Changes in Australia’s Health Status Over Time (VCE SSCE Health and Human Development): Revision Notes

Changes in Australia's Health Status Over Time

Since the early 1900s, Australia has experienced remarkable transformations in the patterns of disease and illness affecting its population. These changes reflect improvements in living conditions, medical advances, public health interventions, and shifts in lifestyle factors. Understanding these historical trends helps us appreciate current health challenges and the progress made over more than a century.

Life expectancy trends

Life expectancy serves as a fundamental indicator of a nation's health status, measuring the average number of years a person can expect to live if current death rates remain unchanged. The most commonly used measure is life expectancy at birth, which provides insight into overall population health.

Australia has witnessed dramatic improvements in life expectancy since 1900. Males born in 2019 can expect to live 80.9 years on average, representing a substantial increase from just 53.8 years in 1900. Similarly, females now have a life expectancy of 85.0 years compared to 57.5 years in 1900. This represents approximately a 40 per cent increase in life expectancy at birth over this period, demonstrating the profound improvements in Australia's health status.

These gains in longevity have not occurred uniformly across the entire period. Analysis of historical data reveals distinct phases of improvement. Between 1900 and 1961, there was steady progress, with male life expectancy increasing by 14 years and female life expectancy rising by 17 years. However, between 1961 and 1972, life expectancy improvements plateaued significantly. Male life expectancy actually decreased slightly from 67.9 to 67.8 years, whilst females experienced only marginal improvement from 74.2 to 74.5 years. This stagnation coincided with peak death rates from cardiovascular diseases and increased prevalence of lifestyle-related diseases such as cancer.

Since 1972, life expectancy has resumed its upward trajectory. Importantly, gains have not been limited to life expectancy at birth. Those aged 65 or more have experienced considerable improvements, with increases of 7.7 years for males and 6.7 years for females. Even amongst the oldest Australians aged 85, life expectancy has increased by 2.3 years for males and 2.5 years for females.

Infant mortality decline

A major contributor to increased life expectancy has been the dramatic reduction in infant mortality. In 1912, infant mortality rates stood at 80 deaths per 1,000 live births for males and 63 per 1,000 for females. By 2019, these rates had plummeted to just 3.7 for males and 2.9 for females, representing a reduction of over 95 per cent.

Year	Males	Females
1912	80	63
2019	3.7	2.9

This massive decline in mortality amongst children aged 0-4 years, particularly infants under one year old, has been fundamental to overall life expectancy improvements. In the early 1900s, deaths of children aged 0-4 accounted for more than 25 per cent of all deaths.

Population ageing

Accompanying increased life expectancy and lower fertility rates (the number of live births per 1,000 women aged 15-49 in one year), Australia's age profile has transformed considerably since 1900. The population structure has shifted from a young, pyramid-shaped distribution to an older, more rectangular profile, reflecting both people living longer and fewer births.

Overall death rates

Corresponding with improvements in life expectancy, overall death rates have decreased substantially. Between 1907 and 2018, age-standardised death rates fell by 73 per cent for males and 77 per cent for females, demonstrating the significant progress made in preventing premature mortality.

Patterns of mortality

Whilst life expectancy and death rates provide important overall measures of health status, examining the types of diseases responsible for deaths reveals more detailed patterns of change. The diseases common in early twentieth-century Australia differ substantially from those prevalent today, though they can be grouped into five broad categories that together accounted for approximately 60 per cent of all deaths at the century's beginning and 83 per cent by its end.

Infectious and parasitic diseases

Infectious diseases are conditions caused by micro-organisms such as bacteria, viruses, parasites or fungi that can spread directly or indirectly between people. This category includes diseases such as COVID-19, tuberculosis, polio, smallpox, hepatitis, and sexually transmitted infections including syphilis and other venereal diseases. Syphilis is a bacterial infection typically transmitted through sexual contact that, without treatment, can damage vital organs including the heart and brain and prove life-threatening. It can also pass from mother to unborn child.

Parasitic diseases occur when organisms such as worms, skin mites, body lice and protozoa enter the body through contaminated food or water, or through contact with infected individuals. Once inside the body, these parasites can cause illness and sometimes death.

In the early twentieth century, infectious and parasitic diseases represented the leading cause of death in Australia, contributing to 13 per cent of all mortality. Living conditions during this period differed markedly from today. Water and food supplies frequently suffered contamination, streets were often littered with rubbish, and public health infrastructure including sewage disposal systems, safe water supplies and food safety controls remained poorly developed or non-existent.

These unsanitary conditions led to outbreaks of numerous diseases including diarrhoea, cholera, smallpox, polio, tuberculosis, measles, whooping cough and diphtheria. Children bore the greatest burden of these illnesses. In 1911 alone, gastroenteritis, diphtheria, scarlet fever, whooping cough and measles caused the death of one in every 30 live-born children, resulting in extremely high infant mortality rates.

Throughout the twentieth century, death rates from both diarrhoea and tuberculosis declined dramatically. This corresponded with an overall reduction in deaths from infectious diseases since 1900. However, in the latter part of the century, emerging diseases such as HIV/AIDS and hepatitis C caused a slight increase in infectious and parasitic disease mortality.

Cancer (neoplasms)

Cancer death rates followed a different pattern, increasing throughout most of the twentieth century and reaching their peak in the mid-1980s before gradually declining between 2000 and 2018. This rise was largely attributable to increased lung cancer incidence, which resulted from the widespread uptake of cigarette smoking that began in the 1920s.

For males specifically, cancer death rates peaked during the 1980s at nearly 290 deaths per 100,000 population before falling to 247 per 100,000 by 2000. This decline reflected the reduction in male smoking rates that commenced in the mid-1970s, demonstrating the delayed but significant impact of smoking cessation on cancer mortality.

Stomach cancer represented the largest cause of cancer deaths in the 1920s but subsequently decreased for both males and females in following decades.

Cardiovascular disease

Cardiovascular diseases, also known as circulatory diseases, affect the heart and blood vessels, interfering with blood circulation throughout the body. The two most significant forms are ischaemic heart disease (including coronary heart disease and heart attacks) and cerebrovascular disease (primarily strokes).

Since 1900, cardiovascular diseases have ranked amongst the major causes of death in Australia. Death rates from these conditions increased steadily, reaching their peak in the mid-1960s. Although cardiovascular disease mortality has declined substantially since then, these conditions remain one of Australia's leading causes of death.

The decline in cardiovascular disease deaths since the 1960s reflects improvements in prevention, treatment and management of these conditions, including better control of risk factors such as high blood pressure and cholesterol, advances in medical and surgical interventions, and healthier lifestyle choices.

Respiratory diseases

Respiratory diseases affect the lungs and other components of the breathing system. This category includes COVID-19, pneumonia, influenza, asthma and chronic obstructive pulmonary disease (COPD). In 1907, pneumonia and influenza represented the primary causes of respiratory disease deaths, but by 2000, COPD had become the leading cause.

Apart from the dramatic spike caused by the 1919 Spanish influenza pandemic, death rates from respiratory diseases fell dramatically across the twentieth century. By 2000, these rates had declined to less than 10 per cent of 1907 levels. Pneumonia deaths also decreased considerably since 1900. Future data may show a similar spike resulting from COVID-19 mortality.

In the early twentieth century, respiratory infection deaths were particularly common amongst mining industry workers, where minimal occupational health and safety regulations left workers exposed to harmful mining dust inhalation.

Deaths from asthma decreased during the first half of the twentieth century before experiencing three distinct peaks in the 1950s, 1960s and late 1980s. Since the 1980s, asthma mortality has reduced by 70 per cent.

COPD mortality patterns differed between genders. Amongst males, COPD deaths increased in the late 1960s before decreasing significantly between 1970 and 2018. For females, however, death rates from COPD increased slightly between 1964 and 1996. Since 1996, female death rates have declined, though 2018 rates remained higher than those in 1964.

Injury and poisoning

This category encompasses deaths from motor vehicle and other accidents, suicide, assault, poisoning, drowning, burns, falls, and complications from medical and surgical care. Since 1900, death rates from injury and poisoning have more than halved for both males and females, with the most rapid decline occurring from the 1970s onwards.

Motor vehicle crash deaths peaked in 1970 at 49 deaths per 100,000 population for males and 18 per 100,000 for females. By 2000, these rates had fallen to 14 and 6 per 100,000 for males and females respectively. This substantial decline reflected various public health interventions introduced by government, commencing with the mandatory wearing of seatbelts in 1970.

Male death rates from injury and poisoning were significantly affected by war deaths. During World War I and World War II, many Australian men served overseas, but deaths occurring abroad were not included in Australian official mortality statistics.

Work-related accidents contributed substantially to accidental deaths since 1900. Working conditions in early twentieth-century Australia were hazardous, involving exposure to toxic substances and physical injury risks due to limited occupational health and safety regulations. Workers often received additional payment called 'danger money' for agreeing to work in risky or hazardous environments.