New findings on health loss and where gains might be made

New findings on health loss and where gains might be made

Thursday 8 August 2013

The Ministry of Health has just released a new “Burden of Disease” study for New Zealand – a culmination of many years of study into disability, disease and premature death.

“We congratulate the Ministry of Health staff for this very impressive body of work at both the national level and the international level,” says Professor Tony Blakely, Director of the Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme (BODE3) at the University of Otago, Wellington.

The findings reinforce the need for the Government to improve the country’s progress towards the smokefree nation goal and improve the nutritional environment.

Key findings include:

• Cancers and cardiovascular disease (heart attacks and stroke) each contribute 17.5% of the health loss, followed by mental disorders (11%), musculoskeletal disorders (9%) and injury (8%).

• Males have a 13% higher rate of health loss than females – but it differs for fatal conditions (much higher for males) and morbidity (higher for females).

• Māori had about a 75% higher rate of health loss than non-Māori.

The main metric used in the study is disability-adjusted life years (DALYs), a composite measure of mortality and morbidity that measures how far our population falls short of ‘ideal’ health. Comparisons can then be made between types of people, diseases and over time.

Professor Blakely says the study is not strictly comparable to a previous Ministry study for 1996.

“But we know from many other statistics – including the recent Global Burden of Disease study – that health status is steadily improving in countries like New Zealand.

“Furthermore the cardiovascular disease burden is falling in its relative contribution, while cancers and neurodegenerative diseases like dementia are rising in their relative contribution. That is, although life expectancy keeps rising, the mix of diseases and conditions that are causing health loss in New Zealand is changing over time.”

A particularly useful part of the current Ministry study are the calculations of how much of the health loss burden (in DALYs) is due to different risk factors, Professor Blakely says.

“This gives us information about how much health gain we as a society might achieve through ‘ideal and complete’ action on modifiable risk factors.”

Figure 1: Attributable burden (percentage of DALYs) for selected risk factors, 2006 (Source: Ministry of Health (2013), Health Loss in New Zealand)

Not surprisingly, tobacco smoking stands out. Nearly a tenth (9.1%) of all health loss in 2006 – mainly early deaths – could be avoided if nobody had ever smoked.

“Achieving the Government’s smokefree nation 2025 goal therefore remains an overwhelming policy priority for improving the overall health of New Zealanders, and reducing inequalities in health, especially between Maori and non-Maori; and low-income versus high-income Kiwis,” Professor Blakely says.

Moreover, dietary risk factors combined, including high salt intake, high saturated fat intake, low vegetable and fruit intake, and excess energy intake, accounted for 11.4% of the health loss in 2006 – more than tobacco, he says.

University of Otago, Wellington’s Associate Professor Nick Wilson says improving the nutritional environment for New Zealanders should therefore be a high priority for the Government.

“Fortunately, this can be done in ways that might also save health costs such as by taxing sugar in soft drinks and regulations that limit maximum salt levels in high-salt processed foods,” Professor Wilson says.

Such smart food taxes and regulations around salt are increasingly being used in European and other countries eg, France, Finland, Hungary and Denmark.

The report presents results for 2006. However, the Ministry also projects what will happen out to 2016. An interesting finding from these projections is that obesity and overweight (BMI) will cause more health loss into the future, and tobacco less health loss (i.e. due to falling tobacco consumption). They have probably just crossed over and now – that is in 2013 – obesity and overweight is causing as much if not more health loss than tobacco.

Figure 2: Trends and projections in health loss attributable to tobacco and high BMI, (Source: Ministry of Health (2013), Health Loss in New Zealand)

ENDS

For an additional perspective on the New Zealand Burden of Disease Study, see this University of Otago blog site: blogs.otago.ac.nz/pubhealthexpert/.

For more information on the Burden of Disease Equity and Cost Effectiveness (BODE3) Programme, please go to: www.uow.otago.ac.nz/BODE3-info.html.

For a list of Otago experts available for media comment, please go to: www.otago.ac.nz/mediaexpertise

The Report is published at www.moh.govt.nz.

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