The current state of women’s health in Australia

[Pages:101]The current state of women's health in Australia

Informing the development of the National Women's Health Strategy 2020?2030

July 2018

Prepared by Professor Gita D Mishra, Dr Hsin-Fang Chung and Professor Annette Dobson, The University of Queensland for Jean Hailes for Women's Health

Contents

1 KEY POINTS ....................................................................................................................... 1

2 INTRODUCTION .................................................................................................................. 5

2.1

Background.................................................................................................................... 5

2.2

Data sources .................................................................................................................. 5

3 OVERVIEW OF HEALTH AND WELLBEING OF AUSTRALIAN WOMEN .................................................. 7

3.1

Population characteristics ............................................................................................. 7

3.2

Reproductive life stage .................................................................................................. 8

3.3

General health and key chronic conditions.................................................................... 9

3.4

Burden of chronic conditions across the life course..................................................... 10

3.5

Factors that affect health ............................................................................................ 11

3.6

Multimorbidity ............................................................................................................ 12

3.7

Strategies, policies and actions related to women's health and wellbeing since 2010 12

4 MENTAL HEALTH AND WELLBEING ........................................................................................ 14

4.1

Overview ..................................................................................................................... 14

4.1.1 Trends in mental disorders ....................................................................................... 17

4.1.1.1 Anxiety disorders.................................................................................................. 17

4.1.1.2 Affective or mood disorders, including depression................................................ 17

4.1.1.3 Substance use disorders ....................................................................................... 17

4.1.1.4 Psychological distress ........................................................................................... 18

4.1.1.5 Eating disorders.................................................................................................... 18

4.1.1.6 Perinatal depression ............................................................................................. 18

4.1.2 Mental disorders across the life course..................................................................... 19

4.1.3 Marginalised and disadvantaged populations ........................................................... 20

4.1.4 Access to mental health services .............................................................................. 23

4.1.5 Strategies, policies and actions ................................................................................. 24

4.1.6 Research needs ........................................................................................................ 27

5 CHRONIC DISEASES AND PREVENTIVE HEALTH .......................................................................... 29

5.1

Overview ..................................................................................................................... 29

5.2

Cardiovascular diseases ............................................................................................... 30

5.2.1 Trends in cardiovascular diseases ............................................................................. 31

5.2.2 Cardiovascular diseases across the life course .......................................................... 31

5.2.3 Marginalised and disadvantaged populations ........................................................... 32

5.2.4 Strategies, policies and actions ................................................................................. 32

5.2.5 Research needs ........................................................................................................ 32

5.3

Cancers ........................................................................................................................ 33

5.3.1 Trends in cancer screening, incidence and survival ................................................... 33

5.3.2 Cancers across the life course ................................................................................... 34

5.3.3 Screening ................................................................................................................. 35

5.3.4 Marginalised and disadvantaged populations ........................................................... 36

5.3.5 Strategies, policies and actions ................................................................................. 36

5.3.6 Research needs ........................................................................................................ 36

5.4

Chronic respiratory conditions..................................................................................... 37

5.4.1 Trends in chronic respiratory conditions ................................................................... 37

5.4.2 Chronic respiratory conditions across the life course ................................................ 37

5.4.3 Marginalised and disadvantaged populations ........................................................... 37

5.4.4 Strategies, policies and actions ................................................................................. 38

5.4.5 Research needs ........................................................................................................ 38

5.5

Musculoskeletal conditions ......................................................................................... 38

5.5.1 Trends in musculoskeletal conditions ....................................................................... 38

5.5.2 Musculoskeletal conditions across the life course ..................................................... 39

5.5.3 Marginalised and disadvantaged populations ........................................................... 39

5.5.4 Strategies, policies and actions ................................................................................. 39

5.5.5 Research needs ........................................................................................................ 40

5.6

Lifestyle risk factors ..................................................................................................... 40

5.6.1 Tobacco.................................................................................................................... 41

5.6.1.1 Trends in tobacco smoking ................................................................................... 41

5.6.1.2 Marginalised and disadvantaged populations ....................................................... 42

5.6.1.3 Strategies, policies and actions ............................................................................. 43

5.6.1.4 Research needs .................................................................................................... 43

5.6.2 Body mass, overweight and obesity.......................................................................... 43

5.6.2.1 Trends in body mass, overweight and obesity....................................................... 44

5.6.2.2 Marginalised and disadvantaged populations ....................................................... 44

5.6.2.3 Strategies, policies and actions ............................................................................. 45

5.6.2.4 Research needs .................................................................................................... 45

5.6.3 Physical activity ........................................................................................................ 46

5.6.3.1 Current Australian guidelines for physical activity and sedentary behaviour ......... 46

5.6.3.2 Trends in physical activity ..................................................................................... 47

5.6.3.3 Marginalised and disadvantaged groups ............................................................... 47

5.6.3.4 Strategies, policies and actions ............................................................................. 47

5.6.3.5 Research needs .................................................................................................... 48

5.6.4 Diet .......................................................................................................................... 48

5.6.4.1 Current Australian guidelines for dietary intake .................................................... 48

5.6.4.2 Trends in dietary intake ........................................................................................ 48

5.6.4.3 Marginalised and disadvantaged groups ............................................................... 49

5.6.4.4 Strategies, policies and actions ............................................................................. 50

5.6.4.5 Research needs .................................................................................................... 50

5.6.5 Alcohol ..................................................................................................................... 50

5.6.5.1 Current Australian guidelines for alcohol .............................................................. 51

5.6.5.2 Trends in alcohol consumption ............................................................................. 51

5.6.5.3 Marginalised and disadvantaged groups ............................................................... 52

5.6.5.4 Strategies, policies and actions ............................................................................. 52

5.6.5.5 Research needs .................................................................................................... 52

6 MATERNAL AND INFANT HEALTH .......................................................................................... 53

6.1

Overview ..................................................................................................................... 53

6.1.1 Trends in markers of maternal health ....................................................................... 54

6.1.1.1 Fertility and infertility ........................................................................................... 54

6.1.1.2 Pregnancy complications ...................................................................................... 55

6.1.1.3 Birth ..................................................................................................................... 56

6.1.1.4 Breastfeeding ....................................................................................................... 57

6.1.2 Markers of maternal health across the life course .................................................... 57

6.1.3 Marginalised and disadvantaged populations ........................................................... 57

6.1.4 Strategies, policies and actions ................................................................................. 58

6.1.5 Research needs ........................................................................................................ 58

7 CONDITIONS PREDOMINANTLY AFFECTING WOMEN .................................................................. 59

7.1

Sexual health ............................................................................................................... 59

7.1.1 Trends in contraception and sexually transmissible infections .................................. 59

7.1.1.1 Contraception....................................................................................................... 59

7.1.1.2 Sexually transmissible infections........................................................................... 60

7.1.2 Sexually transmissible infections across the life course ............................................. 63

7.1.3 Marginalised and disadvantaged populations ........................................................... 64

7.1.4 Strategies, policies and actions ................................................................................. 64

7.1.5 Research needs ........................................................................................................ 65

7.2

Reproductive health .................................................................................................... 65

7.2.1 Trends in markers of reproductive health ................................................................. 65

7.2.1.1 Polycystic ovarian syndrome and adenomyosis..................................................... 65

7.2.1.2 Endometriosis and associated pelvic pain ............................................................. 66

7.2.1.3 Menarche and menopause ................................................................................... 66

7.2.1.4 Hysterectomy ....................................................................................................... 67

7.2.1.5 Genital prolapse ................................................................................................... 67

7.2.2 Markers of reproductive health across the life course .............................................. 68

7.2.3 Marginalised and disadvantaged populations ........................................................... 68

7.2.4 Strategies, policies and actions ................................................................................. 68

7.2.5 Research needs ........................................................................................................ 69

7.3

Family and domestic violence...................................................................................... 69

7.3.1 Trends in family and domestic violence .................................................................... 69

7.3.2 Family and domestic violence across the life course ................................................. 70

7.3.3 Marginalised and disadvantaged populations ........................................................... 70

7.3.4 Access to services ..................................................................................................... 70

7.3.5 Strategies, policies and actions ................................................................................. 71

7.3.6 Research needs ........................................................................................................ 71

8 HEALTHY AGEING AND DISABILITY......................................................................................... 73

8.1

Healthy ageing and disability....................................................................................... 73

8.1.1 Trends in life expectancy .......................................................................................... 74

8.1.2 Marginalised and disadvantaged population............................................................. 74

8.1.3 Strategies, policies and actions ................................................................................. 75

8.1.4 Research needs ........................................................................................................ 75

8.2

Multimorbidity ............................................................................................................ 75

8.2.1 Multimorbidity across the life course........................................................................ 75

8.2.2 Marginalised and disadvantaged populations ........................................................... 76

8.2.3 Strategies, policies and actions ................................................................................. 76

8.2.4 Research needs ........................................................................................................ 76

8.3

Dementia ..................................................................................................................... 77

8.3.1 Trends in dementia................................................................................................... 77

8.3.2 Dementia across the life course ................................................................................ 77

8.3.3 Marginalised and disadvantaged populations ........................................................... 77

8.3.4 Strategies, policies and actions ................................................................................. 78

8.3.5 Research needs ........................................................................................................ 78

8.4

Hearing and vision loss ................................................................................................ 78

8.4.1 Trends in hearing and vision loss .............................................................................. 78

8.4.2 Marginalised and disadvantaged populations ........................................................... 78

8.4.3 Strategies, policies and actions ................................................................................. 79

8.4.4 Research needs ........................................................................................................ 79

8.5

Oral health................................................................................................................... 79

8.5.1 Trends in oral health................................................................................................. 79

8.5.2 Marginalised and disadvantaged populations ........................................................... 79

8.5.3 Strategies, policies and actions ................................................................................. 79

8.5.4 Research needs ........................................................................................................ 80

8.6

Frailty, falls and fractures ............................................................................................ 80

8.6.1 Trends in frailty, falls and fractures........................................................................... 80

8.6.2 Marginalised and disadvantaged populations ........................................................... 80

8.6.3 Strategies, policies and actions ................................................................................. 80

8.6.4 Research needs ........................................................................................................ 81

9 REFERENCES .................................................................................................................... 82

List of Figures

Figure 3-1: Comparison of the estimated Australian female resident age structure in 2015 and

2035 5,10

8

Figure 3-2: Leading causes of non-fatal burden (YLD `000, proportion %) for females, by age

group, 2011 12

10

Figure 3-3: Leading causes of fatal burden (YLL `000, proportion %) for females, by age group,

2011 12

11

Figure 5-1: Death rates for cardiovascular disease, coronary heart disease, and

cerebrovascular disease, 1950-2015 52

31

Figure 5-2: Most commonly diagnosed cancers in women at each age group 62

34

Figure 5-3: Leading risk factor contribution to total burden (DALY `000, proportion %), for

females, by age group, 2011 12

40

Figure 5-4: Daily smokers aged 18 or older and key tobacco control measures in Australia,

1989-90 to 2016 81

42

Figure 5-5: Proportion of people who are daily smokers, by selected demographic

characteristics, 2016 80

42

Figure 5-6: Prevalence of selected chronic conditions in adults, by BMI category, 2014-15

43

Figure 5-7: Actual percentages of obesity by age for women born in four different periods, and

predicted levels to 2035

44

Figure 5-8: Average serves of Australian Dietary Guidelines food groups and discretionary

foods by Indigenous status, 2011-2013

49

Figure 5-9: Percentages of people aged 18 and over who reported consuming alcohol to levels exceeding lifetime risk or single occasion risk by age group, 2001, 2013 and 2016 51

Figure 7-1: Notification rates of chlamydia per 100,000 population between 2007 and 2016, by

gender 140

60

Figure 7-2: Notification rates of gonorrhoea per 100,000 population between 2007 and 2016,

by gender 140

61

Figure 7-3: Proportion of women diagnosed with genital warts at first visit at sexual health

clinics between 2004 and 2016, by age group 140

62

Figure 7-4: Newly diagnosed HIV rate per 100,000 population between 2007 and 2016, by

gender 140

63

Figure 8-1: Number of chronic conditions by age group 180

76

List of Tables

Table 3-1: Selected chronic diseases reported by women, 2014?15 11 .............................................. 9 Table 5-1: Australian guideline for physical activity and sedentary behaviour 92 ............................. 46 Table 6-1: Number of assisted reproductive technology treatment cycles by year in Australia

(NPESU reports) 116,118 ............................................................................................. 54

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