Cut down on salt, drink less and move more: Australia's blueprint to control chronic disease

Chronic diseases are responsible for nine out of ten deaths in Australia, and for much of the health expenditure about which governments are so concerned.

The risk factors underlying these chronic diseases in Australia need to be urgently addressed. Factors such as physical inactivity, obesity, poor nutrition, smoking and alcohol misuse contribute to a range of chronic diseases, including heart disease, diabetes, cancer and respiratory illnesses.

Our new report, released this week, proposes a set of chronic disease targets especially designed for Australia. These draw from the World Health Organisation’s Global Action Plan targets for 2025 and include an additional area: mental health.

The focus is on population-based approaches to prevention, but we also target those at high risk of chronic disease. The 2025 targets Australian experts propose are:

• Life – a 25% reduction in preventable early deaths from chronic diseases
• Alcohol – at least a 10% reduction in harmful drinking
• Exercise – a 10% reduction in inactivity
• Salt – a 30% reduction in salt intake
• Tobacco – a 30% reduction in adult tobacco use and a 60% reduction for people with mental illness
• Obesity – no rise in the level of obesity
• Diabetes - no rise in the level of new diabetes
• Hypertension (high blood pressure) - a 25% reduction across the population
• Mental health – a 10% reduction in suicide rates (by 2020); to halve the employment and education gap for people with mental illness.

How are we doing?

Australia addresses some risk factors better than others. We perform well on tobacco control, for instance, and were the first to introduce plain packaging with graphic health warnings, in 2012. Ireland and the United Kingdom have since introduced plain packaging, and France, Norway, South Africa and Canada are committed to such legislation.

The drop in smoking rates to 12.8% reflects coordinated action using taxation, regulation of sales and advertising, and community education. But we still have work to do.

Australia’s performance in other areas is of major concern. In 2011/12, 63% of adults, or 10.8 million people, were overweight or obese. This makes us one of the heaviest nations in the world. Obesity carries significant health risks for heart disease and stroke, diabetes, high blood pressure, some cancers as well as a range of other chronic diseases.

Salt intake is another area of concern; Australia is falling behind countries such as Britain in this area. In 2013, Australian men consumed 7.1 grams of salt each day and women 5.3 grams. Most salt in the Australia diet comes from processed foods and convenience foods, such as bread, cereals, soups and sauces, pizza and sandwiches.

Reducing Australia’s salt intake by 30% would result in 3,500 fewer deaths a year from strokes and heart attacks and save millions of dollars in the health-care system.

Four out of five Australian children (aged five to 17) don’t get enough physical exercise and more than half of Australian adults are physically inactive. Lack of physical activity contributes to early and preventable deaths and has about the same impact on people’s health as smoking and obesity.

Alcohol is implicated as a cause in more than 200 medical conditions such as cancer and stroke. Alcohol-related presentations to emergency departments are rising, and there is increased risk of injury through accidents and assaults associated with drinking.

Fixing our health and our economy

Chronic diseases are expensive, and monitoring both diseases and risk factors is essential to avert future costs and harms. Health spending on diabetes has been predicted to rise by 400% over coming decades, reaching A$7 billion in 2033. This is largely due to excess weight and obesity.

So how can we reverse this trend?

We need good information about the health of our population so that progress on risk factors such as obesity and high blood pressure can be tracked. Carrying out the Australian Health Survey every five years is essential, so that we have direct measures of blood glucose, blood pressure and cholesterol levels from a population sample. However, there is currently no national commitment to regular health surveys.

To address inequities, both monitoring and interventions need to be planned with the needs of disadvantaged groups in mind. Aboriginal and Torres Strait Islander people, rural Australians and people from low socioeconomic backgrounds bear a greater brunt of chronic disease and risk factor exposure.

For the millions of Australians living with chronic diseases, better coordination of care is key to improving health outcomes. This can be as simple as different health care professionals sharing patient information and coordinating appointments.

Or it may mean preventing chronic diseases from progressing. Vision and foot checks for people with diabetes, for instance, can help prevent complications such as amputations and loss of sight.

Information systems, including e-health records and patient registers, can also help. An IT system that prompts a check on whether a person with chronic lung problems has had the flu vaccine, for instance, could prevent significant illness or hospitalisation.

Finding our way

Australia has an opportunity to act on prevention and to invest in highly cost-effective policies and programs. We have a new national strategy for diabetes, and existing strategies in areas such as alcohol and obesity. What is missing is a focus on implementation.

A broad-based collaborative effort between Commonwealth, state and territory and local governments will be essential if Australia is to put in place effective prevention of chronic diseases by 2025.

Over time, Australian governments have not given adequate or sustained attention to keeping their population well. This must change if Australia is to have a thriving population and economy.

Rosemary Calder does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond the academic appointment above.