Chronic conditions are the leading cause of illness, disability and death in Australia ¹

Chronic conditions defined

The use of the term ‘chronic conditions’ refers to a broad range of chronic and complex health conditions across the spectrum of illness, including mental illness, trauma, disability and genetic disorders.

Chronic conditions have complex and multiple causes; are generally long-term and persistent, and often lead to a gradual deterioration of health and loss of independence. While not usually immediately life threatening, chronic conditions are the most common and leading cause of premature mortality.

Many chronic conditions occur across the life cycle, although they become more prevalent with older age and can compromise quality of life and create limitations and disability.

How common are chronic conditions?

Chronic conditions range from minor conditions (e.g. short sightedness and minor hearing loss) to debilitating and restrictive complaints (e.g. musculoskeletal conditions) to potentially life-threatening illnesses (e.g. cancer and coronary heart disease).

• According to self-reporting in the 2014-15 National Health Survey, 1 in every 2 Australians (50%) have at least one prominent (i.e. arthritis, asthma, back pain, cancer, cardiovascular disease, chronic obstructive pulmonary disease, diabetes or mental health conditions) chronic condition¹.
  
• 2014-15 National Health Survey data also indicated that nearly a quarter of all Australians (23%), and 3 in every 5 Australians (60%) aged over 65 years, had two or more chronic conditions¹.
  
• Chronic conditions were responsible for around three-quarters of the total non-fatal burden of disease in Australia in 2011².
  
• About a third of the burden experienced by the population could be prevented by reducing the exposure to modifiable risk factors (including both behavioural and biomedical risk factors). The risk factors causing the most burden were tobacco use, high body mass, alcohol use, physical inactivity and high blood pressure².
  
• Aboriginal and Torres Strait Islander people experience poorer health and have worse health outcomes than other Australians, with a burden of disease 2-3 times greater than the general Australian population. In addition, they are more likely to:
  • die at a younger age (death rates are around 5 times that for non-Indigenous people in the 35-44yrs age group);
  • experience disability; and
  • report their health as fair ³.
    
• Increasing prevalence of chronic conditions has also been attributed to early detection and improved treatments for diseases that previously caused premature death, as well as behavioural factors, such as smoking or poor diet, that increase the risk of developing chronic conditions.
  
• Population ageing and improved treatments have also contributed to people living longer with chronic conditions.

Mortality

Chronic conditions accounted for around 9 in every 10 deaths in Australia in 2015⁴. Often more than 1 disease is associated with a death and 3 diseases is the average. About 20% of deaths have 5 or more associated diseases³.

Cardiovascular diseases (coronary heart disease and stroke), dementia and Alzheimer’s disease, lung cancer and chronic respiratory disease including chronic obstructive pulmonary disease (COPD) are the most common underlying causes, together being responsible for 2 in every 5 (37%) deaths in Australia⁴.

Cardiovascular diseases and cancer are the two leading causes of death for Aboriginal and Torres Strait Islander people, resulting in 25% and 20% of all deaths respectively, among this population group. Endocrine, metabolic and nutritional disorders (including diabetes) and respiratory conditions are also prominent causes of death among Aboriginal and Torres Strait Islander people, accounting for 8.9% and 7.9% of all deaths respectively¹.

For further detail about mortality rates for individual chronic conditions, please visit the relevant Department of Health web page specific to each condition.

What are the risk factors for chronic conditions?

A diverse range of factors influence the health and wellbeing of the Australian population. These factors are attributes, characteristics or exposures that increase the likelihood of a person developing a disease or health disorder⁵. They can be categorised as follows:

• Behavioural risk factors – these are the most common risk factors for many chronic conditions. As such, they are often a major focus for prevention strategies and interventions.
  – Examples include smoking, poor diet and nutrition, harmful consumption of alcohol, physical inactivity and/or cognitive inactivity.
  
• Biomedical risk factors – these relate to the condition, state or function of the body that contributes to the development of chronic conditions. The effects of a single biomedical risk factor can be intensified when additional biomedical risk factors or behavioural risk factors are present. 
  – Examples include high blood pressure, high blood cholesterol, overweight or obesity, impaired glucose tolerance, stress, mental illness, trauma, or illness (communicable disease).
  
• Non-modifiable risk factors – these comprise individual physical and psychological components. 
  – Examples include age, sex, genetics or intergenerational influences.
  
• Physical environment determinates – these comprise both the natural and built environment, can impact health in a subtle or obvious manner and can occur over the short or long-term.
  – Examples include UV exposure, air pollution, urban environment, or geographical location.
  
• Social and economic determinants – these can be difficult for individuals to control, however they influence the way in which people live their lives⁶. 
  – Examples include beliefs, customs and culture, education and employment status.

It is widely acknowledged that many chronic conditions not only share common risk factors and determinates, but can also be risk factors for each other. While the presence of a single risk factor can lead to illness, there is an increasing risk of developing chronic conditions when more than one risk factor is present.

National Strategic Framework for Chronic Conditions

The National Strategic Framework for Chronic Conditions (the Framework) provides overarching direction for the prevention and management of chronic conditions in Australia.

The Framework provides high level guidance to enable all levels of government and health professionals to develop and implement new and innovative polices, strategies, actions and services to reduce the impact of chronic conditions in Australia.

Further information on the Framework can be found on the National Strategic Framework for Chronic Conditions webpage.

Chronic Conditions Programs and Initiatives

Chronic conditions are addressed at a national level through a wide range of programs and initiatives to support prevention, treatment and management. Significant funding is also provided to ensure that quality clinical research is conducted into chronic conditions, and to maintain national monitoring and surveillance measures.

Programs that support the prevention, management and care of chronic conditions include:

• Evidence-based promotion of healthy lifestyles, including regular physical activity and good nutrition, a range of tobacco control measures and strategies to reduce harmful levels of alcohol consumption, and early detection of cancer and other chronic conditions.
  
• The Medicare Benefits Schedule, which provides subsidies for patient care and includes Medicare items for the planning and management of chronic and terminal conditions. Eligible patients can also be referred by a GP for up to five Medicare subsidised allied health services that are directly related to the treatment of their chronic condition. In order to encourage early detection, diagnosis and intervention for treatable conditions, health assessment items are also available for people aged 45-49 years who are at risk of developing chronic disease, people aged 75 years and older and Aboriginal and Torres Strait Islander people.
  
• The Pharmaceutical Benefits Scheme, which continues to provide subsidies for a range of medicines used in the treatment of, or symptoms associated with, chronic conditions.
  
• Significant investments in research into chronic conditions through the National Health and Medical Research Council (NHMRC), with a focus on investigating the causes, effects, impacts and complications of chronic conditions. Improving the care of patients with multiple and complex chronic conditions has also been identified by the NHMRC as a major focus in its 2013-15 Strategic Plan.
  
• Funding is provided to peak bodies that focus on chronic conditions to support a number of related programs and initiatives.
  

Further details about programs and initiatives relating to individual chronic conditions are available on the relevant Department of Health web page specific to each condition.

---

¹ Australian Institute of Health and Welfare 2016. Australia’s health 2016. Australia’s health no. 15. Cat. no. AUS 199. Canberra: AIHW.

² Australian Institute of Health and Welfare 2016. Australian Burden of Disease Study: impact and causes of illness and death in Australia 2011. Australian Burden of Disease Study series no. 3. Cat. no. BOD 4. Canberra: AIHW.

³ Australian Institute of Health and Welfare 2014. Australia’s health 2014. Australia’s health series no. 14. Cat. no. AUS 178. Canberra: AIHW.

⁴ Australian Bureau of Statistics 2016. 3303.0 – Causes of Death, Australia, 2015. Canberra: ABS. Accessed 17 March 2017.

⁵ World Health Organization. Health Topics: Risk factors [Internet]. Geneva, Switzerland: WHO; 2016 [cited 5 January 2016]. Available from: http://www.who.int/topics/risk_factors/en/

⁶ Australian Institute of Health and Welfare 2012. Risk factors contributing to chronic disease. Cat. No. PHE 157. Canberra: AIHW.