Growing inequalities in Australians’ life expectancy highlights city-country divide
While Australians have among the highest life expectancy in the world, premature deaths associated with inequality and living in remote and regional areas are contributing to a stagnation in the nation’s overall life expectancy.
Researchers from the University of Melbourne analysed de-identified death registration data from the decade to the end of 2016. The data recorded age of death and place of residence, allowing analysts to match it to location remoteness and socioeconomic profile.
They found premature deaths between the ages of 35 and 74 occurred in the lowest socioeconomic areas at double the rate of those in the highest. This gap widened by 26% for women and 14% for men. People living in outer regional, remote and very remote areas had premature death rates about 40% higher than those in major cities, and this gap was also increasing, the research published in the peer-reviewed journal, Australian Population Studies, on Monday found.
The overall life expectancy for Australia is 80.5 years for men and 84.6 years for women. The study found the highest excess mortality compared with the national average was reported for the Northern Territory, Hobart, outer regional, remote and very remote areas in New South Wales. Notably, death rates between the ages of 35 and 74 among the lowest area socioeconomic quintile and outside of major cities have not fallen since 2011.
“Even within major cities, there has been a widening in inequalities in death rates between lower and higher area socioeconomic deciles, but notably no slowdown in the rate of mortality decline in the highest deciles,” the study found.
While the research did not examine the cause of death, Australian Institute of Health and Welfare data shows that in the lowest socioeconomic areas, smoking prevalence is 2.7 times higher and obesity 1.6 times higher than in the highest socioeconomic ones. Dr Tim Adair, from the University of Melbourne’s Global Burden of Disease Group, said obesity in particular was an issue. While health-promotion campaigns had led to great success in reducing overall smoking rates over time, campaigns were having little effect on rates of obesity, which are increasing Australia-wide.
“In particular it’s getting worse among younger adults, and as they grow older this will become more concerning as they will get to ages where obesity can interact with other health conditions and it may well have a detrimental impact on life expectancy,” he said.
He said it was unclear why the premature mortality rates in low socioeconomic areas were higher for women than for men, but he said much of that may be to do with life expectancy for women generally being higher than men.
“So there is an element of men catching up to women as this gap between men and women reduces,” he said.
Dr Melissa Stoneham, a research fellow with and former director of the Public Health Advocacy Institute Western Australia, said she was recently in a remote area where a tin of baby formula cost $64. Fresh produce also costs significantly more in rural, regional and remote areas.
“A lot of Aboriginal and Torres Strait Islanders live in remote communities, especially in the Northern Territory and Western Australia,” she said. “We know that their life expectancy is a lot lower than non-Indigenous people. A lot of regional communities are also farming communities, with young people not having same opportunities on farms as they used to and leaving, creating an older age demographic [that are] more prone to diseases and with more difficulty accessing healthcare.”
She said a key way to address disadvantage was getting essential services into affected communities.
“Of course, getting services into those remote communities is a very expensive to do,” she said. “It’s true some people choose to live in these communities but it doesn’t mean they shouldn’t be given the opportunity to access the same services. They are people, living in our country. Why wouldn’t you buy a ready meal of hot chips when fruit and vegetables are so expensive and a significant chunk of your income or social security payment?”
Aunty Kerrie Doyle, a professor of Aboriginal Torres Strait Islander health from the University of Western Sydney’s school of medicine, said with the fortnightly payment of $1,500 available under the jobkeeper scheme during the Covid-19 pandemic, many were able to afford fresh food for the first time. She’s currently part of a study examining how Covid-19-related subsidies are being used by Aboriginal people, and as part of that is collecting data from stores in remote communities.
“People say Aboriginal people will just spend the money on smokes and alcohol, but our data is showing that’s not the case,” Doyle said. “There has been a massive increase in spending on and there has been a dramatic increase, a doubling, in almost all communities on spending on fruit and vegetables. Kids aren’t going hungry. And when people are less stressed, hungry and poor, domestic violence rates come down and we are seeing that in communities like Katherine in the Northern Territory.”
People living in those areas needed not only resources, but hope for the future, to improve their health, she said. “If you’re watching television and seeing people going on cruises and travelling and getting good education and you know those things are out of reach for you, why wouldn’t you reach for a smoke?”