Australia is falling behind other high-income countries when it comes to gains in life expectancy, and it’s largely attributable to poorer health and higher levels of overweight and obesity in people of my generation and younger – those born after 1970 – according to a study published in April 2019 in the Medical Journal of Australia (MJA).
The study, titled ‘Slower increase in life expectancy in Australia than in other high income countries: the contributions of age and cause of death’, calculated changes in life expectancy in Australia from 1980 to 2016, and compared them with those of 26 other high-income countries over the same time period.
(Life expectancy is the average length of life that an individual born in a particular year or defined time period can expect to have, given the age-specific mortality rates for the population they were born into during this period.)
Australia has a long and proud tradition of developing and implementing innovative public health policies that have resulted in declining mortality and consequently, increased life expectancy.
For example, the world’s first seat belt law was enacted in Victoria in 1970, making the wearing of seat belts compulsory for drivers and front seat passengers. Along with other policies aimed at improving road safety, this led to a substantial reduction in mortality from traffic accidents (especially among young men), and hence a bump in life expectancy that was most noticeable for males.
Our world-leading anti-smoking policies, including heavy taxation of tobacco products, cigarette advertising bans, smoke-free environment legislation and most recently, plain packaging of cigarettes, have achieved consistently lower smoking rates in Australia compared to North America, Europe and the UK over the past few decades. As a direct consequence, Australia was one of the first countries to see significant declines in mortality – principally from lung cancer, major cardiovascular diseases and chronic respiratory diseases – especially in those born between the 1920s and early 1950s.
Public health messages in the 1970s aimed at reducing intake of saturated fats also paid off in a population-wide decrease in cholesterol levels – decades before the introduction of statins – which resulted in a faster decline in cardiovascular disease-related mortality in Australia compared to other high income countries.
The cumulative effect of all these public health policies was that life expectancy in Australia increased more rapidly between the 1970s and the 1990s than during the 1950s and 60s, particularly for males.
Not only that, but life expectancy gains in Australia outstripped average gains in high income countries over the same time period. For example, in 1981, Australian males had a life expectancy 0.7 years longer than the average of the other 26 high income countries. By 2003, they could expect to live 2.3 years longer than these other males.
In 1981, Australia was ranked 12th of 27 high income countries for life expectancy among males; by 1992 we were in 5th place, and in 2003, 4th.
Australian women went from enjoying a life expectancy 0.9 years longer than the average of the 26 other high income countries in 1981, to 1.3 years longer in 2003.
Our ranking among high income countries went from 11th of 27 in 1981, to 7th in 1992, and 5th in 2003.
Most of this improvement in both male and female life expectancy is attributable to comparatively low mortality among Baby Boomers, who reaped the benefits of postwar peace, economic surplus and the public health measures referred to earlier, but came of age before the colonisation of Australia by fast food outlets.
However, life expectancy for Australian males dropped back to 5th place in 2015, and female life expectancy to 7th place.
Put simply, not only has growth in life expectancy in Australia slowed markedly in recent years; we’re also losing ground against other high income countries.
And the primary reason is that Australians who are currently aged under 50 (that is, born in or after 1970) have been dying at higher rates – substantially higher in some cases – than their age peers in more than half of the other 26 high income countries. In fact, among adults currently aged 15–45, mortality rates are higher in Australia than in most other high income countries (although notably, not as high as in the US).
The dramatic decrease in mortality from cardiovascular disease and many types of cancer – largely due to decreased smoking rates and diet-related drops in average cholesterol levels – among Australian Boomers and older Gen Xers made a substantial contribution to the gain in life expectancy up to 2003.
However, the rate of decline in mortality from both cardiovascular disease and cancer has slowed among young and middle-aged Australian adults, and has fallen back compared to western Europe. This is partly due to the fact that life expectancy gains due to smoking cessation are still being realised in Europe, which lagged behind us in tobacco control, whereas they’ve already peaked in Australia.
It’s the increased prevalence of poor dietary habits (particularly higher sugar and calorie intake) and the resulting boom in risk factors for chronic disease such as obesity and high blood pressure in young and middle-aged Australians that really has the authors of this paper worried.
Not only are Australians getting fatter, we’re actually getting fatter faster than most of the rest of the developed world: the prevalence of overweight and obesity in Australia is now higher than in most other high income countries.
As I pointed out in last week’s post, Larger body, shorter life, carrying excess weight increases your risk of premature death. The authors of the MJA study point out that
“Mortality risk from chronic diseases is increased even for moderately overweight people, and for extremely obese people is comparable with that for active smokers.”
As a consequence of our rapidly-expanding waistlines – and I would argue, the fact that excessive weight gain is occurring at younger and younger ages – our current high international ranking for life expectancy is likely to be short-lived.
In fact, another study which used data from the same Global Burden of Disease database as the MJA article predicted that Australia will fall from 5th to 10th ranking in overall life expectancy at birth by 2040, and will be outstripped in gains in life expectancy by all but four of the 26 other high income countries.
What can we do, as citizens and parents, to ensure that current and subsequent generations of Australians continue to enjoy progressive increases in life expectancy?
As the authors of the MJA article stressed, the most significant action we can take is to stem the obesity epidemic. We need to put more effort into cultivating healthier eating habits and healthier relationships with food and, I would argue, less into promoting ‘body image positivity’.
What sort of victory do we gain if we work at becoming ‘comfortable in our own skin’ no matter how overweight we are, if the consequence of this is more chronic disease and a shorter life expectancy?
Fat shaming is never OK, but fat acceptance is no solution either.
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