tag:theconversation.com,2011:/id/topics/australian-institute-of-health-and-welfare-19645/articlesAustralian Institute of Health and Welfare – The Conversation2018-10-26T01:11:01Ztag:theconversation.com,2011:article/1056462018-10-26T01:11:01Z2018-10-26T01:11:01ZThree charts on: how and what Australians eat (hint: it’s not good)<figure><img src="https://images.theconversation.com/files/242394/original/file-20181025-71011-34oau3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Far too much of Australians' diet comes from foods that have virtually no nutrients.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>More than one-third of Australians’ energy intake comes from junk foods. Known as discretionary foods, these include biscuits, chips, ice-cream and alcohol. For those aged 51-70, alcoholic drinks account for more than one-fifth of discretionary food intake.</p>
<p>These are some of the findings from the <a href="https://www.aihw.gov.au/reports/food-nutrition/nutrition-across-the-life-stages/contents/table-of-contents">Nutrition across the life stages</a> report released by the Australian Institute of Health and Welfare today.</p>
<p>The report also shows physical activity levels are low in most age groups. Only 15% of 9-to-13-year-old girls achieve the 60-minute target. The prevalence of overweight and obesity remains high, reaching 81% for males aged 51–70. </p>
<p>The food intake patterns outlined in this report, together with low physical activity levels, highlight why as a country we are struggling to turn the tide on obesity rates.</p>
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<em>
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Read more:
<a href="https://theconversation.com/fat-nation-the-rise-and-fall-of-obesity-on-the-political-agenda-72875">Fat nation: the rise and fall of obesity on the political agenda</a>
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<h2>Not much change in our diets</h2>
<p>The report shows little has changed in Australians’ overall food intake patterns between 1995 and 2011-12. There have been slight decreases in discretionary food intake, with some trends for increased intakes of grain foods and meat and alternatives. </p>
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<p>The message to eat more vegetables is not hitting the mark. There has been no change in vegetable intake in children and adolescents and a decrease in vegetable intake in adults since past surveys. The new data show all Australians fall well short of the <a href="https://www.eatforhealth.gov.au/guidelines">recommended five serves daily</a>. We are are closer to meeting the recommended one to two serves of fruit each day.</p>
<p>Australians are consuming around four serves of grains, including breads and cereals, compared to the recommended three to seven serves. </p>
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<p>One serve of vegetables is equivalent to ½ cup of cooked vegetables. For fruit, this is a medium apple; grains is around ½ cup of pasta. A glass of milk and 65-120g of cooked meat are the equivalent serves for dairy and its alternatives, and meat and its alternatives respectively.</p>
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Read more:
<a href="https://theconversation.com/food-as-medicine-why-do-we-need-to-eat-so-many-vegetables-and-what-does-a-serve-actually-look-like-76149">Food as medicine: why do we need to eat so many vegetables and what does a serve actually look like?</a>
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<p>The data show a trend of lower serves of the five food groups in outer metro, regional and remote areas of Australia. Access to quality, fresh foods such as vegetables at affordable prices is a <a href="https://www.ncbi.nlm.nih.gov/pubmed/25902766">key barrier in many remote communities</a> and can be a challenge in outer suburban and country areas of Australia. </p>
<p>There was also a 7-10 percentage point difference in meeting physical activity targets between major cities and regional or remote areas of Australia. Overweight and obesity levels were 53% in major cities, 57% in inner regional areas and 61% in outer regional/remote areas.</p>
<p>The <a href="https://www.csiro.au/en/Research/Health/CSIRO-diets/CSIRO-Healthy-Diet-Score">CSIRO Healthy Diet Score</a> compares food intake to Australian Dietary Guidelines. You can use these to see how your diet stacks up and how to improve.</p>
<h2>Discretionary food servings</h2>
<p>Discretionary foods are defined in <a href="https://www.eatforhealth.gov.au/sites/default/files/content/The%20Guidelines/n55b_educator_guide_140321_1.pdf">guidelines</a> as foods and drinks that are</p>
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<p>not needed to meet nutrient requirements and do not fit into the Five Food Groups … but when consumed sometimes or in small amounts, these foods and drinks contribute to the overall enjoyment of eating.</p>
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<p>A serve of discretionary food is 600kJ, equivalent to six hot chips, two plain biscuits, or a small glass of wine. The guidelines advise no more than three serves of these daily – 0.5 serves for under 8-year-olds.</p>
<p>Since 1995, the contribution of added sugars and saturated fat to Australians’ energy intake has generally decreased. This may be a reflection of the small decrease in discretionary food intake seen for most age groups. </p>
<p>But across all life stages, discretionary food intakes remain well in excess of the 0-3 serves recommended. Children at 2-3 years are eating more than three servers per day, peaking at seven daily serves in 14-to-18-year-olds. The patterns remains high throughout adulthood, still more four serves per day in the 70+ group.</p>
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Read more:
<a href="https://theconversation.com/junk-food-packaging-hijacks-the-same-brain-processes-as-drug-and-alcohol-addiction-74749">Junk food packaging hijacks the same brain processes as drug and alcohol addiction</a>
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<p>The excess intake of discretionary foods is the most concerning trend in this report. This is due to the doubleheader of their poor nutrient profile and being eaten in place of important, nutrient-rich groups such as vegetables, whole grains and dairy foods.</p>
<p>Our <a href="https://www.mdpi.com/2072-6643/9/5/442">simulation modelling</a> compared strategies to reduce discretionary food intake in the Australian population. We found cutting discretionary choice intake by half or replacing half of discretionary choices with the five food groups would have significant benefits for reducing intake of energy and so-called “risk” nutrients (sodium and added sugar), while maintaining or improving overall diet quality.</p>
<h2>Main contributors to discretionary foods</h2>
<p>Alcohol is often the forgotten discretionary choice. The <a href="https://nhmrc.gov.au/health-advice/alcohol">NHMRC 2009 guidelines</a> state:</p>
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<p>For healthy men and women, drinking no more than two standard drinks on any day (and no more than four standard drinks on a single occasion) reduces the lifetime risk of harm from alcohol-related disease or injury.</p>
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<p>For adults aged 51–70, alcoholic drinks account for more than one-fifth (22%) of discretionary food intake. Alcohol intake in adults aged 51-70+ has increased since 1995. This age group includes people at the peak of their careers, retirees and older people. Stress, increased leisure time, mental health challenges and factors such as loneliness and isolation would all play a part in this complex picture.</p>
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Read more:
<a href="https://theconversation.com/four-ways-alcohol-is-bad-for-your-health-92578">Four ways alcohol is bad for your health</a>
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<p>Young children have small appetites and every bite matters. The guidelines suggest 2-to-3-year-olds should have very limited exposure to discretionary foods. In, studies the <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1803527">greatest levels of excess weight</a> are seen in preschool years.</p>
<p>Biscuits, cakes and muffins are the <a href="https://www.mdpi.com/2227-9067/4/12/104">key source of added sugars</a> for young children. These are also the <a href="http://pediatrics.aappublications.org/content/101/Supplement_2/539.long">top source of energy and saturated fat</a> and a key source of salt in young children. This is the time when lasting food habits and preferences are formed.</p>
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<p class="fine-print"><em><span>Rebecca Golley receives funding from the National Health and Medical Research Council and Hort Innovation. </span></em></p>A report from the Australian Institute of Health and Welfare shows we’re eating less junk food than before, but still far too much.Rebecca Golley, Associate Professor (Research) Nutrition and Dietetics, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1038932018-09-27T20:16:51Z2018-09-27T20:16:51ZHealth care is getting cheaper (unless you need a specialist, or a dentist)<figure><img src="https://images.theconversation.com/files/238298/original/file-20180927-48665-23gg2s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Surgeons and dentists cost more, but drugs are getting cheaper.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/">Shutterstock</a></span></figcaption></figure><p>Public and private health expenditure amounted to 10.3% of gross domestic product in 2016-17, almost exactly the same percentage as in 2015-16, according to figures released today by the Australian Institute of Health and Welfare. </p>
<p>That’s because although we spent 5.9% more on health care than the year before, the dollar value of GDP also climbed by 5.9%.</p>
<p>Perhaps you’re not reassured. You might be worried that although overall health expenditure was no more of a burden than previously, more of it was being funded by us rather than the government, in out-of-pocket spending on doctors, pharmaceuticals, and other aids, appliances and services.</p>
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Read more:
<a href="https://theconversation.com/increased-private-health-insurance-premiums-dont-mean-increased-value-72797">Increased private health insurance premiums don't mean increased value</a>
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<p>There’s not much evidence of that either. Out-of-pocket expenditure climbed just 1.4% to A$29.8 billion in 2016-17 – a very small increase as compared to the
increase in total health expenditure of 5.9% to A$181 billion in 2016-17. And that’s because the population grew. </p>
<h2>Per person, out-of-pocket costs are falling</h2>
<p>Spending per person slipped 0.2%. </p>
<p>When adjusted for inflation, so-called real per person out-of-pocket expenditure fell from $A1,231 to A$1,221 – a drop of 0.8%.</p>
<p>Over the five years from 2011-12, real out-of-pocket payments per person climbed only 5%, a big improvement from the five years to 2011-12 when they climbed
29%. </p>
<p>Does this new good news contradict all those claims that out-of-pocket costs are one of the <a href="https://theconversation.com/australias-health-system-%20is-enviable-but-theres-room-for-improvement-81332">most important issues in the health sector</a>, and “that among wealthy countries we have the <a href="https://theconversation.com/many-%20australians-pay-too-much-for-health-care-heres-what-the-government-needs-to-do-61859">third-highest reliance on out-of-pocket payments</a>”?</p>
<h2>But out-of-pocket costs remain high</h2>
<p>Not at all. Australia has one of the highest ratios of out-of-pocket recurrent health spending among wealthy countries, although it has fallen slightly from 17.9% to 17.7% since 2011-12.</p>
<p>The data help us focus on where we most need to reduce out-of-pocket
expenses.</p>
<h2>Especially for specialists</h2>
<p>For specialists, they are high and growing; an average of A$155 per person, up
43% since 2011-12.</p>
<p>In contrast, out-of-pocket payments for general practitioners were only A$31 per
person, up just 4% since 2011-12.</p>
<p>But averages don’t tell us much. The Institute of Health and Welfare says the typical out-of-pocket cost of out-of-hospital medical services varies from A$80 per person to A$255 per person, according to where you live.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/many-australians-pay-too-much-for-health-care-heres-what-the-government-needs-to-do-61859">Many Australians pay too much for health care – here's what the government needs to do</a>
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<p>Many of these high out-of-pocket payments are in high-income regions where most people can afford to pay, but not everyone in those regions can pay.</p>
<p>A worrying 7.3% of Australian adults who needed to see a specialist in 2016-17
said they delayed or didn’t go because of the cost. </p>
<h2>And especially for dentists</h2>
<p>For dental services, out-of-pocket costs reached A$240 per person, per year. Even those with private health insurance still paid 46% of dental fees charged.</p>
<p>Many people without insurance avoided the dentist altogether. Some 27% of the bottom fifth of the population, who are most disadvantaged, delayed or did not see a dentist when they should have in 2016-17 due to the cost.</p>
<h2>While medicine gets cheaper</h2>
<p>On the plus side, per-person out-of-pocket payments for pharmaceuticals have fallen 15% since 2011-12.</p>
<p>That’s due partly to the reduction in the price that occurs when patents expire.</p>
<p>The table below shows the amount spent out-of-pocket per person per year in 2016-17 for the different types of health services. </p>
<p>Also shown is the percent change in real (inflation adjusted) expenditure per person since 2011-12:</p>
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<li><p>Medications not subsidised by government: A$394 (10%)</p></li>
<li><p>Prescription medicines subsidised by government: A$58 (-15%)</p></li>
<li><p>Dental services: A$240 (11%)</p></li>
<li><p>Aids and appliances: A$118 (1%)</p></li>
<li><p>Allied health professional services: A$95 (-17%)</p></li>
<li><p>Unreferred (GP and other) medical services: A$31 (4%)</p></li>
<li><p>Referred specialist and other medical services: A$155 (43%)</p></li>
<li><p>Hospital services: A$133 (9%)</p></li>
<li><p>Other health services: A$29 (21%)</p></li>
<li><p><strong>Total health expenditure: A$1,221: (5%)</strong></p></li>
</ul>
<p><em>Calculated by author from AIHW Health expenditure Australia 2016-17</em></p>
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<p class="fine-print"><em><span>John Goss is a member of the Australian Labor Party. </span></em></p>New figures show we are spending less on health than we used to but it mightn’t last, and surgeons and dentists are charging more.John Goss, Adjunct Associate Professor, Health Research Institute, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/795722017-06-25T20:11:43Z2017-06-25T20:11:43ZThree charts on: cancer rates in Australia, where liver cancer is on the rise while other types fall<figure><img src="https://images.theconversation.com/files/175094/original/file-20170622-30227-39gmf0.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3994%2C2658&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The incidence of liver cancer is increasing and has the potential to become a national health crisis.</span> <span class="attribution"><span class="source">from shutterstock.com </span></span></figcaption></figure><p>Liver cancer is a looming health threat in Australia, recent findings from the Australian Institute of Health and Welfare’s (AIHW) <a href="http://www.aihw.gov.au/publication-detail/?id=60129559785">Burden of Cancer report</a> suggest. </p>
<p>While rates of other cancers are falling or remaining static, liver cancer is the only “top ten” cancer for which rates increased between 2003 and 2011.</p>
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<p>The “burden” of cancer is a measure also called “Disability Adjusted Life Years” (or DALYs), capturing quality and quantity of life. It combines the impact of the number of deaths (and how young people die) and number of people ill from a disease, accounting for how sick or disabled they are and for how long. This allows comparisons across different diseases. </p>
<p>Using “rates” allows comparisons across time, taking account of differences in population numbers and age profiles.</p>
<h2>Liver cancer crisis?</h2>
<p>While still not a common cancer, making up less than 1.5% of the 125,000 cancer cases diagnosed in 2013, liver cancer rates have <a href="http://www.aihw.gov.au/acim-books/">increased fivefold</a> since 1982. Action is required due to the <a href="http://ww2.health.wa.gov.au/%7E/media/Files/Corporate/general%20documents/WA%20Cancer%20Registry/The-Cancer-Effect-All-Cancers-Survival-2010-2014.ashx">poor five-year-survival rate</a> of less than 20%.</p>
<p>But why are diagnosis rates going up?</p>
<p>Unpublished work in progress, which builds on a <a href="http://onlinelibrary.wiley.com/doi/10.1111/azph.2015.39.issue-5/issuetoc">series of studies</a> by the Cancer Control Group at QIMR Berghofer Medical Research Institute in Brisbane, suggests liver cancer is caused by five main factors.</p>
<p>Tobacco smoking caused 365 liver cancer cases, or about 21% in 2013 in Australia. Hepatitis C virus contributed to 330 cases (19%) of liver cancer. Hepatitis B virus accounted for 281 cases (16%), alcohol 266 cases (15%) and obesity 451 (25%).</p>
<h2>What’s to blame?</h2>
<p><a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129556763">Falling smoking rates</a> suggest liver cancer figures should have been have been higher in the past. Due to the lag time between when people smoked and cancer diagnosis, tobacco is still a leading driver of liver cancer. Current smoking trends leave us optimistic these rates may drop in the future. </p>
<p>Similarly, alcohol consumption is on a <a href="http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4364.0.55.001%7E2014-15%7EMain%20Features%7EAlcohol%20consumption%7E25">modest decline</a> and is unlikely to explain the increase in liver cancer. </p>
<p>Obesity is a different story. Well-documented <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129556760">increases in overweight and obesity</a> will likely be a driver of liver cancer through the pathways of diabetes and non-alcoholic fatty liver disease, a condition where fat accumulates in liver cells. </p>
<p>But the major engine driving increased liver cancer is likely to be the rising prevalence of people infected with hepatitis B and hepatitis C viruses. Chronic hepatitis causes infection and inflammation of the liver, which can lead to scarring called cirrhosis. In some, this leads to cancer.</p>
<p>Around <a href="http://wiki.cancer.org.au/policy/Liver_cancer/Causes">450,000 Australians</a> live with either hepatitis B or hepatitis C. The two viruses are passed on in quite different ways. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/24090323">More than 90%</a> of people with hepatitis B virus were born overseas in countries where the virus is common, such as the Asia Pacific or sub-Saharan Africa. </p>
<p>Meanwhile, <a href="https://kirby.unsw.edu.au/sites/default/files/kirby/report/SERP_HepBandC-Annual-Surveillance-Report-Supp-2016.pdf">injecting drug users</a> dominate the 227,000 people with chronic hepatitis C virus in Australia, making up 57% of those affected. </p>
<h2>Liver cancer in Indigenous Australians</h2>
<p>Aboriginal people are another major group among which hepatitis B virus is endemic and hepatitis C is disproportionately common. High rates of viral infection in these communities (as in any community) are often untreated and tend to persist. This is especially the case when high rates of incarceration, needle sharing and other infection transmission behaviours occur. </p>
<p>While other causes of the disease are also at play, hepatitis rates are likely to be the main culprit to explain disturbing liver cancer rates in Australia’s First Nations people. It has become the third-most-common cancer in that group. </p>
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<h2>Other cancer deaths expected to rise</h2>
<p>Liver cancer is predicted to grow to become the fifth-most-common cause of cancer death in 2020 in Australian men and the sixth-biggest killer in women. This will eclipse melanoma as a cause of death.</p>
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<p>Higher death rates from pancreatic and brain cancers may be linked to a lack of successful treatment for these cancers. Increased pancreatic cancer mortality is also linked to smoking. Increased lung cancer mortality in women is linked to the higher uptake of smoking by women in the 1970s and ’80s. The elevated bowel cancer death rates expected in women do not take into consideration the effect of the government’s <a href="http://www.health.gov.au/internet/screening/publishing.nsf/Content/bowel-screening-1">National Bowel Cancer Screening Program</a>, which should soon start to show benefits in reduced mortality from that cancer.</p>
<h2>Averting the ‘crisis’</h2>
<p>Improved efforts to identify and treat people with hepatitis B and C viruses are required to combat liver cancer. </p>
<p>Infant vaccination for hepatitis B virus is making great strides, with <a href="https://kirby.unsw.edu.au/sites/default/files/kirby/report/SERP_HepBandC-Annual-Surveillance-Report-Supp-2016.pdf">participation rates exceeding 90%</a> in general and Indigenous populations. While this is good news, the challenge of reaching inbound migrant communities remains.</p>
<p>Needle exchange programs in prisons and outside are vital strategies to reduce needle sharing – the vehicle for much of the transmission of hepatitis C virus.</p>
<p>Efforts to reduce smoking, obesity and alcohol consumption are under way, but persistence is vital, especially in Indigenous communities. Tools are available to avert the “liver cancer crisis”, but we need to use them.</p><img src="https://counter.theconversation.com/content/79572/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Terry Slevin is employed by Cancer Council Western Australia and is affiliated with Cancer Council Australia and Curtin University. He is a Fellow of the Public Health Association of Australia (PHAA) and a Board member of the WA Health Promotion Foundation. He has been involved in funded cancer research programs on various topics over more than two decades. </span></em></p>While other cancer rates fall or remain static, liver cancer is on the rise. Here’s why we need to start paying attention.Terry Slevin, Adjunct Professor, School of Psychology and Speech Pathology, Curtin University; Education and Research Director, Cancer Council WA; Chair, Occupational and Environmental Cancer Committee, Cancer Council AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/789932017-06-11T20:31:12Z2017-06-11T20:31:12ZFactCheck Q&A: are rates of drug use 2.5 times higher among unemployed people than employed people?<figure><img src="https://images.theconversation.com/files/172661/original/file-20170607-5704-1s46ltx.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Social Services Minister Christian Porter, speaking on Q&A.</span> <span class="attribution"><span class="source">Q&A</span></span></figcaption></figure><p><strong>The Conversation fact-checks claims made on Q&A, broadcast Mondays on the ABC at 9.35pm. Thank you to everyone who sent us quotes for checking via <a href="http://www.twitter.com/conversationEDU">Twitter</a> using hashtags #FactCheck and #QandA, on <a href="http://www.facebook.com/conversationEDU">Facebook</a> or by <a href="mailto:checkit@theconversation.edu.au">email</a>.</strong></p>
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<figcaption><span class="caption">Excerpt from Q&A, June 5, 2017. Quote begins at 4:04.</span></figcaption>
</figure>
<blockquote>
<p>… We absolutely know that rates of drug use amongst unemployed are 2.5 times higher than amongst employed people. <strong>– Social Services Minister Christian Porter, <a href="http://www.abc.net.au/tv/qanda/txt/s4659222.htm">speaking on Q&A</a>, June 5, 2017.</strong></p>
</blockquote>
<p>The 2017-18 federal budget introduced a <a href="https://www.dss.gov.au/sites/default/files/documents/05_2017/budget_2017_-_welfare_reform_-_fact_sheet_for_web_0.pdf">random drug testing trial</a> for recipients of the Newstart Allowance for job-seekers and Youth Allowance in three locations. During a discussion of the measure on Q&A, Social Services Minister Christian Porter said “rates of drug use amongst unemployed are 2.5 times higher than amongst employed people”.</p>
<p>Is that right?</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"871707254692732928"}"></div></p>
<h2>Checking the source</h2>
<p>Asked for sources to support his statement, a spokesperson for Christian Porter confirmed the minister was referring to illicit drugs, and directed The Conversation to page 84 of the Australian Institute of Health and Welfare’s <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129549848">2013 National Drug Strategy Household Survey</a>.</p>
<p>The relevant finding reads:</p>
<blockquote>
<p>Use of illicit drugs in the past 12 months was more prevalent among the unemployed, with people who were unemployed being 1.6 times more likely to use cannabis, 2.4 times more likely to use meth/amphetamine and 1.8 times more likely to use ecstasy than employed people.</p>
</blockquote>
<h2>Collecting data on employment status and drug use</h2>
<p>The <a href="http://www.aihw.gov.au/2016-national-drug-strategy-household-survey/">National Drug Strategy Household Survey</a> quoted by the minister’s spokesperson is a reliable and comprehensive dataset. </p>
<p>The federal government has conducted the survey every three years since 1998. It is currently conducted by the Australian Institute of Health and Welfare, a federal government agency. The survey collects data on drug use and drug-related issues in the Australian population.</p>
<p>The first findings of the <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/ndshs-2016/key-findings/">2016 survey</a> were <a href="https://theconversation.com/three-charts-on-australias-changing-drug-and-alcohol-habits-78597">released on June 1</a> this year, but those results didn’t include detailed employment data. The latest employment-level data <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129549642">is from 2013</a>, when the Australian Institute of Health and Welfare collected information from almost 24,000 people across Australia.</p>
<p>The <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129549848">2013 survey</a> asked questions about people’s use of illicit drugs, alcohol, and tobacco.</p>
<p>The Australian Institute of Health and Welfare defines “illicit drugs” as “illegal drugs, drugs and volatile substances used illicitly, and pharmaceuticals used for non-medical purposes”. So that’s the definition used in this FactCheck. You can read the full list of drugs included <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/ndshs-2013/glossary/">here</a>.</p>
<h2>Recent drug use among employed and unemployed people</h2>
<p>The data below is based on the number of employed and unemployed people aged 14 and over who said they had used the drugs listed at least once in the 12 months prior to the 2013 survey.</p>
<p>Compared to employed people, unemployed people were 1.5 times more likely to have used an illicit drug. They were:</p>
<ul>
<li><p>1.4 times more likely to have used cocaine;</p></li>
<li><p>1.6 times more likely to have used pharmaceuticals for non-medical purposes;</p></li>
<li><p>1.6 times more likely to have used cannabis;</p></li>
<li><p>1.8 times more likely to have used ecstasy; and</p></li>
<li><p>2.4 times more likely to have used methamphetamine (for example, ice and speed).</p></li>
</ul>
<p>So, according to the Australian Institute of Health and Welfare data, Porter’s statement that drug use among unemployed people is 2.5 times higher than among employed people is a selective use of the data. It’s true for methamphetamine use, but not for other types of drugs, or illicit use of drugs overall.</p>
<p>The most commonly used illicit drug among unemployed people was cannabis, which had been used by 18.5% of that population in the previous 12 months. Methamphetamine had been used by 5.6% of the unemployed population in that period.</p>
<p>In the 12 months prior to the 2013 survey, 24.5% of unemployed people had used illicit drugs, compared to 16.8% of employed people. </p>
<iframe src="https://datawrapper.dwcdn.net/LOcXg/5/" scrolling="no" frameborder="0" allowtransparency="true" allowfullscreen="allowfullscreen" webkitallowfullscreen="webkitallowfullscreen" mozallowfullscreen="mozallowfullscreen" oallowfullscreen="oallowfullscreen" msallowfullscreen="msallowfullscreen" width="100%" height="480"></iframe>
<h2>Other trends in illicit drug use</h2>
<p>According to the data, a larger proportion of unemployed people had <em>never</em> used illicit drugs (55.5%) compared to employed people (48.8%).</p>
<iframe src="https://datawrapper.dwcdn.net/G0cDg/5/" scrolling="no" frameborder="0" allowtransparency="true" allowfullscreen="allowfullscreen" webkitallowfullscreen="webkitallowfullscreen" mozallowfullscreen="mozallowfullscreen" oallowfullscreen="oallowfullscreen" msallowfullscreen="msallowfullscreen" width="100%" height="480"></iframe>
<iframe src="https://datawrapper.dwcdn.net/D20CL/4/" scrolling="no" frameborder="0" allowtransparency="true" allowfullscreen="allowfullscreen" webkitallowfullscreen="webkitallowfullscreen" mozallowfullscreen="mozallowfullscreen" oallowfullscreen="oallowfullscreen" msallowfullscreen="msallowfullscreen" width="100%" height="480"></iframe>
<p>While people who were unemployed were less likely to have ever used illicit drugs, those who did were 1.4 to 2.4 times more likely to have used them in the previous 12 months.</p>
<p>Overall, unemployed people were 1.5 times more likely than employed people to have taken an illicit drug in the the previous 12 months.</p>
<h2>Verdict</h2>
<p>Christian Porter’s statement that “rates of drug use amongst unemployed are 2.5 times higher than amongst employed people” was incorrect. </p>
<p>Australian Institute of Health and Welfare data showed unemployed people were 1.5 times more likely than employed people to have used an illicit drug in the previous 12 months.</p>
<p>The figure Porter quoted relates to methamphetamine, which unemployed people were 2.4 times more likely than employed people to have used in the past 12 months. <strong>– Nicole Lee</strong></p>
<h2>Review</h2>
<p>I agree with this FactCheck. The Australian Institute of Health and Welfare has the most appropriate and up-to-date statistics on drug use by Australians with the most recent data on this particular issue being for 2013.</p>
<p>I have checked the Australian Institute of Health and Welfare data. The data show the unemployed had been recent drug users at a higher rate than employed people in the year leading up to the 2013 survey. But overall this was at a rate a bit less than 1.5 times that of the employed, not 2.5 times as Christian Porter said on Q&A. <strong>– Peter Whiteford</strong></p>
<hr>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/162128/original/image-20170323-13486-72k52f.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/162128/original/image-20170323-13486-72k52f.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/162128/original/image-20170323-13486-72k52f.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/162128/original/image-20170323-13486-72k52f.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/162128/original/image-20170323-13486-72k52f.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/162128/original/image-20170323-13486-72k52f.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/162128/original/image-20170323-13486-72k52f.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/162128/original/image-20170323-13486-72k52f.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The Conversation FactCheck is accredited by the International Fact-Checking Network.</span>
</figcaption>
</figure>
<p><em>The Conversation’s FactCheck unit is the first fact-checking team in Australia and one of the first worldwide to be accredited by the International Fact-Checking Network, an alliance of fact-checkers hosted at the Poynter Institute in the US. <a href="https://theconversation.com/the-conversations-factcheck-granted-accreditation-by-international-fact-checking-network-at-poynter-74363">Read more here</a>.</em></p>
<p><em>Have you seen a “fact” worth checking? The Conversation’s FactCheck asks academic experts to test claims and see how true they are. We then ask a second academic to review an anonymous copy of the article. You can request a check at <a href="mailto:checkit@theconversation.edu.au">checkit@theconversation.edu.au</a>. Please include the statement you would like us to check, the date it was made, and a link if possible.</em></p><img src="https://counter.theconversation.com/content/78993/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee works as a paid consultant in the public, private and not for profit health sector to support treatment and policy implementation. She has previously been awarded grants by the state and federal government, NHMRC and other public funding bodies for alcohol and other drug research.</span></em></p><p class="fine-print"><em><span>Peter Whiteford has received funding from the Australian Research Council and the Department of Social Services. He is affiliated with the Centre for Policy Development. </span></em></p>Social Services Minister Christian Porter told Q&A that ‘rates of drug use amongst unemployed are 2.5 times higher than amongst employed people’. Is that correct?Nicole Lee, Professor at the National Drug Research Institute, Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/653362016-10-04T23:44:21Z2016-10-04T23:44:21ZFactCheck: Is suicide one of the leading causes of maternal death in Australia?<figure><img src="https://images.theconversation.com/files/140227/original/image-20161004-20213-o9fhmq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Suicide is uncommon during pregnancy -- it occurs more frequently when a pregnancy is over.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/mikel450/7544423608/in/photolist-cuF9i7-rQVijN-6eunts-kAQebc-hfoPc3-8uW4Ee-3wd6ZE-3GSarN-6KUZPG-8dbGLR-npGxaH-79TMC2-9w296Q-aM9d4R-q6L74n-aKH57z-9k2sRG-qQFizY-9G1H4N-ahjewq-3aqnNy-4ZETCg-akNWYh-M9sRY-34wTCm-deFesQ-6ShhSr-oMnyps-M9Ae6-M9sQE-3aqnpj-owUwSb-M9tVb-47gCiJ-3ESukT-6XmKNK-3akRov-6qnV3k-3akQLr-aM9fF8-emcipD-M9u1C-j4wBu-hpsHQ1-M9sSU-6uZESC-2V17Zw-3aqnrd-doDzxQ-h5rET3">Mikel Garcia Idiakez/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span></figcaption></figure><blockquote>
<p>The Committee notes that … suicide has become one of the leading causes of maternal death in Australia. – The Obstetrics Clinical Committee, <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/24913E0474E75768CA2580180016A033/$File/MBS-Obstetrics.pdf">report</a> to the <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/MBSReviewTaskforce">Medicare Benefits Schedule Review</a>, August 2016.</p>
</blockquote>
<p>The federal government’s <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/MBSReviewTaskforce">Medicare Benefits Schedule review</a> is well underway. Teams of clinicians are looking at more than 5,700 items on the Medicare Benefits Schedule (MBS) to see if health services are up to date and in line with the latest clinical evidence.</p>
<p>In its <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/24913E0474E75768CA2580180016A033/$File/MBS-Obstetrics.pdf">report</a> for the review, the Obstetrics Clinical Committee called for changes aimed at ensuring more women were screened for perinatal (meaning the period just before and after birth) anxiety and depression by suitably qualified health professionals.</p>
<p>The committee said suicide has become one of the leading causes of maternal death in Australia.</p>
<p>Is that right?</p>
<h2>Checking the source</h2>
<p>Obstetrics is the branch of medicine and surgery that specialises in the care of women before, during and after childbirth. The <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/MBSR-committees-obstetrics">Obstetrics Clinical Committee</a> is a group of 11 experts commissioned by the federal government to review the obstetrics items on the MBS and report on their findings.</p>
<p>When asked for data to support the assertion, the committee’s chair Professor Michael Permezel referred The Conversation to the Australian Institute of Health and Welfare report <a href="http://www.aihw.gov.au/publication-detail/?id=60129551119">Maternal deaths in Australia 2008-2012</a>.</p>
<h2>Is suicide a leading cause of maternal death?</h2>
<p>Yes. The <a href="http://www.aihw.gov.au/">Australian Institute of Health and Welfare (AIHW)</a> produces the best data on this question. </p>
<p>Its latest <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129551117">report</a> on the issue, which was the one the committee cited, was released in 2015 and covers the years 2008 to 2012. It shows that suicide is one of the leading causes of maternal death in Australia. If late maternal deaths are included, it is the leading cause.</p>
<p>When we’re talking about this issue, it’s important to distinguish between “maternal death” and “late maternal death”:</p>
<ul>
<li>Maternal death is when a woman dies in pregnancy or within 42 days after the end of any pregnancy</li>
<li>Late maternal death is when a woman dies within 12 months of the end of any pregnancy.</li>
</ul>
<p>In Queensland, suicide is <a href="https://www.health.qld.gov.au/improvement/networks/docs/qmpqc-report-2015-full.pdf">the leading cause of death</a> for women during pregnancy and within 12 months of the end of a pregnancy. Suicide was <a href="http://www.hqsc.govt.nz/assets/PMMRC/Publications/tenth-annual-report-FINAL-NS-Jun-2016.pdf">the leading cause of maternal death</a> in New Zealand between 2006 and 2013, and remains a leading cause today.</p>
<p>Suicide is uncommon during pregnancy – it occurs more frequently when a pregnancy is over. Recent investigations have revealed a high proportion of late maternal deaths are linked to preexisting mental health disorders and what clinicians call “psychosocial distress”. Psychosocial distress is a broad term that covers depression, stress and dissatisfaction with life.</p>
<p>There are standard definitions used worldwide to describe the type, or category, of maternal death: </p>
<ul>
<li>Direct deaths – those directly attributable to the pregnancy, for example, post-partum bleeding</li>
<li>Indirect deaths – when preexisting conditions, such as heart disease, are exacerbated by pregnancy</li>
<li>Incidental deaths – are not usually related to pregnancy, for example, accidents.</li>
</ul>
<p>Suicide, homicide and deaths related to mental health, such as accidental overdose, are described as being due to “psychosocial causes”. </p>
<p>The <a href="http://www.who.int/en/">World Health Organization</a> <a href="http://www.who.int/bulletin/volumes/87/10/09-071001/en/">recently recommended</a> that deaths from psychosocial causes be categorised as “direct deaths” – directly attributable to the pregnancy. This recommendation has not yet been widely adopted. </p>
<p>In Australia, death by suicide is usually categorised as an “indirect” death if there is evidence the mother had a preexisting mental health condition.</p>
<p>Some international reports continue to class deaths by suicide and other psychosocial causes as “incidental” – not related to pregnancy. This means they don’t count towards the maternal mortality ratio, which is the international measure of the number of women dying during pregnancy or within 42 days of a pregnancy ending. </p>
<h2>How many deaths are we talking about?</h2>
<p>The latest AIHW <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129551117">report</a> on the issue notes:</p>
<blockquote>
<p>Maternal death in Australia is a rare event in the context of worldwide maternal deaths. In 2008–2012, there were 105 maternal deaths in Australia that occurred within 42 days of the end of pregnancy, representing a maternal mortality ratio (MMR) of 7.1 deaths per 100,000 women who gave birth.</p>
</blockquote>
<p>The AIHW data show there were 16 deaths in the psychosocial causes category, of which 12 were due to suicide. Death by psychosocial causes ranked equal first with heart disease. Death by suicide ranked equal second with sepsis, obstetric haemorrhage and non-obstetric haemorrhage.</p>
<p>Australian state and territory data also show suicide to be a prominent feature in maternal death. The <a href="https://www.health.qld.gov.au/improvement/networks/docs/qmpqc-report-2015-full.pdf">latest report</a> by the <a href="https://www.health.qld.gov.au/improvement/networks/qmpqc.asp">Queensland Maternal and Perinatal Quality Council</a> reported on 40 maternal deaths – including late maternal deaths – over 2013 and 2014.</p>
<p>Out of these 40 deaths, 12 (28%) were due to psychosocial causes – making it the largest category. Overall, suicide was the leading cause of maternal death in Queensland in 2013-14.</p>
<p>The <a href="http://www.hqsc.govt.nz/assets/PMMRC/Publications/tenth-annual-report-FINAL-NS-Jun-2016.pdf">most recent report</a> from New Zealand shows a similar picture. Between 2006 and 2013, 24% of maternal deaths were due to suicide. That’s 22 women out of 90 who died by suicide during pregnancy or within 42 days of their pregnancy ending.</p>
<h2>What don’t we know?</h2>
<p>What is unknown is the nature of the relationship between pregnancy and suicide. Not all pregnancies are diagnosed or recorded, especially if a woman is early on in her pregnancy when she dies by suicide. </p>
<p>Despite efforts to capture all deaths in pregnancy and in the postpartum period, experts still don’t know yet the full story. To gain a full understanding of the impact of pregnancy on suicide risk, we would need to compare the suicide rates for women who were or had recently been pregnant, and those who had not.</p>
<h2>Verdict</h2>
<p>The <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/MBSR-committees-obstetrics">Obstetrics Clinical Committee</a> was correct to say suicide is one of the leading causes of maternal death in Australia. If late maternal deaths are included in the analysis, it is the leading cause. <strong>– David Ellwood.</strong></p>
<hr>
<h2>Review</h2>
<p>I have reviewed this article and the author presents a fair and accurate view of the data.</p>
<p>Suicide has also been found to be a leading cause of maternal death in the <a href="http://onlinelibrary.wiley.com/store/10.1111/j.1471-0528.2010.02847.x/asset/j.1471-0528.2010.02847.x.pdf;jsessionid=3E32E4EC9E3834118E826600CD8E6AA5.f04t02?v=1&t=itnslmv2&s=3d1cb4776103d69bd1b539684185f1b6ed606c49">United Kingdom</a> and the <a href="https://www.ncbi.nlm.nih.gov/pubmed/22015873">United States</a>.</p>
<p>A paper my colleagues and I <a href="https://www.hindawi.com/journals/bmri/2013/623743/">published in 2013</a> showed that of the women who died by suicide and trauma in Australia between 2000 and 2006, 67% had a mental health condition, and/or a condition related to substance abuse.</p>
<p><a href="https://www.hindawi.com/journals/bmri/2013/623743/">We reported</a> a notable peak in deaths from suicide and trauma from nine to 12 months after the end of pregnancy when compared to deaths in the first three months after the end of a pregnancy. The World Health Organization wants to see more emphasis placed on this issue and clearer identification of deaths by suicide up to one year after the pregnancy ends.</p>
<p>We may be underestimating the numbers of late maternal deaths by suicide. If Australia follows the WHO recommendation to classify more deaths by suicide as directly attributable to pregnancy, we would likely see the numbers rise. <strong>– Hannah Dahlen</strong></p>
<hr>
<p><em>If this article has raised issues for you or if you’re concerned about someone you know, call <a href="https://www.lifeline.org.au/">Lifeline</a> on 13 11 14.</em></p>
<hr>
<p><div class="callout"> Have you ever seen a “fact” worth checking? The Conversation’s FactCheck asks academic experts to test claims and see how true they are. We then ask a second academic to review an anonymous copy of the article. You can request a check at checkit@theconversation.edu.au. Please include the statement you would like us to check, the date it was made, and a link if possible.</div></p><img src="https://counter.theconversation.com/content/65336/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David Ellwood is Chair of the Queensland Maternal and Perinatal Quality Council, and a member of the National Maternal and Mortality Advisory Group. He is Deputy Head of School (Research) at Griffith University School of Medicine and Director of Maternal-Fetal Medicine at Gold Coast University Hospital. </span></em></p><p class="fine-print"><em><span>Hannah Dahlen has received funding from the NHMRC and the ARC. She is the national spokesperson for the Australian College of Midwives.</span></em></p>The clinical committee reviewing obstetrics services for the federal government’s Medicare review said suicide is one of the leading causes of maternal death in Australia. Is that true?David Ellwood, Professor of Obstetrics & Gynaecology, Griffith UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/463472015-08-20T02:17:56Z2015-08-20T02:17:56ZAustralia’s changing profile: fewer divorces, higher incomes, more rental stress<figure><img src="https://images.theconversation.com/files/92405/original/image-20150819-10836-t146je.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Australians are living and working longer, marrying later and earning more that past generations.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/hamedmasoumi/3747165802/in/photolist-6H8cQW-7PJQNQ-7gRgPz-4uoqDy-8Reb3T-FvR7p-oKnXqX-hMojwm-aVgMt-hMoiQm-asMv8U-dTPAkr-rZLG2-7XA9nB-6PGVE3-aVhf3-voutTi-pripqq-aZt9ox-9h8GP4-cT2JXb-7XA9iX-aVhu6-e5ZoYz-yP9Yf-6z2y7i-7ama9u-7f1hwD-7Zv3ct-mrcfLX-3E47nj-6vdmeV-aVh74-oZH8qk-v1DB7W-dAy34r-5VBc2N-vhHw2-2jzAER-rjF45-ghW7DJ-pE3d4Q-58vVdb-byz9Wt-9ewWeV-682rDg-aKZJu-dNMXcF-kexRXr-ke9CfH">Hamed Masoumi/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Divorce rates are on the decline in Australia, people are marrying and having children later in life, and more of us live alone, according to a <a href="http://www.aihw.gov.au/publication-detail/?id=60129552015">new report</a> by the Australian Institute of Health and Welfare.</p>
<p>We’re also better educated, with more adults participating in the workforce than a decade ago. But many of us are in mortgage debt and experiencing rental stress.</p>
<p>Released today, the biennial report card on Australia’s welfare shows the increased number of Australians above retirement age may have added to Australia’s welfare expenditure, with a rise of 2.6% recorded annually between 2003 and 2013. But this increase was slower than the growth of Australia’s economy. Gross domestic product (GDP) grew at 2.9% in the same period.</p>
<p>Overall, labour force participation rates for people between 15 and 64 rose in the past 20 years from 73% in 1992 to 76% in 2014. Women drove much of the change with female workforce participation rising from 62% to 71% over the same period. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/92367/original/image-20150819-10863-a1x0fg.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/92367/original/image-20150819-10863-a1x0fg.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/92367/original/image-20150819-10863-a1x0fg.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=631&fit=crop&dpr=1 600w, https://images.theconversation.com/files/92367/original/image-20150819-10863-a1x0fg.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=631&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/92367/original/image-20150819-10863-a1x0fg.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=631&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/92367/original/image-20150819-10863-a1x0fg.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=793&fit=crop&dpr=1 754w, https://images.theconversation.com/files/92367/original/image-20150819-10863-a1x0fg.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=793&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/92367/original/image-20150819-10863-a1x0fg.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=793&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="http://www.aihw.gov.au">Australian Institute of Health and Welfare</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>On average, Australians are earning more. In 2011, the average disposable household income for people living in private housing was A$918 per week, compared with A$894 in 2009.</p>
<p>But some Australians aren’t reaping the same rewards. Youth unemployment is on the rise and Indigenous Australians are over-represented in welfare payments.</p>
<p>The report also found: </p>
<ul>
<li>In 2012, nearly 50% of Indigenous Australians reported government payments as their principal source of income. This was more than three times the rate for non-Indigenous people (16%). However, the proportion is lower than in 2002, when it was 63% for Indigenous people. </li>
<li>Indigenous children are more than twice as likely as non-Indigenous to be assessed as developmentally vulnerable when they enter their first year of schooling. But this decreased from 47% in 2009 to 43% in 2012.</li>
<li>In 2013–14 Indigenous children were receiving child protection services at seven times the rate of non-Indigenous children.</li>
</ul>
<p>The Conversation’s experts dig deeper into the report’s findings on changing family structures, welfare expenditure and home ownership.</p>
<hr>
<h2>Welfare spending</h2>
<p><strong>Nicholas Biddle, Quantitative Social Scientist at Australian National University</strong></p>
<p>Although welfare expenditure has increased as a share of tax revenue, the AIHW reports that: “welfare expenditure fell from 9.5% of GDP in 2003–04 to 9.0% in 2012–13”.</p>
<p>On the one hand, this is good news. We are spending less on income support, which allows us to spend more on education, health, leisure and other things that make life worth living. </p>
<p>There are important caveats to this story though, particularly when you drill down into the data. First, welfare spending has increased as a share of taxation revenue, from 32.8% in 2003-04 to 34% in 2012-13. </p>
<p>More importantly though, many would only consider the fall as a percentage of GDP as a good news story if it was the result of people no longer needing the support. Here the data is less positive. More people are working but more people are also struggling to find work. </p>
<p>In June 2004, the unemployment rate was 5.5%. In June 2013 it was 5.7% and it is <a href="http://www.abs.gov.au/ausstats/abs@.nsf/mf/6202.0">now 6.1%</a>. And the youth labour force participation has declined from 71% in 2008 to 67% in 2014. And we all know the population is ageing so the number of people of pension age is also increasing. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/92470/original/image-20150820-32454-lxr4pk.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/92470/original/image-20150820-32454-lxr4pk.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/92470/original/image-20150820-32454-lxr4pk.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=278&fit=crop&dpr=1 600w, https://images.theconversation.com/files/92470/original/image-20150820-32454-lxr4pk.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=278&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/92470/original/image-20150820-32454-lxr4pk.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=278&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/92470/original/image-20150820-32454-lxr4pk.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=350&fit=crop&dpr=1 754w, https://images.theconversation.com/files/92470/original/image-20150820-32454-lxr4pk.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=350&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/92470/original/image-20150820-32454-lxr4pk.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=350&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="attribution"><a class="source" href="https://aihw.gov.au">Australian Institute of Health and Welfare 2015</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
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<p>How are we spending less on welfare when more people are looking for work and more are of retirement age? Well, simply, the payment rate for many benefits <a href="http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Education_Employment_and_Workplace_Relations/Completed_inquiries/2010-13/newstartallowance/report/index">has not kept up</a> with income growth. </p>
<p>This raises a different policy discussion to the one we often have. Welfare isn’t <a href="http://www.afr.com/opinion/welfare-blowout-doesnt-add-up-20140123-iy7fm">“blowing out”</a> as some have claimed. Rather, Australia has a <a href="http://insidestory.org.au/the-budget-fairness-and-class-warfare/">highly targeted welfare system</a> with a very high share of spending devoted to the poor.</p>
<p>The policy question is whether we are spending enough on those who really need it.</p>
<hr>
<h2>Home ownership</h2>
<p><strong>Kate Shaw, Future Fellow in Urban Geography and Planning at the University of Melbourne</strong></p>
<p>Australia performs well on many measures – we are well educated and living longer than before, as should be expected in one of the wealthiest countries in the world. But fewer Australians own their home outright (from 42% in 1995 to 31% in 2011), more have a mortgage (from 30% in 1994 to 37% in 2011), more are renting, more are in mortgage and rental stress, and more of us are homeless. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/92380/original/image-20150819-10847-1am5hmx.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/92380/original/image-20150819-10847-1am5hmx.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/92380/original/image-20150819-10847-1am5hmx.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=348&fit=crop&dpr=1 600w, https://images.theconversation.com/files/92380/original/image-20150819-10847-1am5hmx.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=348&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/92380/original/image-20150819-10847-1am5hmx.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=348&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/92380/original/image-20150819-10847-1am5hmx.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=438&fit=crop&dpr=1 754w, https://images.theconversation.com/files/92380/original/image-20150819-10847-1am5hmx.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=438&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/92380/original/image-20150819-10847-1am5hmx.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=438&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption"></span>
<span class="attribution"><a class="source" href="http://aihw.gov.au">Australian Institute of Health and Welfare</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
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<p>An unaffordable housing market is not a natural consequence of Australia’s wealth. It is a direct result of policy decisions over the last two decades that have favoured property owners over renters and caused house prices to outstrip wages. A median-priced house in Melbourne or Sydney now requires up to ten times the median income. This situation entrenches privilege and exacerbates income inequality. </p>
<p>Even the International Monetary Fund (IMF) now <a href="https://www.imf.org/external/pubs/cat/longres.aspx?sk=42986.0">admits</a> that “when the rich get richer, benefits do not trickle down”. The IMF advocates increasing the income share of the poor and the middle class as the most effective way to increase economic growth. This IMF <a href="https://www.imf.org/external/pubs/cat/longres.aspx?sk=42986.0">report</a> says the best way to tackle inequality is to “focus on raising human capital and skills and making tax systems more progressive”.</p>
<p>To raise human capital, we need to ensure a range of secure, affordable housing types and invest in training and job creation programs.</p>
<p>To make Australia’s tax system more progressive, we need (at least) to phase out negative gearing and the discount on capital gains tax on investment properties (and not increase the GST).</p>
<p>Removing tax incentives for investment properties would not only provide billions of dollars for public, community and other non-profit housing initiatives, it would dampen the investor frenzy pushing prices well beyond the reach of first home-buyers. </p>
<p>But the government knows all this.</p>
<hr>
<h2>Family structure</h2>
<p><strong>Nick Parr, Associate Professor in Demography at Macquarie University</strong></p>
<p>Australia’s growing and ageing population, as well as the increase in the percentage of people born overseas, are interconnected trends.</p>
<p>Between 2004 and 2014, Australia’s overseas-born population grew from 4.8 to 6.6 million. As well as immediately increasing the numbers born overseas, immigration contributes to Australia’s population <a href="https://theconversation.com/why-our-big-australia-is-getting-bigger-20846">growth</a> by adding to birth numbers. But the numbers of children per migrant are now <a href="http://www.abs.gov.au/AUSSTATS/abs@.nsf/ProductsbyCatalogue/F41B99AB234B2074CA25792F00161838?OpenDocument">smaller</a> than those of Australian-born people.</p>
<p>Overall, these factors are expected to result in <a href="https://theconversation.com/population-growth-could-go-far-beyond-igr-projections-38490">huge</a> increases to the Australian <a href="http://www.demographic-research.org/volumes/vol31/11/">population</a>.</p>
<p>The report also shows people marrying later and more living alone. In 2012, nearly one quarter (23%) of all households had one resident. This is compared to just 11% in 1961.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/92370/original/image-20150819-10879-1xysker.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/92370/original/image-20150819-10879-1xysker.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/92370/original/image-20150819-10879-1xysker.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=267&fit=crop&dpr=1 600w, https://images.theconversation.com/files/92370/original/image-20150819-10879-1xysker.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=267&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/92370/original/image-20150819-10879-1xysker.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=267&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/92370/original/image-20150819-10879-1xysker.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=335&fit=crop&dpr=1 754w, https://images.theconversation.com/files/92370/original/image-20150819-10879-1xysker.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=335&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/92370/original/image-20150819-10879-1xysker.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=335&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="attribution"><a class="source" href="http://aihw.gov.au">Australian Institute of Health and Welfare</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Factors contributing to this include increasing numbers of people whose relationship or marriage has ended, or who have not partnered; and older people who are widowed.</p>
<p>Australia’s divorce rate dropped from 2.7 per 1,000 people in 2003 to 2.1 per 1,000 in 2013. Declining divorce rates since 2001 among those under the age of 45 may be linked to the postponement of <a href="http://jos.sagepub.com/content/41/2/163.short">marriage</a> and the greater financial resources of those who are married.</p><img src="https://counter.theconversation.com/content/46347/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Divorce rates are on the decline in Australia, people are marrying and having children later in life, and more of us live alone. Our experts respond to the new report on Australia’s welfare.Kate Shaw, Future Fellow, The University of MelbourneNicholas Biddle, Fellow, Australian National University, Australian National UniversityNick Parr, Associate Professor in Demography, Macquarie UniversityLicensed as Creative Commons – attribution, no derivatives.