Health of the Nation

Asthma

ASTHMAWhat is it?• A long-term medical condition in which airways are too sensitive and over-reactive • Characterised by “attacks”, which have symptoms such as wheezing, breathlessness, chest tightness, coughing• Symptoms are caused by 3 main problems inside airways:

– muscle constriction

– inflammation

– excessive mucus

•Attacks are normally reversible, and are controlled by good self-management, including appropriate medication use

Extent of AsthmaPrevalence

• Australia has one of highest prevalence rates in the world

• 30-40% of Australians will have symptoms consistent with asthma at some time

• 2.013 million Australians reported having asthma (2004/5)

• This is over 10% of the total population

• Highest prevalence is in the 15 – 24 yr age group (12.4%)

Commonly reported long term conditions 2004-5

Prevalence : Gender mix

• Australia: Males 9%, females 11.5%

• NSW adults: 8.8% males, 12% females

• In males, prevalence is much higher in childhood (16.5%)

Trends

• Prevalence increased in the 1980’s to mid-90’s

• Recently the trend has plateaued, and may have reversed in children (i.e. reducing)

• Hospitalisation rates reduced by 46% between 89-90 and 04-05

• Over this time, the self-reported prevalence increased, so a reduction in hospitalisations may mean better asthma management outside hospitals, but this is not clear nor proven

Self-reported prevalence

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1995 2001 2004/5

Asthmaprevalence (%)

Extent of AsthmaCost to individuals: Quality of life• Up to 60 % of people with asthma have night-time symptoms at some point

• Majority of people are triggered by vigorous exercise

• One of the most common reasons for hospitalisation and ED visits in children

Extent of AsthmaCost to individuals: mortality• Death rates have fallen steadily since early 90’s

• Current average around 300/year, mostly over 55’s

• 0.3% of deaths in NSW

• Many are avoidable

• Major risk factors: – delay in seeking help– failure to recognise the severity of asthma

Asthma death rates 1960-2005

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1960 1965 200519891978

Cost to society

• One of top ten reasons to see a GP

• Major cause of work and school absenteeism, reduced productivity

• Good disease management is proven to significantly lower costs and usage of the health care system, even in severe asthma

• 45% of costs might be saved if optimal control was achieved for all people with severe asthma

Cost to societyFinancial (based on 2000/1)

• ~$700 million/year (1.4% of total recurrent health spend)

• This covers pharmaceutical prescriptions, devices, medical consults and hospital services

• More than half of this is for medications, and the highest spend is in children

• This increased by 21% from 93/4, but overall health expenditure increased by 26%, so this is below average

Groups affectedInequities

• Little difference across the country

• Variations in prevalence in some specific geographic areas, but no real difference between urban and rural

• Difference truly lies in the impact of the disease, e.g. in areas such as

– access to services– trigger factors

Aboriginal and Torres Strait Islander

• 16% prevalence overall in Aboriginal population

• Prevalence significantly higher in Aboriginal females than non-Aboriginal females

• Hospitalisation rates higher in Indigenous communities

• Access to services/remoteness can also be an issue

• Smoking rates are around 50% - common trigger, and also accelerates the loss of lung function

CALD/NESB

• Prevalence significantly lower in those from a non-English-speaking background

Economically disadvantaged

• Significantly higher prevalence in lower income households

• Higher hospitalisation rates

• High rates of smoking

Older people

• High death rates

• Difficulties in awareness and accurate diagnosis

• High levels of hospitalisation in winter months

Government InputExpenditure• Health Priority: 1999 - $8 million over 3 years

• 2001: Further funding to support best practice management

• 2005: $27.1 million over 4 years

– also $27.6 million in Medicare GP incentives

Government inputActivities• Australian Centre for Asthma Monitoring established 2002

• National Asthma Strategy written for 2006-8 – a framework for continued efforts to improve asthma care http://www.nationalasthma.org.au/html/strategy/strat0608/assets/nas_sum2006_08.pdf

• National Service Improvement Framework – identifies where Australia might best spend money to reduce the impact of asthma http://www.health.gov.au/internet/wcms/publishing.nsf/Content/pq-ncds-asthma

FinancialsLocal level funding• Government grants allocated to specific projects and programs

– E.g. Asthma Friendly Schools Program– E.g. Community Support Program

• Other funding to Asthma Foundation NSW– donations, bequests– grants from trusts and foundations for specific programs

What’s being done?

Prevention

Management

Cure??

What’s being done?Prevention/Management/Cure??• Prevention

– rallying govt around issues such as smoking

• Cure– significant amounts of money put into research towards a cure

• Management– most of input goes into this area

Health Promotion ProgramsNational Asthma Week 2007• Donated funding received from Volvo

• National Campaign developed, movie/teaser style

• Community Service Announcement on TV

• Focus on viral emails

• Aimed at young males – hard group to reach

• www.2xhale.com.au

• ASTHMA IS SERIOUS

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Health Promotion ProgramsAsthma Friendly® Schools• National Program, Federally funded

• Aim to create asthma friendly environments

• Aimed to be streamlined nationally, though there are variations in implementation in each state

• Across the country, current target is that 80% of schools are working towards, and 50% of schools are Asthma Friendly

• www.asthmafriendlyschools.org.au

Asthma Friendly Schools

• 3 Main areas– staff education– safety equipment available– policies in place to support education and equipment use

• Outcomes: – staff can safely deal with an asthma emergency at any time– kids at school with asthma are supported and understood– should avert deterioration in asthma attack, and attacks should be managed quickly and effectively, thus with better health outcomes

DetailsWebsites to visit•Australian Government: www.health.gov.au

– For consumers; Health Priorities; Asthma

• Asthma – Expert View. Christine Jenkins.– www.healthinsite.gov.au (asthma)

• Asthma Foundation NSW: www.asthmansw.org.au

• Asthma Foundations Australia www.asthmaaustralia.org.au

• National Asthma Council: www.nationalasthma.org.au• Australian Institute of Health and Welfare : www.aihw.gov.au/publications/aus/ah06/ah06-c03.pdf

DetailsOther references used• The Health Dollar in Australia. Gordon Gregory, National Rural Health Alliance. 9th National Rural Health Conference, 7-10 March 2007.

• Health of the people of NSW, Chief Health Officer Report 2006. NSW Health 2006

• Australian Bureau of Statistics: National Health Survey 2004-05