular diseaseCardiovascular diseases are diseases of the heart and blood vessels, including coronary heart disease, stroke and heart failure. Cardiovascular disease is the largest cause of death among females, accounting for more than one in every three (37 per cent) female deaths. Importantly, many cardiovascular disease deaths are premature, as they occur in women aged less than 84 years, which is the current life expectancy for women.
However, the public health impact of cardiovascular disease among women is wider than the deaths it causes. About two million (20 per cent) females are living with cardiovascular disease, and even more are at risk. With prevalence rates of high blood pressure at 27 per cent, overweight and obesity at 54 per cent, high cholesterol at 48 per cent, insufficient physical activity at 76 per cent and daily smoking at 15 per cent in women, there is ample scope for prevention. Cardiovascular disease accounted for 18 per cent of the overall disease burden for females in 2003. As life expectancy rises, the burden of cardiovascular disease on women will increase.
Women’s awareness of cardiovascular disease as the leading cause of death in Australia is low (26 per cent) with 39 per cent of Australian women incorrectly believing breast cancer to be the leading cause of death.16
DiabetesThe number of Australian women with diabetes is increasing with National Health Survey estimates of 3 per cent of the population reporting having received a diagnosis from a doctor or nurse. The highly preventable Type 2 diabetes makes up an estimated 88 per cent of all diabetes types and, if undiagnosed or poorly managed, can result in cardiovascular disease, stroke, peripheral vascular disease, kidney failure, nerve disease, limb amputations and blindness.
The incidence of diabetes increases with age and Type 2 diabetes is closely associated with a higher body mass index. National Health Survey data indicates higher rates of diabetes among Australians born overseas (4.2 per cent), those in the most socioeconomically disadvantaged fifth of the population and among Indigenous Australians (11 per cent) compared with the general population rates of 4 per cent.
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Estimates of gestational diabetes, based on hospitalisations, indicated that during 2007–08, 5 per cent of females aged 15–49 years who gave birth in hospital had been diagnosed with gestational diabetes. More than one-third of these cases occurred in women aged 35 years and older.
CancerCancer is a major cause of death in the Australian population, causing 29 per cent of all deaths and 26 per cent of women’s deaths in 2007. The leading cause of cancer deaths in Australian was lung cancer, followed by breast cancer and colorectal cancer. Overall age-standardised death rates for cancer have fallen 16 per cent over the previous two decades with the most dramatic reduction (60 per cent) being in cervical cancer death rates, largely due to the success of the National Cancer Screening Program.
The five year relative survival rates for cancer have improved for women from 53 per cent for those diagnosed in 1982–1986 to 64 per cent for those diagnosed in 1998–2004. However, survival rates for the leading cause of cancer death, lung cancer, remain relatively poor.
Respiratory diseaseBoth asthma and chronic obstructive pulmonary disease (COPD) feature in the top ten leading specific causes of burden of disease and injury for Australian women. COPD is also a major cause of death for women aged 45 years and older.
Women are particularly vulnerable to COPD due to their smaller lungs and sensitive airways.17 While genetic factors and environmental exposure play a role in the development of COPD, the single greatest cause is a history of tobacco smoking. The shortness of breath and persistent cough associated with COPD become more acute over time and will, in most cases, result in disability levels that prevent productive work and self-care.
Australia has a high prevalence of asthma by international standards, although rates in those aged 35 years and younger have decreased from 14 per cent to 11.4 per cent between 2001 and 2004–05. Women have an overall higher rate of asthma (10.9 per cent) than men (8.9 per cent) and experience higher death rates and a greater burden of disease and disability in the older age groups.
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ObesityThe steady increase in obesity rates over the past few decades has put Australia in the worst third of Organisation for Economic Cooperation and Development (OECD) countries. This weight increase has been consistent across almost every age group and affects both women and men. Based on measured height and weight in 2007–08, 25 per cent of children aged 5–17 years were overweight or obese as were 61 per cent of adults.18
Obesity is identified by the Australian Longitudinal Study on Women’s Health as the primary cause of chronic illness in Australian women. 19
In addition to the increased rate of Type 2 diabetes and cardiovascular disease, the known consequences of obesity include mental health disorders such as depression, anxiety and social dysfunction. Each of these has been shown to increase in overweight women and decrease when women have lost weight.20
Poor nutrition is a contributing factor to obesity. The majority of Australian women do not consume the daily recommended intake of either fruits or vegetables. This remains the case regardless of whether or not they are aware of what the intake should be.
Physical inactivityA lack of physical activity is linked to poor health, including many chronic diseases, injuries, excess body weight and low bone-mineral density. Out of the modifiable health risk factors, physical inactivity is the second largest contributor, after tobacco smoking, to the burden of disease and injury in Australia. 22
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In 2007, equal proportions of men and women reported undertaking very low levels of physical activity (less than 100 minutes) or no physical activity in the week prior to the National Survey of Mental Health and Wellbeing. More women than men reported undertaking physical activity at low levels (100 minutes to less than 1,600 minutes), whereas more men than women undertook moderate/high levels of physical activity in the week prior to the survey (over 1,600 minutes).
Only 36 per cent of women exercised at sufficient levels during 2007–08. Around one-third of Australian women do not exercise at all. Increasing physical activity not only assists with control of excess weight but is also linked with reducing stress, anxiety and depression. 23
Tobacco useRates of cigarette smoking in Australia have been falling for decades. About 1 in 6 Australians aged 14 years and over now smoke daily, compared to around half of all adults
in the 1950s. Smoking rates among children and young people have generally shown a significant drop with 1 in 18 among 12 to 19 year olds smoking daily. 24
In 2007, women (15.2 per cent) were less likely than men (18 per cent) to be daily smokers. However, this was not the case across all age groups. Australian women aged between 14 and 19 years were more likely to smoke on a daily basis than males in the same age group. 25 Smoking during pregnancy can have long term, serious effects on the baby and is associated with pregnancy complications, poor perinatal outcomes and adverse infant and childhood health outcomes.26
The Australian Longitudinal Study on Women’s Health found that 30 per cent of women who were smokers and not pregnant (at any time of being surveyed) had quit smoking over the years from 1996 to 2006. The survey also found that while at least half of the women who were smokers before pregnancy quit smoking during pregnancy, 30 per cent or more did not. 27
Excessive alcohol consumptionLevels of risky alcohol use across Australia have shown little improvement across the past decade with around 1 in 10 Australians putting their long-term health at risk through excessive drinking. Double that number drank in a way that put their short-term health at risk. 28 For women, five to six standard drinks on one occasion is considered ‘risky’ in the
short term and seven or more is considered ‘high risk’.
Table 3 shows that in 2007, 30.5 per cent of Australian women aged 14 and over drank at a level considered risky or high risk for short-term alcohol-related harm. This included:
6.2 per cent of women who drank at risky or high risk levels on a weekly (at least) basis;
10.9 per cent who drank at risky or high risk levels for short-term harm at least monthly;
and 13.4 per cent who drank at these levels once or more a year.
Men, in general, are more likely than women to consume alcohol at risky or high risk levels for short-term harm across all age groups, except among those aged 14 to 19 years, where nearly 3 in 10 young women put themselves at risk of short-term alcohol-related harm by binge drinking at least once a month.
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|Risky or High risk|
|Men||At least yearly||At least monthly||At least weekely||Total|
|60 and over||17.3||67.8||6.4||4.5||4.0||14.9|
|60 and over||31.1||61.3||3.9||2.1||1.5||7.5|