Chapter 10
Chronic illness, disability and rehabilitation
205
Consequences of unhealthy lifestyles include an alarming
increase in the incidence chronic disorders (WHO, 2010).
Physiological changes in the body often occur before the
appearance of symptoms of chronic illness. Major risk factors for
chronic illness, which represent a growing challenge to public
health, include unhealthy eating habits, decreased energy
expenditure associated with a sedentary lifestyle, increasing
age, and tobacco use and alcohol consumption (WHO, 2010).
In addition, serious psychiatric or mental illness puts people at
greater risk for chronic illness than the general population and
leads to higher morbidity and mortality rates of chronic illness
(Lin et al., 2011; Robson & Gray, 2007).
In Australia and New Zealand, chronic illnesses constitute
the top 10 contributors representing 80% of the total illness
burden (ADHA, 2012). Despite the media attention on the
benefits of maintaining healthy lifestyles, many Australians and
New Zealanders are overweight, smoke and lead sedentary lives
(New Zealand Ministry of Health [NZMOH], 2008). A 2009
ADHA (2009a) report described that almost all people aged 65
years and over have one chronic condition and more than 80%
of this age group report having three or more long-term condi
tions (ADHA, 2012). The most prominent conditions reported
were cardiovascular disease, cancer, chronic lower respiratory
diseases and diabetes, as illustrated in Figure 10-1.
In Australia, the federal government has identified nine
national health priorities, with eight of the nine related to
chronic illness (AIHW, 2013). These national health prior
ities are:
•
Cardiovascular illness
•
Cancer
•
Diabetes
•
Asthma
•
Arthritis and Musculoskeletal conditions
•
Obesity
•
Dementia
•
Injury prevention and control
•
Mental health.
The eighth area relates to injury prevention (ADHA,
2009b). As this area has significant potential to affect the rate
of disability and chronic conditions, it also has great signifi
cance to the total health burden of the nation.
The prevalence of most conditions increased with age, and
the types of conditions most commonly reported also differed
markedly across age groups. Among children and young
adults, asthma was the most commonly reported condition
for children less than 15 years, while hay fever was the most
prevalent condition for young people aged 15 to 24 years. The
most common conditions prevalent in older people (those
aged 55 years and over) were sight conditions, arthritis, back
and disc problems, hypertension and hearing loss. However,
some people do not consider vision and hearing loss as chronic
conditions and include them as disabilities.
New Zealand also has a high prevalence of chronic condi
tions and illnesses that accounts for more than 80% of deaths
in the total population (NZMOH, 2012a; 2012b). Chronic
(long-term) illnesses are more common in people over 45 years
of age. The most common illnesses reported were asthma
(11%), cardiovascular illness, chronic obstructive pulmo
nary disease (COPD), diabetes (5%), mood disorders (16%),
migraine and eczema. The associated risk factors reported
for most of these illnesses were being overweight and obese
(26%), smoking (19.9%), hazardous drinking (17.7%), high
blood pressure (16%), and high blood cholesterol (10%). As
in Australia, many of these conditions and illnesses result in
high levels of disability.
Chronic conditions often lead to disability and
impairment
;
the physiological or psychological limitations associated with
various chronic conditions deplete overall reserves that ulti
mately causes an individual to lose independence.
Figure 10-2 illustrates the different levels of care people
need with chronic conditions. The demands imposed on the
health system by chronic illness led to the development of the
National Chronic Disease Strategy (NHPAC, 2006), which is
0
0
100,000
200,000
300,000
400,000
20
40
60
Age
Age
Disability-adjusted life years lost
due to burden of disease
2023
2003
80
100
0
0
100,000
200,000
300,000
400,000
20
40
60
80
100
Other Musculoskeletal
Injuries Diabetes Chronic respiratory Mental
Neurological
Cardiovascular Cancer
Figure 10-1
The increasing burden of disease.
(From Begg, S., et al. (2007). The burden of disease and injury in Australia 2003. AIHW cat. no. PHE 82. Available June 2009 from
publications/index.cfm/title/10317. Redrawn from Australian Department of Health and Ageing. (2009a). Primary Health Care Reform in Australia: Report to
Support Australia’s First National Primary Health Care Strategy (Fig. 1, p. 10). Viewed April 2013 at
nsf/content/nphc-draftreportsupp-toc.)
