The risks of the bush health deficit are not so remote
About a third of our health suffering is self-induced; it’s what we eat, drink, smoke and how we exercise. The Australian Health Survey from the Bureau of Statistics reveals a new gap which few have noted; the bush health gap.
Outer regional and remote Australians are 50% more likely to smoke, 28% more likely to drink dangerously and 20% more likely to binge. Thankfully, today’s ABS data shows that nationwide, smoking and drinking rates falling but the news isn’t so good on obesity.
Since the last health survey in 2007, Australia’s overweight and obesity rate climbed from 61% to over 63%. That represents each and every year, an additional 110,000 overweight Australians for our health system to manage. What is more disturbing how much worse the situation is in the bush. Urban obesity rates are 25% compared to 35% in remote areas. Add the overweight to bush obesity numbers and total ticks over 70%.
This bush health gap has a range of causes. A high proportion of remote Australians are Indigenous, so their diabolical health status contributes to a lower average. On top of that, both incomes and access to health and fitness services are lower in the bush.
The ABS spells this out with a state by state breakdown, no more extreme than the health difference between the urban high-income ACT and the Northern Territory. Smoking rates are 14.7% compared to 24.4% in the top end. Over 41% of ACT residents are physically active, compared to just 34.3% in the Territory.
If our personal choices are responsible for a third of our life-years lost, then it is a fair bet that a similar proportion of our $130 billion annual health budget is spent fighting the results.
The uncomfortable truth is that the cost of smoking, heavy drinking, obesity and inactivity all add up. But the overall health and welfare costs per obese Australian has never been estimated, until now.
Australia’s new Preventive Health Agency (ANPHA) has strived to measure the cost of a single obese Aussie. Hypothetically named ‘William,’ his parents gave him sugary drinks and sweet snack rewards as a child and didn’t emphasise physical activity. He was overweight by the age eight and obese by fifteen.
William falls into a pretty nasty category, with his risk of diabetes quadrupled and heart failure doubled. Worse, 5% of all cancers are linked to his obesity. Sure enough, by his mid-thirties, his doctor has him on blood pressure and cholesterol medications. By the end of that decade, he has acquired diabetes which can’t be managed without medication.
Williams opts for gastric banding surgery in his thirties, but has little choice about the joint replacement or two he needs to remain mobile in his fifties. After a decade of regular emergency presentations and occasional admissions, he dies in his late sixties.
Because we only ever see our health through a rear view mirror, the health demise of a hypothetical citizen makes for chilling reading. That’s because a combination of discounting and moral hazard means we all subconsciously delay investments in our own health, because in the end, the bills are mostly picked up by others.
William’s rocky road adds up to over $75,000 in lifetime health expenses almost entirely paid for by others. If William was the only obese person in his suburb, then it might be ok. But in the bush he is fast becoming the norm, with just three in ten remote Australian adults not being overweight or obese.
Sure not every overweight adult will be a health burden. Some will live a long and happy life while others may succumb young, quickly and without troubling the health system. But the statistical reality of obesity can’t be ignored. It costs us a fortune and a simple focus on more health workers in the bush treats the symptoms as much as it does the cause.
In addition to every health dollar spent on obesity, another eight dollars are paid out in welfare. If we model William leaving the workforce with his first joint replacement, there will be disability payments and an associated carers’ payment for a family member. Include Colagiuri’s range of other direct non-health costs and costs exceed half a million dollars.
On top of this, Diabetes Australia has begun to quantify the costs of declining productivity and obesity-related absenteeism to employers.
Thanks to Australia’s universal health and welfare, we rarely feel the direct costs of health care provision. In remote Australia, where obesity and overweight continues to scale new heights, the limited access and high cost of health services will make this battle the hardest of all to win.
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