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Chapter 10

Chronic illness, disability and rehabilitation

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

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.

2003

2023

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Disability-adjusted life years lost due to burden of disease 0

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Age

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 www.aihw.gov.au/ 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 www.yourhealth.gov.au/internet/yourhealth/publishing. nsf/content/nphc-draftreportsupp-toc.)