Every year the Australian Bureau of Statistics puts out stats on birth and death. They issued a lot last week, but the coverage was small. We are more interested in the beginning and end of working life than the beginning and end of life itself. We are more interested in the balance of trade than in the balance of health.
For the first time since statistics began, you are more likely to die of cancer than any other cause. Tragically, women are smoking themselves to death. Conversely, men are slowly stopping themselves from smoking themselves to death.
The big-ticket items in media coverage _ AIDS, murder and suicide _ hardly rate on the death tables.
Last week’s statistics and a book put out earlier this year by the Australian Institute of Health and Welfare, Australia’s Health 1992, show the trends.
The good news is that the death rate fell for every age group last year, continuing the trend from the year before. We are all living longer. This, of course, cannot go on indefinitely. There will come a time with the aging population that death rates will rise.
The other good news is that fewer people are dying in car accidents and from heart attacks. This is fairly well-known. What is less well-known is that the people saved from road death and heart death are now living on only to die of cancer later.
The actual death rate from cancer has stayed the same, with two exceptions: stomach cancer is inexplicably down and female lung cancer is up. However, as a percentage of total deaths, cancer is increasing. As the general death rate falls, cancer forms a greater proportion of deaths. It is now 26.3 per cent of deaths. Heart disease is next at 26.1. The male rate was 27.4 and the female 24.9. It was the first time cancer became the leading cause of death for both males and females.
It is not because treatment is less successful or that cancer itself is any worse but simply because, it would seem, improvements other areas mean that more people stay alive longer to get cancer.
The exception is female lung cancer. The female death rate for all cancers had stayed at around 125 per 100,000 women for decades, until about 1985. In the past seven years it has gone steadily up. By 1989 it was 154. In 1990 it was stayed at 154 and last week’s figures put it at 158 for 1991. This increase can be put down to increase in lung cancer. Lung cancer has not only caused this increase but it has wiped out the gains made in stomach cancer. About 500 more women per year are dying of lung cancer now than five years ago.
Ninety per cent of lung cancer can be put down to smoking. As men are giving up their lung cancer rates are falling. As women take it up their lung-cancer death rate is rising. Women are smoking themselves to death. And lung cancer has the lowest survival rate of the major cancers. Only 11 per cent survive five years, compared to 75 per cent for breast cancer.
The increase in female lung-cancer deaths, on a base of 1986, per year is now almost as great as the total number of people who died from AIDS in 1990.
Very simply, the figures last week show that women are smoking themselves to death in AIDS-like proportions. That is not an exaggeration. And very brutally, because they pose no threat to the rest of community or because they are not in a politically precious pressure group, little is done.
The increase in female lung-cancer deaths in the one year to the latest 1991 figures is simply appalling. In 1990, 1664 women died of lung cancer in Australia. In 1991 it had risen to 1820, an increase of 9.4 per cent. This is in one year. It is a preventable tragedy.
The male lung cancer rate is nearly four times the female rate, but it is falling. It is the most common form of male cancer and causes nearly a quarter of male cancer deaths. And still nearly three times the number of male AIDS deaths.
Sadly, the Australia’s Health 1992 reports: “”Awareness of the harm caused by smoking, including its contribution to the development of lung cancer, is not yet universal. A tenth of Australian lower blue collar workers aged 16 years or older reported they were unaware of any illnesses caused by smoking, compared with 5 per cent of upper white collar workers. Eleven per cent of those with 9 or less years education reported being unaware of any illnesses caused by smoking, compared with only 4 per cent of those with 12 or more years education.”
It is scarcely credible that anyone does not know smoking causes cancer. But there it is. Obviously the education programs have to be constant and directed at the illiterate in the same pictures-tell-the story style of television news bulletins and television advertising.
Even with better campaigns the report warns that the lag times are long with lung cancer.
The ABS figures show AIDS deaths rising over the past four years: 231, 392, 519, 588. The increase is still dramatic, but the rate of increase is slowing. The sample is small, but the figures show that the female AIDS rate more than doubled over the year from 10 in 1990 to 24 in 1991. It is still a male disease. 564 males died in 1991 whereas 24 females died.
As a cause of death, its media noise far out-strips the reality. 588 dies of AIDS whereas 31,285 died of cancer.
Overall heart-attack deaths fell from 31,174 in 1990 to 30,323, despite the rise in population. This is because of better diet, less smoking among men and better treatment. Quitting smoking gives a fairly immediate improvement for heart-attack prospects, but its effect on cancer is more long-term.
The increase in cancer deaths of 821 from 1990 to 1991 is not significantly higher than the population increase, especially if an allowances is made for the extra female lung-cancer deaths.
Lung cancer aside, Australia’s Health 1992 shows an underlying steady death rate for cancer since 1920. It has none of the huge fluctuations seen in heart, respiratory, circulatory and other diseases over that time.
The suicide rate went up markedly from 1990 to 1991, from 2161 to 2360, overtaking road deaths which fell 268 to 2221. Suicides tend to go slightly up in times of recession. The trend for suicide among young males has been continuously up since the 1950s and in general went up during the 1980s. It is now 13 per 100,000 population.
The state-by-state statistics are interesting. (I will leave out the Northern Territory for this purpose because its high Aboriginal population makes the comparison invalid. In general, health in the NT is much worse because of it.)
The ACT has the lowest standardised death rate at 6.1 per 1000. The national rate is 6.6. Western Australia is next at 6.3 and Tasmania highest at 7.4. This has nothing to do with the age of the population because the standardised rate takes account of that. Australia’s Health 1992 has not explanation for the differences and says so.
Obviously the average age at death is lowest in the ACT because of the age structure of the population.
Some causes of death in the ACT, expressed as a percentage of total deaths, are well outside the national averages, largely because of the age structure. We have a lot fewer strokes and heart disease, but more cancer, road deaths and suicides.
Male heart deaths are 22 per cent of ACT deaths, but 26 per cent nationally. Female heart deaths are 22 compared to 24.6. Female cancer at 32.6 in the ACT is markedly higher than the national rate of 24.9. Male cancer marginally higher at 28.4 compared to 27.4 nationally. The female stroke rate at 7.1 is markedly lower than the national rate of 12.8. We have double the road deaths and suicides, but these are young male ways to die and we have more young males than nationally.
Overall, the ABS figures show an improving picture for life in Australia. Life expectancy is 74.4 years for males and 80.3 for females. The average age at death was 72.2 for males (71.0 in 1986) and 78.8 for females (77.6 in 1986). The death rate has fallen from 9.9 per 1000 (12.9 males, 8.0 females) in 1971 to 6.6 per 1000 (8.5 males, 5.1 females) in 1991.
There has been a significant drop in the death rate for 85s and over. For males it dropped from 190.8 per 1000 in 1990 to 181.4 for males and for females from 159.2 to 153.4.
Since the mid-1960s there has been very large reductions in the death rate for both males and females aged 30-55, almost halving or better for each five-year cohort. Medicine is looking after us better and we are looking after ourselves better.
Infant mortality has shown significant and continuous improvements since the mid-1960s. In 1966 20 boys and 16 girls in every 1000 died before their first birthday. Now it is eight boys and six girls.
The improvement in the last year was significant. In 1990 male infant mortality was 9.3. It dropped to 7.9 in 1991. The female rate dropped from 7.4 to 6.2.
Since 1973 the major improvements have come in the first day after birth and to a lesser extent from one to six days. The death rate for those aged seven to 27 days has remained fairly static.
Australia’s Heatlh points out that Japan’s infant mortality at 4.6 is much lower than Australia’s, so improvements can be made.
South Australia had the lowest infant mortality at 5.5 per cent, substantially lower than the national average, once again indicating that improvement is possible.
So this is the cross-section of the Australian way of death. As we cure more heart disease, cancer, the tenacious crab, has the same death rate as in the 1920s. As we prevent more car accidents, the suicide rate steadily climbs. AIDS, on the periphery, increases. As we make birth and the first year of life safer, more young women take up smoking and more are dying from it. The 9.4 per cent increase in female lung-cancer deaths in the one year to 1991 is just shocking.
The starkest, yet under-stated, message in the ABS statistics issued last week is to young women.