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Released 2008

South Australia:
Our Health
and Health Services



South Australia: Our Health and Health Services

The National Library of Australia Cataloguing-in-Publication entry: 

Title: South Australia [electronic resource]: our health and  
health services / SA Health.

Publisher: Adelaide: SA Dept of Health, 2008.

ISBN: 9780730898207 (pdf)

Subjects: Public health South Australia.

Other Authors/Contributors: South Australia. Dept. of Health.

Dewey Number: 362.1099423

Disclaimer

This publication is a guide only and is not intended as professional advice. 
Readers are encouraged to seek appropriate professional advice before 
relying upon any of the material contained in it. While care has been taken 
to ensure the material contained in this publication is up-to-date at the 
time of printing, the Department of Health accepts no responsibility for the 
accuracy or completeness of the material in the publication and expressly 
disclaims all liability for any loss or damage arising from reliance upon any 
information contained within it.



South Australia: Our Health and Health Services



Foreword 1

Acronyms 2

Executive Summary 4

Introduction 10

1 Population profi le 12
1.1 Age and sex distribution 14

1.2 Population growth and projection 16

1.3  Geographic distribution 18

1.4 Socioeconomic status 20

1.5  Aboriginal people 22

2 Health status 24
2.1  Self-assessed health status 26

2.2  Life expectancy 28

2.3  Healthy life expectancy 30

2.4  Burden of disease 32

2.5  Mortality 35

2.6  Avoidable mortality 38

2.7  Health inequalities 40

2.8  Services and initiatives 44

3 Health priority areas 46
3.1  Injury 50

3.2  Cardiovascular health, including stroke 52

3.3  Cancer 54

3.4  Diabetes 56

3.5  Asthma 58

3.6  Chronic respiratory conditions 60

3.7  Renal disease/failure 62

3.8  Arthritis and musculoskeletal conditions 65

3.9  Living with chronic conditions 67

3.10  Services and initiatives 69

4 Risk factors for health 72
4.1  Smoking 76

4.2  Diet and nutrition 77

4.3  Alcohol abuse 79

4.4  Overweight and obesity 80

4.5  Physical activity/inactivity 82

4.6  High blood pressure 83

4.7  High blood cholesterol 84

4.8  Sexually transmitted diseases 85

4.9  Blood-borne diseases 86

4.10  Environment 88

4.11  Immunisation rates 92

4.12  Screening 93

4.13  Services and Initiatives 94

5 Mental illness 98
5.1  Psychological distress 101

5.2  Current mental health conditions 102

5.3 Burden of disease 103

5.4  Hospitalisation (public hospitals) 104

5.5  Community mental health contacts 106

5.6   Mental health-related encounters 
with general practitioners 107

5.7  Suicide deaths 108

5.8  Services and initiatives 109

6 Oral health 112
6.1 Children s oral health 114

6.2 Adult oral health 116

6.3  Dental services in South Australia 119

6.4 Services and initiatives 121

Contents



7 Mothers, babies, 
 children and youth 123
7.1  Child-bearing in South Australia: 
 trends in fertility 126

7.2  Infant mortality 129

7.3  Maternal deaths 132

7.4   Interventions in childbirth: 
caesarean section 133

7.5 Teenage pregnancy 134

7.6  Terminations of pregnancy 135

7.7  Hospital services for children 
 and adolescents 136

7.8  Immunisations 141

7.9   Mental health and wellbeing of 
young people in South Australia 143

7.10   Children and adolescents with 
physical disabilities 146

7.11 Services and initiatives 147

8 Older people 150
8.1  Chronic diseases 152

8.2  Main years of life lost due to disability 154

8.3  Mortality 156

8.4  Hospitalisation 157

8.5  Mental health 159

8.6  Falls 160

8.7  Living arrangements 161

8.8  Services for older people 162

8.9  Services and initiatives 166

9 Aboriginal people 168
9.1  Aboriginal population and distribution 170

9.2  Life expectancy and causes of death 172

9.3  Burden of disease 175

9.4  Birthing outcomes 177

9.5  Chronic disease 181

9.6   Selected hospitalisations   
environmental health 184

9.7  Risk factors 186

9.8  Mental health 189

9.9  Oral health 191

9.10  Health service access and equity 194

9.11 Data issues associated with 198
 Aboriginal people

9.12  Services and initiatives 200

10 Health care services 
 and resources 204
10.1  Hospital care 207

10.2  General practitioners 215

10.3  Potentially preventable hospitalisations 218

10.4  Home and nursing services 220

10.5  Hospital avoidance program 224

10.6  Finance 225

10.7  Services and initiatives 228

11 Safety and quality 230
11.1  Blood safety 233

11.2  Medication safety 234

11.3  Health care associated infections 236

11.4   Pressure ulcer prevention 
and management 237

11.5  Patient evaluation of health services 238

11.6  Sentinel events incident management 240

11.7  Falls, fall-related injuries 
 and falls incidents 242

11.8 Initiatives 246

Appendices 249
Appendix 1   Glossary 249

Appendix 2   Data sources 254





page 1South Australia: Our Health and Health Services

Foreword

South Australia: Our Health and Health Services 2008 is the first publication to provide a comprehensive picture 
of the health status of South Australians. The report uses population health information and an extensive array 
of other health and demographic data to portray our current state of health and to illustrate how risk factors 
associated with lifestyle choices, socioeconomic circumstances and environmental conditions can lead to 
ill health. The report also contains information on the health services and facilities that serve the people of 
South Australia and the initiatives   both underway and planned   that will lead to improvements in the 
health and wellbeing of our people.

Most South Australians enjoy good health. Our hospitals provide a comprehensive range of services to people 
who are acutely ill. Our out-of-hospital sector provides a broad range of services designed to improve, stabilise 
or maintain our health and wellbeing. These services include post-acute care, the management of people 
with chronic health conditions, the management of people with mental health illnesses, early intervention 
programs to prevent the onset of disease, and a range of health promotion activities to encourage healthy 
living and good lifestyle choices. 

Our health system is comprehensive and our standards of health care are very high. The health outcomes that 
our system delivers to the people of South Australia are matched by very few other countries in the world; 
this does not mean however, that better outcomes cannot be achieved.

Good health is not experienced by all South Australians and it is our Government s goal to advance the health 
and wellbeing of those individuals, and of specific populations groups, whose health status is not as high 
as the general population. South Australia s Strategic Plan has a range of targets relating to improved health 
status, and there are programs and activities in place to ensure we achieve these targets. 

The SA Health Care Plan describes the planned reformation of our health system and how these changes 
will help us to deal with the ever-increasing demand for health services and improving the health status of 
South Australians. The Plan s key objectives are to improve significantly the coordination of care across the 
system, to ensure care is provided in the most appropriate setting, to place a much a greater emphasis 
on early prevention, to promote further the benefits of healthy living and to better manage people with 
long-term health problems.

The Social Inclusion Board provided a series of recommendations on how our mental health system should 
be reformed, in the Report  Stepping Up . The reforms are aimed at rebuilding, relocating and restructuring 
our mental health services and will be phased in over the next five years. These changes will ensure that 
consumers have access to a wider variety of high quality, client focused services, closer to where they live. 

The importance of data and information in evaluating health status and the effectiveness of health programs 
and services cannot be overstated. This report contains a wealth of information that describes South 
Australians  current state of health. The same information also will be used as a  marker  for measuring future 
changes in health status and will help the Health Performance Council to determine whether or not our 
health system is providing the right level of health care, and has the right blend of services, to achieve the best 
possible health status for the people of South Australia.

Hon John Hill MP Hon Gail Gago MLC
Minister for Health Minister for Mental Health and Substance Abuse



page 2 South Australia: Our Health and Health Services

Acronyms

AACAT Adelaide Aged Care Assessment Team 

ABDC  Audit and Best Practice in 
Chronic Disease research program 

ABS Australian Bureau of Statistics

ACAM Australian Centre for Asthma Monitoring 

ACIR   Australian Childhood 
Immunisation Register

AHMAC  Australian Health Minsters  
Advisory Council 

AIDS Acquired Immune Deficiency Syndrome

AIHW  Australian Institute of Health 
and Welfare

AIMS Advanced Incident Management System

APAC  Australian Pharmaceutical 
Advisory Council

APY Anangu Pitjantjatjara Yankunytjatjara

BEACH  Bettering the Evaluation and 
Care of Health 

BFV Barmah Forest arbovirus

BLIS Booking List Information System

BMI Body mass index

CALD  Culturally and linguistically diverse 
populations or communities

CAMHS Child Adolescent Mental Health Services

CATI Computer-Assisted Telephone Interview

CBIS Community-based Information System 

CCC Country Consolidation CME 

CI Confidence interval

CKD Chronic Kidney Disease

COPD Chronic obstructive pulmonary disease

CPI Clinical Practice Improvement 

CRF Cultural Respect Framework 

CYH Child and Youth Health 

DALY Disability adjusted life years

DASSA  Drug and Alcohol Services 
South Australia

dmft  Decayed plus missing plus filled 
deciduous teeth

DMFT  Decayed plus missing plus filled 
adult teeth

ED Emergency department

ELD  Expected years lost to disability as a 
proportion of total life expectancy

EPA Environmental Protection Authority

ERP Estimated resident population

ESRD End-stage renal disease 

ESRG Extended service-related groups 

FSF Family Safety Framework

FWE Full-time workforce equivalents

GDP Gross Domestic Product 

GFR Glomerular filtration rate 

GP General practitioner

HACC Home and Community Care 

HALE Health adjusted life expectancy

HCV Hepatitis C Virus 

HIV Human Immunodeficiency Virus

ICD-10  International Classification of Diseases, 
Tenth Edition

IHD Ischaemic heart disease

IMVS  Institute of Medical and 
Veterinary Science 

IRSD  Index of Relative Socioeconomic 
Disadvantage

ISAAC  Integrated South Australian 
Activity Collection 

IVF In-vitro fertilisaton

JRA Juvenile rheumatoid arthritis 

K10 Kessler Psychological Distress Scale   10

LE Life expectancy

LOS Length of stay 

LSA Local Service Area

MAHPET  Mapping Aboriginal Health Partnerships 
for Policy-Evidence Transfer 

MDC Metropolitan Domiciliary Care 

MET Medical Emergency Team



page 3South Australia: Our Health and Health Services

MGP Midwifery Group Practice 

MRSA Antibiotic resistant golden staph

NATSIHS  National Aboriginal and Torres Strait 
Islander Health Survey

NGO Non-government organisation

NHS National Health Survey

NIMC National Inpatient Medication Chart 

NIPS  National immunisation 
programs schedule 

OBD Occupied bed day

OECD  Organisation for Economic Co-Operation 
and Development

PBS Pharmaceutical Benefits Scheme 

PEHS Patient Evaluation of Health Services 

PHIAC  Private Health Insurance 
Administration Council 

PHIDU  Public Health Information 
Development Unit

PIRSA  Primary Industry and Resources 
South Australia

RACF Residential Aged Care Facility 

RAISE  Regional Aboriginal Integrated Social 
and Emotional 

RRV Ross River arbovirus

RCA Root Cause Analysis 

RDNS Royal District Nursing Service 

RFE Reasons for encounter 

RIST Remote Aboriginal Stores and Takeaways 

SA South Australia

SADS SA Dental Service 

SAIMMS  South Australian Integrated Mosquito 
Management Strategy 

SAMSS  South Australian Monitoring 
and Surveillance System

SAPOL South Australian Police 

SASP South Australia s Strategic Plan 

SD Statistical Division 

SEIFA Socioeconomic indexes for areas

SHA System of Health Accounts

SIDS Sudden infant death syndrome

SLA Statistical Local Area

STD Sexually transmitted disease 

STED Septic tank effluent disposal 

TQEH The Queen Elizabeth Hospital

UN United Nations

WCH Women s and Children s Hospital

WHO World Health Organization

YLD Years lost to disability or illness

YLL Years of life lost



page 4 South Australia: Our Health and Health Services

Executive Summary

The health of South Australians generally is very good. Life expectancy is a universally accepted indicator 
of health status. Australia has the fourth highest life expectancy of all OECD countries. The average life 
expectancy for males in South Australia is 78.1 years, marginally below the Australian average of 78.5 years 
and the average life expectancy for females in South Australia is 83.4 years, slightly above the national 
average of 83.3 years. The median age at death for males and females in South Australia is 77.5 years and 
83.6 years respectively; the highest of all states and territories in Australia.

Infant mortality rate is another international comparator for assessing the health of populations. The rate 
varies between 3 and 7 deaths per 1 000 live births in developed countries; it rises to 100 or more in some 
developing countries. South Australia s infant mortality rate is the lowest of any Australian state or territory, 
at 4.0 deaths per 1 000 live births compared to the national average of 4.8.

South Australians also rate their own health status as high. The South Australian Monitoring and Surveillance 
System (SAMSS) is a randomised survey of approximately 6 000 South Australians per annum undertaken by 
the Department of Health. Just over 83 per cent of respondents aged 16+ years, when asked about their state 
of health in the 2006 07 SAMSS survey, reported their overall health as either excellent, very good or good.

Most South Australians enjoy good health, yet more can be done to further improve the overall health status 
of people living in the state. Health and wellbeing is influenced by a variety of factors. Biology and genetic 
make-up clearly influence health status, and the propensity for people to develop diseases and to migrate 
towards ill-health, but they are not the only factors. Lifestyle choices and environmental, social and political 
factors also have a bearing on how long people remain in a state of good health and wellbeing.

This report describes not only the health of South Australians and the factors that impact on their health, 
but also the range and use of health services provided in the state, and the initiatives being undertaken and 
planned to achieve higher levels of health and wellbeing for the people of South Australia.

The key features and statistics from each of the report s 11 chapters are provided below.

Population profi le (chapter 1, page 12)

The estimated residential population of South Australia at June 2007 was 1 584 513.

Females slightly outnumber males and the proportion of females in the population increases with age.

South Australia s population is projected to reach 1 768 391 people based on the High series method. It is 
government policy that South Australia s population will increase to 1 736 879 people by 2021, and 2 million 
people by 2050, based on the 2 Million by 2050 method. 

The population is predominantly urban, but the state has to deal with the issue of extreme remoteness 
for some of its residents.

The Index of Relative Socioeconomic Disadvantage score at the 2001 Census for the metropolitan regions 
was 1 007, marginally higher than for South Australia at 1 000.

There were an estimated 26 044 Aboriginal people living in South Australia at June 2006.



page 5South Australia: Our Health and Health Services

Health status (chapter 2, page 24)

South Australia during the last 20 years has shown a steady increase in life expectancy at birth, and also 
in health adjusted life expectancy at birth.

The burden of disease in South Australia decreased slightly between 1999 2001 and 2001 2003, with males 
recording a higher disease burden than females.

South Australia s age adjusted death rate in the 20 years to 2005 decreased by 32 per cent. 

Cardiovascular disease and malignant neoplasms were responsible for almost two-thirds of life lost to 
premature mortality in 2001 2003.

Seventy per cent of the years of life lost to death in South Australia in 2001 2003, occurring in people aged 
younger than 75 years, was categorised as potentially avoidable.

The rate of potentially avoidable mortality is 86 per cent higher in the most disadvantaged geographical areas 
compared to the least disadvantaged. The largest absolute differences between high and low disadvantage 
areas occurred in smoking, diabetes and alcohol harm.

Health priority areas (chapter 3, page 46)

Injury, domestic violence, cardiovascular conditions, cancer, diabetes, asthma, renal disease/failure, arthritis 
and musculoskeletal conditions together account for over 60 per cent of South Australian s burden of disease.

Prevention strategies continue to provide the greatest opportunities for health improvements for these 
conditions at the population level.

Injury is the leading cause of mortality in South Australians aged 1 44 years. Falls remain the most prominent 
injury threat among older people.

Mortality due to cardiovascular conditions has declined over the past decades, but this condition remained 
the leading cause of death in South Australia in each of the five years from 1999 2000 to 2003 04.

About one in three people will have cancer during his or her life. There were 8 456 new cases of cancer 
diagnosed, and 3 302 deaths, in South Australia in 2005.

The prevalence of diabetes has been increasing in South Australia over recent decades.

Asthma was reported by 13.4 per cent of South Australians aged 16+ years, and in 14.8 per cent of those 
aged 2 15 years.

The prevalence of respiratory conditions has remained relatively stable over the past five years.

The number and rate of people in South Australia requiring kidney dialysis and/or transplantation has 
increased progressively over recent years, in common with the rest of Australia.

Twenty per cent of South Australians reported that they had arthritis.

Risk factors for health (chapter 4, page 72)

Nearly 21 per cent (20.7) of people aged 15+ years self-reported being current smokers. People aged 20 49 
years were significantly more likely to report being current smokers than were people in other age groups. 
Males were significantly more likely than females to report being current smokers.

About 90 per cent of people surveyed aged 19+ years were not eating the recommended five serves of 
vegetables per day; this figure was even higher for people aged 80+ years.

Nearly 30 per cent of people surveyed in 2006 07 aged 16+ years were classified as being at risk of harm 
from alcohol in the short-term; this risk was greater for people aged 50 69 years.

Close to 60 per cent of people were classified as overweight or obese. In general, men more than women, 
as well as people aged 40 69 years, were significantly more likely to be classified as overweight or obese.



page 6 South Australia: Our Health and Health Services

Just over 50 per cent of people surveyed were doing enough physical activity; the proportion of those aged 
16+ years in this category significantly increased in 2006 07.

The 2004 05 National Health Survey shows a higher percentage of South Australian people aged 18+ 
are at risk or high risk of harm from alcohol compared to the Australian population. A higher percentage 
of South Australians over Australian people are overweight or obese. There is a lower percentage of 
South Australians than Australians who currently smoke, and fewer who exercise at moderate and high levels. 

The proportion of adults aged 16+ years with high blood pressure has not changed in recent years.

Not quite 15 per cent of people aged 16+ years self-reported having high cholesterol, with about the same 
levels in males and females. Many more older people reported having current high levels of cholesterol than 
did younger people.

Notifications of chlamydia infections (in both males and females) have increased considerably. The number 
of Hepatitis C Virus incident cases has increased slightly.

Nearly one-quarter-of-a-million doses of influenza vaccine were distributed in 2005 06, an increase on 
2004 05. Most people aged 65+ years received annual influenza vaccination.

South Australia maintains immunisation coverage above 90 per cent for children aged 12 15 months 
and 24 27 months; this coverage is at or above national levels.

The coverage in June 2006 for meningococcal C vaccine in South Australia was 84.7 per cent for children 
aged 1 5 years compared to Australia coverage of 83.9 per cent.

There has been a marked increase in the numbers of notified cases of gonorrhoea and syphilis in recent years.

There were over 800 000 screening mammograms provided to nearly one-quarter-of-a-million individual 
women across South Australia from July 1988 to June 2006. Just over 4 400 breast cancers were diagnosed 
by BreastScreen SA from January 1989 to December 2005.

Nearly 70 per cent of women aged 20 69 years were screened for cervical cancer in 2004 05.

Mental illness (chapter 5, page 98)

Psychological distress decreased for people 16+ years between 2002 03 and 2006 07. People aged 16 19 
years and 20 29 years had higher levels of psychological distress than did other age groups. More women 
than men in South Australia experience distress.

Mental illness accounted for nearly 10 per cent of the total burden of disease in South Australia in 2003 
measured by Disability adjusted life years (DALYs). The burden of disease was 12.3 per cent if alcohol and 
substance use illnesses were included. The highest ranked burden of disease in the mental health category 
was depression.

South Australia in 2006 07 had nearly 17 000 hospital separations for mental health-related illnesses   
just over 4 per cent of all public hospital separations. Depression was the most common diagnosis 
for mental health hospital separations, while schizophrenia accounted for the most patient days in hospital. 
Mental health hospital separations increased by 3.1 per cent between 2002 03 and 2006 07.

There were nearly 400 000 community mental health contacts during 2006 07, with about equal rates 
for males and females; 80 per cent of the encounters related to depression, sleep disturbance and anxiety, 
with depression the highest at 42.5 per cent.

The standardised death rate from suicide in South Australia was 10.7 per 100 000 population in 2006 
(16.7 for males and 4.9 for females). This figure is higher than the national average of 8.6 per 100 000 
population (13.6 for males and 3.8 for females).



page 7South Australia: Our Health and Health Services

Oral health (chapter 6, page 112)

Around 40 per cent of the population experiences pain from teeth, gums or dentures in a 12-month period. 

There has been more than a 40 per cent increase in dental decay among South Australian children since 
the late 1990s, paralleling a similar national trend. Forty per cent of children by five years of age have decay 
experience and 60 per cent of this is untreated.

Children from country areas, lower socioeconomic backgrounds, CALD (culturally and linguistically diverse 
populations or communities), or who are Aboriginal, have more dental decay experience than do others.

The proportion of South Australian adults with all their teeth extracted (edentulous) has fallen by 60 per cent 
over the past 30 years.

There has been a 12 per cent increase in decay for low-income adults attending public dental clinics since 
the cessation of the Commonwealth Dental Health Program in 1997. The amount of untreated decay has 
increased by 50 per cent.

Aboriginal adults have fewer teeth with dental decay experience and less gum disease than do other 
concession card holders attending public dental clinics.

There are 54.8 practising dentists per 100 000 population compared with the national average of 46.9 
per 100 000 in 2000. 

Nearly all primary school and secondary school aged children receive dental care within a two-year period. 
Attendance at the dentist reduces for adults after the school years, and is lowest at 71 per cent for people 
aged 25 44 years old.

Waiting lists have reduced in recent years, except for specialist dental services.

Mothers, babies, children and youth (chapter 7, page 123)

Around 19 000 women give birth in South Australia each year and, after more than a decade of decline, this 
number is now increasing. Fertility in under-30-year-old women is declining, while that for over-30s is increasing.

Infant mortality in South Australia is currently around 4.0 per 1 000 live-births, comparing very favourably 
with other developed countries. Much improvement can be attributed to the fall in cases of Sudden Infant 
Death Syndrome (SIDS).

South Australia has very low maternal deaths by international standards; however, the rate in Aboriginal 
women is 5.4 times higher than for others in the community.

The proportion of women giving birth by caesarean section in South Australia is rising, with more occurring 
in private than in public hospitals.

Nearly 4 per cent of South Australia s 15 19 year-old girls became pregnant in 2006; a decline of 1 percentage 
point over the past decade. Around half these teenage pregnancies are terminated.

Nearly 5 000 pregnancies were terminated among women of all ages in 2005; this number has been declining 
steadily since 2001.

There are around 53 000 hospital admissions each year of people aged 0 17 years. Major medical reasons 
for admission are asthma and bronchitis,  croup , and gastroenteritis; nearly all these conditions are treated 
in public hospitals. The most common surgical procedures are tonsillectomy/adenoidectomy and myringotomy, 
with at least half of these procedures occurring in private hospitals.

Nearly all children in South Australia are immunised by the age of two years. Rubella cases have fallen over 
the past 10 years, as have whooping cough cases in 0 4-year-olds.

Around 14.1 per cent of South Australia s 4 17 year-olds have mental health problems, but only 29 per cent 
of them receive any services. Help is described by half the parents of these children as too expensive or the 
location of its availability is unknown.

Around 4 000 children aged 0 17 years in South Australia may have physical disabilities sufficiently severe 
that they require rehabilitation services.



page 8 South Australia: Our Health and Health Services

Older people (chapter 8, page 150)

Arthritis is the most prevalent chronic condition for older men, followed by cardiovascular disease 
and diabetes. The most prevalent chronic conditions for older females are arthritis, osteoporosis and 
cardiovascular disease.

The largest proportion of older people in hospital for chronic disease were there for  care involving dialysis , 
followed by chronic obstructive pulmonary disease and stroke.

Dementia and Alzheimer s disease are the leading causes of the morbidity burden in older people 
of both genders. 

Death rates for older people declined quite significantly over the period from 1995 to 2004. 

Older patients accounted for 38 per cent of all hospital separations in 2006 07 and for 51 per cent of all 
patient days, yet represented only 15 per cent of the state s population.

Just over 10 per cent of older people have a current doctor-diagnosed mental health condition.

There were 9 095 separations in both private and public hospitals as a result of falls by older people 
during 2006 07.

Aboriginal people (chapter 9, page 168)

Life expectancy for South Australian and Western Australian Aboriginal people (1996 2001) as a combined 
group was 58.5 years for males and 67.2 for females (separate data for South Australia is not available).

The median age of death for Aboriginal males in 2005 was 42.4 years and for Aboriginal females 47.5 years.

External causes of death such as transport accidents, intentional self harm and assault accounted for 23.9 
per cent of South Australian Aboriginal deaths in 2005.

The leading causes of premature mortality for Aboriginal South Australians between 2001 2003 were 
ischaemic heart disease, road traffic accidents, suicide and self-inflicted injuries, and Type 2 diabetes.

Aboriginal women accounted for 2.7 per cent (487) of the confinements in South Australia in 2005. 
Aboriginal teenage women have a higher proportion of confinements than do non-Aboriginal teenage 
women; typically around 20 per cent (21.5 per cent in 2005), compared to around 5 per cent.

The crude hospitalisation rate for diabetes for Aboriginal South Australians in 2006 07 was 3.3 times higher 
than for other South Australians.

The crude hospitalisation rate for renal disease for Aboriginal South Australians in 2006 07 was eight times 
higher than for other South Australians.

The crude hospitalisation rate for mental health conditions for Aboriginal South Australians in 2006 07 
was 3.5 times higher than for other South Australians.

Survey data in 2004 05 show that well over half of Aboriginal South Australians were current smokers, 
and the same proportion were overweight or obese.

South Australian Aboriginal children (4 16 years of age) have higher rates of dental decay, missing teeth, 
filled teeth and unhealthy gums than do other South Australian children.



page 9South Australia: Our Health and Health Services

Health care services and resources (chapter 10, page 204)

Hospital use has increased progressively over the years, with an increase of nearly four per cent from 
2005 06 to 2006 07.

Separations in private hospitals between 2002 03 and 2006 07 increased by 13.3 per cent. Separations 
in public hospitals increased by 11.8 per cent. The average length of stay in South Australian hospitals 
(excluding same-day separations) has decreased.

Presentations in metropolitan public hospital emergency departments increased by 5.8 per cent in 2006 07 
over the previous financial year; nearly 50 per cent were resuscitation/emergency/urgent cases.

The percentage of emergency patients seen within the specified waiting time targets has increased among 
metropolitan public hospitals.

Just over 80 per cent of elective surgery patients during 2006 07 were seen within the clinically 
appropriate time.

The South Australian GP headcount during 2005 06 was 2 042. The number of full-time workload equivalent 
GPs practising in the state was 1 404, an increase of 2.9 per cent over the previous year.

The number of potentially preventable hospitalisations increased 6.7 per cent between 2004 05 and 2005 06.

The Royal District Nursing Service of SA Inc (RDNS) had 20 648 clients within metropolitan Adelaide, 
made over half-a-million nursing and support visits, and conducted nearly a quarter-of-a-million other client 
contacts during 2006 07.

Metro Home Link provided nearly 15 000 care packages to nearly 13 000 patients during 2006 07; 
nearly 8 000 of the total were hospital avoidance packages, while the remainder were hospital supported 
discharge packages.

The State Government provided financing of $3.043 billion to Health Regions and other health entities 
during 2006 07.

Safety and quality (chapter 11, page 230)

Nearly 20 per cent of red cell transfusions in 2002 were outside the national guidelines. The introduction 
of the BloodSafe  program and its implementation in eight metropolitan hospitals has reduced this rate 
to 6 per cent.

A large proportion of medicine-related incidents   up to 50 per cent   are preventable. Medication errors 
in the public hospital system are estimated to cost $380 million per annum.

The National Inpatient Medication Chart was in use in all South Australian public hospitals from March 2007.

Health care-associated infection and appropriate antibiotic use in South Australia s public and private 
metropolitan hospitals has been monitored since 2001; an improvement has been seen during this time in the 
overall rate of bloodstream infection and the rate of infection due to MRSA (antibiotic-resistant golden staph) 
has been halved.

The Patient Evaluation of Health Services (PEHS) Program indicated consumers had an overall satisfaction rate 
of nearly 90 per cent in 2005.

SA Health is committed to learning from adverse events that occur in the health system. The first national 
sentinel event report was released in 2007 by the Australian Institute of Health and Welfare (AIHW) based on 
all states (including South Australia) and territories contributing their sentinel event information to a national 
report. Analysis of adverse events and reporting of improvements made as a result is published annually 
in the South Australian Patient Safety Report.



page 10 South Australia: Our Health and Health Services

Introduction

This document is the first publication of South Australia: our health and health services. The report:

provides an overview of the health of the people of South Australia &gt;

 describes the determinants of health and outlines the extent to which South Australians are being exposed  &gt;
to the risk factors associated with ill-health

describes the health and wellbeing of vulnerable populations &gt;

 lists the health priority areas, and the initiatives put in place and planned to address health needs  &gt;
in these critical areas

describes the wide range of health services that are available within South Australia and their use. &gt;

The report aims to provide meaningful information and data to people working within the health industry 
and the wider public; within it is some information that is technical in nature and, where possible, 
explanations are provided to enhance the readers  understanding of the processes and concepts in relation 
to these more technical aspects of the report. References also are provided to web sites and publications that 
provide further background information on these measures.

The report has been structured in such a way that it can be read in its entirety or as individual chapters. 
Some duplication of information has occurred in making chapters  self-contained . This method was 
considered necessary to accommodate readers whose interests, at a particular point in time, relate to a 
specific element or feature of South Australia s health and health services. A downloadable version of the 
report, and its individual chapters, can be obtained on SA Health s web site at &lt;www.health.sa.gov.au&gt;.

The report contains a large number of population health indicators and other pieces of information, 
in both statistical and narrative form, that provide a comprehensive overview of the health status 
of people living within South Australia, how that status compares with other jurisdictions within Australia 
(where appropriate) and how it has changed over time. Interstate comparisons and trends over time enable 
better evaluation of the health system and population health status by providing reference points for 
measuring relative performance.

South Australia s health status in many areas compares favourably with that of other jurisdictions and has 
improved over time. Much can be done to improve health status further, however, and this report describes 
many of the changes in lifestyle, and the interventions and initiatives that can be introduced or enhanced, 
that will lead to improved health outcomes; examples include extending disease screening programs, 
greater monitoring and surveillance of specific diseases, targeting the health needs of specific population 
groups with poorer health status, and introducing further early intervention programs to promote good health 
through better lifestyle choices.

The information in this report has been derived from a large number of sources including hospitalisation 
data, health survey data, deaths data, census data, Medicare Australia data, communicable disease data, 
disease register and surveillance data, and health publications and journals. The most recent and available 
data have been presented within this report. Data have been provided in calendar years (for example, 2007) 
and financial years (for example, 2006 07). Some measures span multiple calendar or financial years.

The report is divided into 11 chapters, beginning with a demographic profile of South Australians and 
followed by an overview of their health status and the priority areas for improvement. The next chapter 
is a description of risk factors and their potential impact on the health of South Australians, and this precedes 
chapters on the specific health programs of mental health; oral health; and maternal, infant and child health. 
The report also profiles the health status of Aboriginal people within the state, drawing comparisons with 
non-Aboriginal people; describes the range and type of health service providers and related service use 
and finally, lists specific safety and quality issues and initiatives within the health arena in South Australia 
and nationally.

Each chapter begins with a summary of the key issues and indicators, and concludes with a section on the 
services provided and initiatives undertaken that are relevant to the specific chapter. Details also are provided, 
as appendices, on the various data collections and sources used to generate the report.



page 11South Australia: Our Health and Health Services

SA Health and health services more generally are undergoing considerable change aimed at ensuring 
services are available where and when they are needed, avoiding unnecessary duplication and providing 
the most effective, safe and efficient health services to the people of South Australia.

The new Health Care Bill 2008 provides the mechanism for changes in governance arrangements within 
SA Health that will make health services and regions directly accountable to the Department of Health, 
paving the way for a more coordinated and responsive health system. The SA Health Care Plan and 
South Australia s Strategic Plan are the blueprints for improved service provision and for improving the 
health status of South Australians. The indicators and other information in this report, along with the 
strategic targets within both plans, provide a foundation for measuring future improvements.



page 12 South Australia: Our Health and Health Services

chapter 1

1  Population pro? le

In this chapter

Age and sex distribution &gt;

Population growth and projection &gt;

Geographic distribution &gt;

Socioeconomic status &gt;

Aboriginal people &gt;

Summary

The estimated residential population of South Australia at June 2007 was 1 584 513.  &gt;

 The South Australian population continues to age. The median age of the South Australian population  &gt;
in 2003 was 38.3 years, compared with 38.9 years in 2007.

 South Australia has the oldest population of all the states and territories. People aged 65 years or more  &gt;
made up 15.2 per cent of the state s population as at June 2007, compared with 14.9 per cent in 2003.3

 The female population in June 2007 slightly outnumbered the male population   50.6 per cent to 49.4  &gt;
per cent respectively; this is projected to continue until 2021.

 The proportion of females in the population increases with age. Females in June 2007 made up 55.9  &gt;
per cent of the South Australian population aged 65 years or more, and 63 per cent of the population 
aged 80+ years.

 The state is projected to reach 1 768 391 people by 2021 (an average increase of approximately  &gt;
0.8 per cent per annum) based on the High series method. South Australia s population, based on the 
2 Million by 2050 method, is projected to increase at an average rate of 0.7 per cent per year, reaching 
1 736 879 people by 2021.

 The South Australian population is predominantly urban. Approximately 72 per cent of the South Australian  &gt;
population in June 2006 lived in the metropolitan area, 13 per cent lived in inner regional areas, and 15 
per cent in outer regional and remote areas.

 Adelaide in 2021 will remain the dominant population centre in South Australia. A majority of the  &gt;
growth in Adelaide is predicted to occur in the north and south of the city. The populations of most local 
government areas along the South Australian coast will increase, while the population of most inland areas 
of South Australia is predicted to decline.

 The Index of Relative Socioeconomic Disadvantage (IRSD) is one of the Socioeconomic Indexes for Areas  &gt;
(SEIFA) based on Census data. Areas can be defi ned using this index as relatively advantaged (high scores) 
or relatively disadvantaged (low scores). The IRSD score at the 2001 Census for the metropolitan regions 
was 1 007, marginally higher than the index score of 1 000 for South Australia as a whole.

 There were an estimated 26 044 Aboriginal people living in South Australia at June 2006, according to  &gt;
experimental estimated residential populations. Aboriginal people accounted for 1.7 per cent of the total 
South Australian population and 5.0 per cent of the total Aboriginal population in Australia.3



page 13South Australia: Our Health and Health Services

chapter 1

Introduction

South Australia has the fifth largest population of Australia s eight states and territories. The estimated 
residential population (ERP) for South Australia was 1 584 513 people as at June 2007, a 1.0 per cent increase 
over the previous year, according to the Australian Bureau of Statistics (ABS).3 The South Australian population 
comprises 49.4 per cent males and 50.6 per cent females. Aboriginal people comprise 1.7 per cent of the total 
South Australian population, compared with 2.3 per cent Aboriginal people in Australia.1

Approximately 88.2 per cent of South Australians are Australian citizens, and 0.6 per cent overseas visitors.1 
South Australians born overseas accounted for 20.3 per cent of the state s population, compared to 22.2 
per cent for Australia.1

South Australia is a highly urbanised state, with 71.7 per cent of its population living in Adelaide.1 
The Adelaide metropolitan area continues to grow both north and south, as well as east into the Mount 
Lofty Ranges. South Australia s coastline also is experiencing population growth.7

Key demographic indicators associated with health status and health inequalities are critical when considering 
the current and future health needs of South Australians. These demographic indicators are used within this 
chapter to describe the South Australian population.



page 14 South Australia: Our Health and Health Services

chapter 1

1.1  Age and sex distribution

South Australia has the oldest population of all the states and territories, as a result of lower fertility, 
disproportionately low migration gain and higher net interstate losses. 

The South Australian population has continued to age, with people aged 65+ years contributing 15.2 per cent 
of the state s population in June 2007, compared with 14.9 per cent in June 2003. The proportion of younger 
people continues to decline. The proportion of the state s population in June 2007 who were children aged 
under 15 years was 18.1 per cent, compared with 18.8 per cent in June 2003.3

South Australia s median age continues to be the highest of all states and territories in Australia, with the 
median age (the age at which half the population is older and half is younger) increasing from 38.3 years 
in 2003 to 38.9 years in 2007. This increase is consistent with the national trend, with Australia s median age 
increasing from 36.2 years in 2003 to 36.8 years in 2007.2

Females outnumbered males by 19 101 in South Australia in 2007. The state s sex ratio (number of males 
per 100 females) was 97.6, with 782 706 males and 801 807 females. The sex ratio for South Australia 
was below that of Australia (98.9).3

The number of females in South Australia aged 65+ years (134 463) was 26.5 per cent higher than the 
number of males in this age group (106 259). There are more than twice as many females (22 092) as males 
(10 621) aged 85+ years.

60 50 40 30 20 10 0 

FemaleMale

0 10 20 30 40 50 60

85+

80 84

75 79

70 74

65 69

60 64

55 59

50 54

45 49

40 44

35 39

30 34

25 29

20 24

15 19

10 14

5 9

0-4

Age groups
(years)

Source: Australian Bureau of Statistics, 3101.0 Australian Demographic Statistics, TABLE 6   Estimated Resident Population, 
 Age Groups   at 30 June 2007.

Graph 1.1.1  Age and gender profile, June 2007, South Australia ( 000)



page 15South Australia: Our Health and Health Services

chapter 1

The median age at death represents the age at which the deaths in a given time period relate to exactly 
half the people above that age and half below it. Both South Australian males and females had the highest 
median age at death in 2005, at 77.5 years and 83.6 years respectively. The average median age at death 
of all Australian males and females, in comparison, was 76.8 and 82.9 years respectively. 

55

60

65

70

75

80

85

Y
ea

rs

New
South
Wales

Victoria Queensland Western
Australia

South
Australia

Tasmania Australian
Capital
Territory

Northern
Territory

Males

Females

Graph 1.1.2  Median age at death, Australia, 2005

Source: Australian Bureau of Statistics, 3101.0   Australian Demographic Statistics, Mar 2007 (tables 11 &amp; 12).



page 16 South Australia: Our Health and Health Services

chapter 1

1.2  Population growth and projection

The population of South Australia increased by an average of 0.8 per cent per annum in the five years 
leading up to June 2007, nearly half that experienced by Australia as a whole (1.4 per cent). The estimated 
resident population of South Australia at June 2007 was 1 584 513 million people, an increase of 16 309 
from the previous year.3

South Australia s population increased 4.2 per cent between June 2002 and June 2007, one of the 
smallest rates of all Australian states and territories.3 The state s population as at June 2007 was 7.5 per cent 
of Australia s total.

State population projections based on the High series

Planning SA, a South Australian State Government agency, has produced population projections for 
South Australia presenting four demographic scenarios   High, Medium, Low and 2 million target. 
These projection scenarios were prepared with guidance by the Interdepartmental Forecasting Committee 
and the assistance of academic demographers. These four population projections have been endorsed by 
State Cabinet for use by South Australian State Government agencies.

Shown here is the High series of Planning SA projections. South Australia s population based on this 
projection series is projected to steadily increase and reach 1 768 391 people by 2021 (an average increase 
of approximately 0.8 per cent per annum).

The ageing of South Australia s population, similar to the rest of Australia, is projected to continue. 
South Australia s age structure will change substantially by 2021, with 47.1 per cent more people aged over 
64 years and 1.9 per cent more people aged less than 25 years.

Children aged 0-14 years, at June 2007, represented just over 18 per cent of South Australia s population.3 
This age group is projected by 2021 to represent approximately 17 per cent of the population. People
aged 65+ years or more represent just over 15 per cent of the population and are projected to be close to 
20 per cent of the total population in 2021.

0

20 000

40 000

60 000

80 000

100 000

120 000

140 000

  0
 4

  5
 9

10
 1

4

15
 1

9

20
 2

4

25
 2

9

30
 3

4

35
 3

9

40
 4

4

45
 4

9

50
 5

4

55
 5

9

60
 6

4

65
 6

9

70
 7

4

75
 7

9

80
 8

4

85
+

N
um

be
r 

of
 p

eo
pl

e

June 2007
High series
2 million target

Graph 1.2.1  State population projections, South Australia

Note:  Projected population methods above are the state-level high series, and the target of 2 million by 2050 scenario.
Source: Planning SA, 2007.



page 17South Australia: Our Health and Health Services

chapter 1

The Adelaide Statistical Division based on the High series projection is projected to continue as the major 
driver of population growth in the state. The Estimated Residential Population (ERP) in June 2006 for this 
division was 1.14 million5, and it is projected to be 1.29 million by 2021.

This Division will continue to have one of the younger populations and attract the dominant share of 
overseas immigrants to the State, according to Planning SA. Outer Adelaide is projected to have the fastest 
rate of population growth in the State with most of the growth resulting from flows of older retirees to 
the southern coast and of young home buyers to the Adelaide Hills seeking cheaper land on the outskirts 
of metropolitan Adelaide.9

The projected average annual rate of population growth between 2006 and 2021 is 1.8 per cent per annum 
in Outer Adelaide, the highest rate of growth projected for any statistical division in the state, and close to 
twice the rate of growth projected for Adelaide Statistical Division, the second fastest growing division.9,5

1.2.1 State population projections based on the 2 Million by 2050 method
The South Australian Government has a population policy identifying specific population targets that, 
if achieved, will result in a total state population of 2 million by the end of year 2050.

Planning SA has prepared projections based on this target that show South Australia s population would 
increase at an average rate of 0.7 per cent per year, reaching 1 736 879 people in 2021.

The proportion of people aged 0 24 years is projected to increase by 2.5 per cent by 2021. Older people aged 
65+ years at the same time are projected to increase by 46.8 per cent and represent approximately 
20 per cent of the state s population.

The major contributors of growth in the South Australian population are natural increases (births minus 
deaths) and net overseas migration. The projected population numbers for the state in 2021 are affected 
by assumptions about future migration, from both overseas and interstate.9



page 18 South Australia: Our Health and Health Services

chapter 1

1.3  Geographic distribution

There are wide variations in regional population growth rates. The geographic distribution of the population 
within South Australia is concentrated overwhelmingly in Adelaide, the site of most economic activity 
and employment.

The population of Adelaide Statistical Division (SD) at June 2006 was 1.115 million people.5 Adelaide s yearly 
population increased by 9 272 people (0.8 per cent), while the remainder of the state increased by 3 288 
people (0.7 per cent).5 Adelaide SD accounted for 71.7 per cent of South Australia s population at June 2006.5 
This proportion is projected to increase to 76 per cent by 2051.4

Population growth has been relatively strong in the inner-regional areas, such as Mount Barker in the 
Mount Lofty Ranges, as well as in suburbs neighbouring the large horticultural industries in the south and 
north of Adelaide. Other towns within close proximity of Adelaide also are experiencing a share of the state s 
population growth   for example, Victor Harbor, Goolwa, Barossa Valley, Nuriootpa and Kapunda.11

South Australia has approximately 178 000 people living in outer regional areas, and 60 000 living in remote 
and very remote areas.4 There have been considerable population increases at regional centres such as 
Mount Gambier, Port Lincoln and Roxby Downs; this is mainly a result of large agricultural, aquaculture 
and mining industries in the areas, requiring extensive human resources.11

SA Health comprises three regions that manage the provision of health services in the metropolitan area: 
Central Northern Adelaide Health Service; Southern Adelaide Health Service; and the Children, Youth 
and Women s Health Service.

The first two regions are responsible for providing services in defined geographical areas while the third region 
provides statewide services to children, youth and women. Country Health SA   while a single country 
health region   provides a more integrated system of care across country South Australia. Maps of the three 
geographical regions are shown opposite.

0

10

20

30

40

50

70

80

Adelaide

Pe
r 

ce
nt

 o
f 

po
pu

la
ti

on 60

 Inner regional   Outer regional   Remote   Very remote 

Graph 1.3.1  Population distribution, June 2006, South Australia

 Adelaide Inner regional Outer regional Remote Very remote

Population 1 115 078 201 348 178 000 46 822 13 408
Per cent of population 71.7 13.0 11.4 3.0 0.9

Source: Australian Bureau of Statistics, Cat. No. 3218.0   Regional Population Growth, Australia.



page 19South Australia: Our Health and Health Services

chapter 1

The distribution of population for the SA Health geographic regions, based on the June 2006 Estimated 
Residential Population, is Central Northern Adelaide with 791 880, Southern Adelaide with 334 833 and 
Country with 441 491 people.

Refer to Chapter 10 for more information on SA Health services.

Port Lincoln

Port Augusta

Murray Bridge

Berri

Mount Gambier

Aldinga

Noarlunga Centre

Mt 
Barker

Glenelg

Bedford Park

Adelaide

Pt Adelaide

Modbury

Salisbury

Elizabeth

Gawler

Ceduna

Central
Northern 
Adelaide

Southern 
Adelaide

Country Health, SA

Figure 1.3.1  South Australian Health Service Regions 



page 20 South Australia: Our Health and Health Services

chapter 1

1.4  Socioeconomic status

There is a common link among a person s socioeconomic status, health-related behaviour, and health status. 
People living in areas of low socioeconomic status in South Australia are more likely to be unemployed, 
or unskilled/semi-skilled, and are less likely to have a motor car, or own a home.10

People with low socioeconomic status are more likely to smoke and/or consume large amounts of alcohol, 
and less likely to be physically active, and/or buy and consume healthy food.10

The Index of Relative Socioeconomic Disadvantage (IRSD) is one of the Socioeconomic Indexes for Areas 
(SEIFA) developed by the Australian Bureau of Statistics based on Census data. The IRSD is based on 
information available relating to education, income, occupation, Aboriginal status, ethnicity, and housing. 
Areas can be defined using this index as relatively advantaged (high scores) or relatively disadvantaged 
(low scores).12

The IRSD score at the 2001 Census for the metropolitan regions (excluding Gawler) was 1 007, 
marginally higher (seven index points) than the index score for South Australia of 1 000.6

Ceduna

Port Lincoln

Port Augusta

Port Pirie

Whyalla

Murray Bridge

Berri

Mount Gambier

Aldinga

Noarlunga Centre

Mt Barker

Glenelg

Bedford Park

Adelaide

Pt Adelaide

Modbury

Salisbury

Elizabeth

Gawler

Central
Northern 
Adelaide

Southern 
Adelaide

Country Health, SA

Health Regions

SEIFA Index of Disadvantage

676 800

800 900

900 1000

1000 1051

1051 1116

Figure 1.4.1  Socioeconomic status, South Australia, 2001 

Source: Australian Bureau of Statistics, Cat. No. 2033.4.55.001   Census of Population and Housing: 
 Socio-Economic Indexes for Areas (SEIFA), South Australia   Data Cube only, 2001.



page 21South Australia: Our Health and Health Services

chapter 1

1.4.1 Central Northern Adelaide Health Services region
This region had a very wide variation in index scores. The most disadvantaged Statistical Local Areas 
(SLAs) were Playford West Central (with an index score of 758), Port Adelaide Enfield Port (795) and 
Playford Elizabeth (803). The areas with the highest IRSD scores (most advantaged) were located in the 
eastern suburbs and included Burnside South-West (an index score of 1 117), Adelaide Hills Ranges (1 114), 
and Adelaide Hills Central (1 113).6

1.4.2 Southern Adelaide Health region
The most disadvantaged SLAs in the Southern region were Onkaparinga North Coast (an index score of 899), 
Onkaparinga Hackham (920), and Onkaparinga Morphett (953). The SLAs with the highest IRSD scores 
(most advantaged) in the south were Mitcham North-East (an index score of 1 111), Mitcham Hills (1 102), 
and Onkaparinga Reservoir (1 086).6

1.4.3 Country Health SA
The IRSD score in 2001 for country South Australia was 983, slightly below the index score for South Australia 
of 1 000.6 The lowest index scores were recorded for SLAs in the north and west of the state. The lowest 
scores coincide with areas having above-average Aboriginal populations.

The majority of the regions in country South Australia had IRSD scores below 1 000, indicating that they 
experience greater levels of disadvantage than in the state as a whole. The IRSD score for Northern and 
Far Western (926) was lower than the state average by 74 index points.6



page 22 South Australia: Our Health and Health Services

chapter 1

1.5  Aboriginal people

There were an estimated 26 044 Aboriginal people living in South Australia at June 2006, according to 
the experimental Estimated Residential Population. Aboriginal people accounted for 1.7 per cent of the total 
South Australian population and 5.0 per cent of the total Aboriginal population in Australia.3

The Aboriginal population is younger than the rest of the population, with 36.1 per cent of the population 
under 15 years of age compared with approximately 18.1 per cent of all South Australians.

The highest numbers of Aboriginal people are aged 5 9 years. The number of Aboriginal people within each 
age group starts to decrease after this age cohort, while the other South Australian population peaks in the 
45 49 age group, and decreases after that.

The Aboriginal population in South Australia aged 65 years or more is 3.5 per cent, compared to 15.1 per cent 
of all South Australians (for June 2006). There also is a substantial drop in the number of Aboriginal people 
aged between 20 24 and 25 29 years, illustrative of a relatively high mortality rate among young adults.

0 
4

5 
9

10
 1

4

15
 1

9

20
 2

4

25
 2

9

30
 3

4

35
 3

9

40
 4

4

45
 4

9

50
 5

4

55
 5

9

60
 6

4

65
+

Age groups (years)

0

300

600

900

1 200

1 500

1 800

Pe
op

le

Males

Females

Graph 1.5.1  Aboriginal population, June 2006, South Australia

Source: Australian Bureau of Statistics, 3101.0   Australian Demographic Statistics, Mar 2007 (tables 11 &amp; 12).



page 23South Australia: Our Health and Health Services

chapter 1

1.6  Notes

1.  Australian Bureau of Statistics, 2006 Census QuickStats: South Australia, viewed 29 June 2007, 
&lt;http://www.censusdata.abs.gov.au/ABSNavigation/prenav/ViewData?subaction=-1&amp;producttype=
QuickStats&amp;areacode=4&amp;action=401&amp;collection=Census&amp;textversion=false&amp;breadcrumb=PL&amp;period=
2006&amp;javascript=true&amp;navmapdisplayed=true&amp;&gt;

2.  Australian Bureau of Statistics, 2007, Population by Age and Sex, Australian States and Territories Jun 2007, 
Cat. no. 3201.0, Table 2, viewed 12 December 2007, &lt;http://www.abs.gov.au/AUSSTATS/abs@.nsf/
DetailsPage/3201.0Jun%202007?OpenDocument&gt;

3.  Australian Bureau of Statistics, 2007, Australian Demographic Statistics Jun 2007, Cat. no. 3101.0, 
viewed 7 December 2007, &lt;http://www.abs.gov.au/ausstats/abs@.nsf/81d2945d3269ee5cca25709a
00138ffb/6949409dc8b8fb92ca256bc60001b3d1!OpenDocument&gt;

4.  Australian Bureau of Statistics, 2006, Population Projections, By age and sex, South Australia   Series A, 
Cat. no. 3222.0 Table A4, viewed 2 July 2007, &lt;http://www.abs.gov.au/AUSSTATS/abs@.nsf/
DetailsPage/3222.02004%20to%202101?OpenDocument&gt;

5.  Australian Bureau of Statistics, Regional Population Growth, Australia, cat. no. 3218.0, ABS, 
viewed 2 July 2007, &lt;http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/3218.0Main%20
Features52005-06?opendocument&amp;tabname=Summary&amp;prodno=3218.0&amp;issue=2005-
06&amp;num=&amp;view=#SOUTH%20AUSTRALIA&gt;

6.  Australian Bureau of Statistics, 2006, Census of population and housing: socio-economic indexes for areas 
(SEIFA), Australia, data cube: Excel spreadsheet, Cat. no. 2033.0.55.001, viewed 14 August 2007, 
&lt;http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/2033.0.55.0012001?OpenDocument&gt;

7.  Department for Environment and Heritage, Current land use in South Australia, Department for 
Environment and Heritage, Adelaide, 2007, viewed 18 August 2007, &lt;http://www.environment.sa.gov.
au/reporting/land/landuse/current.html&gt;

8.  Department for Environment and Heritage, Changes in population growth, Department for Environment 
and Heritage, Adelaide, 2007, viewed 18 August 2007, &lt;http://www.environment.sa.gov.au/reporting/
human/population/changes.html&gt;

9.  Planning SA, Population Projections for South Australia (2001 31) and the State s Statistical Divisions (2001 21), 
Primary Industries and Resources SA, Planning SA, Adelaide, June 2007, viewed 18 August 2007, 
&lt;http://dataserver.planning.sa.gov.au/publications/1173p.pdf&gt;

10.  Department of Health, Better Choices Better Health, Department of Health, Adelaide, April 2003, viewed 
18 August 2007, &lt;http://www.dh.sa.gov.au/generational-health-review/documents/GHR_Main_Report_
WEB.pdf&gt;

11.  Government of South Australia, Prosperity through people: a population policy for South Australia, 
Government of South Australia, Adelaide, March 2004, viewed 18 August 2007, 
&lt;http://www.southaustralia.biz/move/Files/Population_Policy.pdf&gt;

12.  Department of Health, A Social Health Atlas of South Australia, 3rd Ed, Public Health Information 
Development Unit, Department of Health, Adelaide, 2006 viewed 18 August 2007, &lt;http://www.
publichealth.gov.au/publications/a-social-health-atlas-of-south-australia-%5Bthird-edition%5D.html&gt;



page 24 South Australia: Our Health and Health Services

chapter 2

2  Health status

In this chapter

Self-assessed health status &gt;

Life expectancy &gt;

Healthy life expectancy &gt;

Burden of disease &gt;

Mortality  &gt;

Avoidable mortality &gt;

Health inequalities  &gt;

Services and initiatives &gt;

Summary

 Health status indicators suggest that South Australia enjoys a high level of health overall. More than   &gt;
three quarters (83.2 per cent) of all respondents aged 16+ years reported in 2006 07 that their health  
status was excellent, very good or good, according to the South Australian Monitoring and Surveillance 
System (SAMSS).

 South Australia has shown, during the last 20 years, a steady increase in life expectancy at birth.   &gt;
Life expectancy at birth for the period 2003 2005 was 78.1 years for males and 83.4 years for females. 
Females continue on average to live longer than males; however, the gap narrowed from 6.9 years  
in 1984 to 5.3 years in the 2003 2005 period.

 Health adjusted life expectancy at birth has increased in South Australia, from 69.8 years in 1999 2001   &gt;
to 70.4 years in 2001 2003 for males, and from 74.9 years in 1999 2001 to 75.1 years in 2001 2003  
for females. 

 The burden of disease in South Australia (measured by years of life lost and years of life lost to disability)  &gt;
decreased slightly between 1999 2001 and 2001 2003, with males recording a higher disease burden  
than females.

 South Australia s age adjusted death rate in the 20 years to 2005 decreased by 32 per cent to 6.2 per 1 000  &gt;
persons. The Australian rate, by comparison, fell by 39 per cent to 6.0 per 1 000. 

 Cardiovascular disease and malignant neoplasms were responsible for almost two-thirds of life lost to  &gt;
premature mortality.

 Seventy per cent of the years of life lost to death in South Australia, occurring in people aged under   &gt;
75 years, was categorised as potentially avoidable.

 There are clear differences in disease burden across levels of geographic area grouped by socioeconomic  &gt;
disadvantage. The rate of potentially avoidable mortality is 86 per cent higher in the most disadvantaged 
areas compared to the least disadvantaged.

 As area disadvantage increases so does health loss attributed to risk factors. The largest absolute differences  &gt;
between high and low disadvantage areas occurred in smoking, diabetes and alcohol harm.



page 25South Australia: Our Health and Health Services

Introduction

A range of summary indicators describing the health status of the South Australian population is included 
in this chapter. The indicators include self-reported health ratings, life expectancy and mortality. Healthy life 
expectancy also is included to provide insight into the relative contribution of various diseases, conditions and 
causes of injury to the population, and to give a perspective not only on whether South Australians are living 
longer, but whether this time is being spent in good health.

Avoidable mortality provides a perspective on deaths that are potentially avoidable given available knowledge 
about social and economic policy impacts, health behaviours and health care.1

Health inequalities also are described within the chapter through both avoidable mortality data and burden 
of disease data; this highlights the relationship between relative socioeconomic disadvantage and population 
health loss due to disease, injury and death.

chapter 2



page 26 South Australia: Our Health and Health Services

2.1  Self-assessed health status

A measure of self-assessed health status has been derived from survey data. Respondents to the South 
Australian Monitoring and Surveillance System (SAMSS) survey were asked whether they perceived their health 
status to be excellent, very good, good, fair or poor. The indicator provides a simple and global tool which  
has been used increasingly in studies where researchers seek to understand the factors that contribute to the 
level of health achieved and health inequalities.2

The results of the 2006 07 SAMSS indicate that 83.2 per cent of respondents aged 16+ years reported their 
overall health as excellent, very good or good, and 16.8 per cent of respondents reported their overall health 
as fair or poor. There were no significant differences in the proportion of males compared to females who 
reported their overall health status as excellent/very good/good or fair/poor as shown in the table below. 

People aged 50+ years were more likely to report their overall health as fair or poor, while people aged  
16 to 49 years were more likely to report their overall health as excellent, very good or good.

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Excellent, very good or good 84.8 83.4 84.7 83.8 83.2 
Fair or poor 15.2 16.6 15.3 16.2 16.8 

2002 03 2003 04 2004 05 2005 06 2006 07

Note: Self-assessed health status was determined by asking respondents if they would rate their health 
 as excellent, very good, good, fair or poor.   
Source:  SA Health, South Australian Monitoring and Surveillance System (SAMSS), 16+ years. 

2002 03 2003 04 2004 05 2005 06 2006 07

Financial year

Pe
r 

ce
nt

100

90

80

70

60

50

40

30

20

10

0

Excellent, 
very good, 
good

Fair, poor

Graph 2.1.1  Self-assessed health status, proportion of the population aged 16+ years 

Excellent, very good or good 
Fair or poor 

83.4  83.0
16.6  17.0

Males Females

Table 2.1.1  Self-assessed health status, proportion of the population aged 16+ years, 2006 07 



page 27South Australia: Our Health and Health Services

chapter 2

16 19 
years 

20 29 
years 

30 39 
years 

40 49 
years 

50 59 
years 

60 69 
years 

70 79 
years 

80+ years 
 

88.1 91.3 88.4 87.6 80.1 77.1 70.6 64.3 Excellent, very
good, or good

11.9 8.7 11.6 12.4 19.9 22.9 29.4 35.7 Fair or poor 

Note: Self-assessed health status was determined by asking respondents if they would rate their health as excellent, 
 very good, good, fair or poor.   
Source:  SA Health, South Australian Monitoring and Surveillance System (SAMSS), 16+ years. 

100

90

80

70

60

50

40

30

20

10

0

Age groups (years)

Pe
r 

ce
nt

16 19 20 29 30 39 40 49 50 59 60 69 70 79 80+

Excellent, 
very good, 
good

Fair, poor

Graph 2.1.2  Self-assessed health status, by age group, proportion of the population aged 16+ years



page 28 South Australia: Our Health and Health Services

2.2  Life expectancy

Life expectancy is one form of population health measure estimating the average number of years a person 
can expect to live, on the assumption that current death rates continue to apply.

Life expectancy at birth in South Australia during the last 20 years shows a near-steady increase, consistent 
with other developed countries.5 Life expectancy among males increased by 6.6 per cent to 78.1 years.  
Female life expectancy started from a higher base and increased at a lower rate of 4.3 per cent to 83.4 years. 
These different rates of change reduced the sex differences in life expectancy. The gap closed from 6.9 years  
in 1984 to 5.3 years in the 2003 2005 period.

Average life expectancy at birth in Australia increased by 6.1 years (8.4 per cent) to 78.5 years for males 
during the last 20 years. Female life expectancy at birth increased to 83.3 years, an improvement of 4.5 years, 
or 5.7 per cent.6

South Australian females had the fourth highest life expectancy at birth in Australia of 83.4 years, over 
2003 2005, while South Australian males had the seventh highest of 78.1 years. The average life expectancy 
at birth for all Australian females over the same period, in comparison, was 83.3, for males was 78.5 years.

chapter 2

Note: Australian Bureau of Statistics figures are drawn from full period life tables. 
 Latter two periods are three-year averages. 
Source: Australian Bureau of Statistics, provided by consultancy in May 2006. 

    1984 1989 1994 1995 1996 1997 1998 1999 2000 2001 2002 2002 2004 2003 2005

Males   72.9 73.8 75.1 75.6 75.7 76.1 76.2 77.0 76.6 77.5 77.7 78.0 78.1
Females   79.8 79.8 81.2 81.5 81.6 81.6 81.9 82.5 82.4 82.3 82.6 83.1 83.4

19
84

19
85

19
86

19
87

19
88

19
89

19
90

19
91

19
92

19
93

19
94

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19
97

19
98

19
99

20
00

20
01

20
02

20
02

 2
00

4

20
03

 2
00

5

Period

66.0

68.0

70.0

72.0

74.0

76.0

78.0

80.0

82.0

84.0

86.0

A
ge

 in
 y

ea
rs

Males

Females

Graph 2.2.1  South Australia life expectancy (at birth) by gender



page 29South Australia: Our Health and Health Services

chapter 2

Y
ea

rs

Australian state or territory

70

73

76

79

82

85

New
South
Wales

Victoria Queensland Western
Australia

South
Australia

Tasmania Australian
Capital
Territory

Northern
Territory

Males

Females

Graph 2.2.2  All Australians average life expectancy at birth, 2003 2005

Source: Australian Bureau of Statistics, Deaths 2005, Australia, Cat. no. 3302.0, AusInfo, Canberra.



page 30 South Australia: Our Health and Health Services

2.3  Healthy life expectancy

Life expectancy (LE) is a familiar summary measure of health accounting for mortality. The question is raised, 
however   in light of steadily increasing LE in the developed world   of whether or not people are spending 
this extra time in good health. A range of individual indicators such as health registry records and population 
health surveys can help to answer this question. 

Recent developments in methods to summarise population health include burden of disease studies.  
These studies use data from many sources to produce summary health measures that account for mortality 
and morbidity. Health adjusted life expectancy (HALE) uses life expectancy estimates and burden of disease 
morbidity figures, and makes further adjustments according to the amount of time spent in less than  
perfect health.

The overall level of population health can be calculated using HALE for a range of ages in a way that is 
sensitive to probabilities of survival and death, as well as to the prevalence and severity of an exhaustive set  
of health states amongst the population.8 HALE has been calculated in a number of burden of disease studies, 
including the Australian studies.9-12

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1999 2001 2000 2002 2001 2003

Three-year average period

A
ge

 in
 y

ea
rs

68

70

72

74

76

Male

Female

Graph 2.3.1  Health adjusted life expectancy (at birth)

 1999 2001 2000 2002 2001 2003

Males  LE HALE ELD/LE LE HALE ELD/LE LE HALE ELD/LE
    (per cent)   (per cent)   (per cent)

 Age 0 77.3 69.8 9.8 77.5 70.0 9.7 77.8 70.4 9.6
 15 62.9 55.7 11.4 63.1 55.9 11.4 63.3 56.2 11.2
 30 48.7 42.1 13.5 48.9 42.3 13.4 49.1 42.6 13.2
 45 34.7 28.8 17.2 34.9 28.9 17.0 35.0 29.2 16.7
 60 21.4 16.3 23.6 21.6 16.5 23.4 21.8 16.8 22.9
 75 10.6 7.2 31.6 10.6 7.3 31.1 10.7 7.5 30.2

Females
         
 Age 0 83.0 74.9 9.8 83.0 75.0 9.7 83.1 75.1 9.6
 15 68.4 60.6 11.4 68.5 60.8 11.3 68.6 61.0 11.2
 30 53.7 46.7 13.0 53.8 46.8 12.9 54.0 47.1 12.8
 45 39.3 33.0 15.9 39.3 33.2 15.7 39.5 33.4 15.5
 60 25.5 20.2 20.9 25.6 20.3 20.6 25.8 20.5 20.4
 75 13.4 9.7 27.3 13.4 9.8 26.8 13.5 9.9 26.3

Note:  *ELD is the expected years lost to disability as a proportion of total life expectancy.
 Estimates are subject to revisions arising from further developments to methods and revision of input data.
Source: SA Health, SA Burden of Disease study, www.health.sa.gov.au/burdenofdisease.



page 31South Australia: Our Health and Health Services

chapter 2

The developing series of South Australian estimates of HALE begin with three-year averages for 1999 2001.13 

The total HALEs at birth were 69.8 years for males and 74.9 for females. Around 10 per cent of total life 
expectancy at birth was lost to disease and injury-related disability. HALE increased to 70.4 years for males  
and 75.1 for females by 2001 2003; this represents an increase in HALE of 0.9 per cent and 0.3 per cent 
for males and females respectively, and tracks satisfactorily against South Australia s Strategic Plan targeted 
increases of 5 per cent and 3 per cent by 2014.

Average health expectancy is consistently higher among females than males across the lifespan.  
The proportion of life expectancy lost to severity-weighted illness (ELD), however, is higher among males  
and becomes increasingly pronounced from around age 50.

The SA Burden of Disease study also has produced estimates of HALE for health regions and selected  
sub-regions, which are available from the study web site. The smaller the area examined, the more variation  
or statistical error there will be in the estimate, as a general rule.

South Australian level results are in line with earlier Australian estimates in which HALE at birth in 1996  
was estimated as 68.7 years for males and 73.6 for females12; it is similar also to the Global Burden of Disease 
study estimates for the established market economies in 1990, in which LE was estimated as 67.4 years  
for males and 73.9 years for females.

Improving mortality and/or morbidity outcomes in the population can increase HALE; that is, reducing 
incidence of mortality will improve life expectancy, while reducing incidence of disease and injuries will 
improve the morbidity component of HALE. The latter reduction also allows for the curing or remission  
of prevalent disease.

&lt;
1

1 
4

5 
9

10
 1

4

15
 1

9

20
 2

4

25
 2

9

30
 3

4

35
 3

9

40
 4

4

45
 4

9

50
 5

4

55
 5

9

60
 6

4

65
 6

9

70
 7

4

75
 7

9

80
 8

4

85
+

0

10

20

30

40

50

60

70

80

Age

A
ge

 in
 y

ea
rs

0

5

10

15

20

25

30

35

40

EL
D

 p
er

 c
en

t 

Male-HALE
Male-ELD

Female-HALE
Female-ELD

Graph 2.3.2  Health adjusted life expectancy by age, South Australia 2001 2003

Note:  Estimates are subject to revisions arising from further developments to methods and revision of input data.
Source: SA Health, SA Burden of Disease study, www.health.sa.gov.au/burdenofdisease.



page 32 South Australia: Our Health and Health Services

2.4  Burden of disease

Burden of disease methods, like health expectancy measures, account for time lived in health states worse 
than ideal health and the severity of those states.14,15 Burden of disease methods differ from health expectancy 
measures in that they describe health gaps, or the difference between the actual and an optimum or target 
health of a population for population health outcomes. The key function is a reduction of the impact of both 
premature mortality and various states of morbidity to a common metric. This metric produces an overview  
of health in a population at a given point in time.

Disability adjusted life years (DALY) is the measure most frequently used for calculating health gaps.  
DALY is used to calculate life years lost from a range of diseases and injuries, using a range of assumptions 
about the severity and duration of mental or physical disability.16 DALY comprises two components: mortality  
is represented by the amount of years of life lost (YLL), and morbidity by the amount of years lost to disability 
or illness (YLD). Refer to the glossary for a detailed description of both YLD and YLL.

Conditions responsible for the most health loss occurring in South Australia are listed in the following tables. 
These conditions provide a measure of need, while not necessarily indicating areas most amenable to change 
or prevention, or measuring intervention effect, economic efficiency or equity. This need moreover can be 
broken down by sex, age, condition, risk factor and for smaller geographic areas.

chapter 2



page 33South Australia: Our Health and Health Services

South Australians recorded 111 647 YLL or an average of 73.5 years of life lost per 1 000 persons per year 
from premature death in the period 2001 2003; of these, 60 765 YLL (54.3 per cent of total) were recorded 
for males and 50 882 YLL (45.6 per cent) for females. It is estimated, using age and gender standardised  
rates for South Australia, that premature death was responsible for 65.9 YLL per 1 000, down from 68.1 YLL  
per 1 000 in the period 1999 2001. The Australian average YLL for 2003 was around 64.3 per 1 000.

South Australians recorded 100 473 YLD or an average of 66.1 years of life lost per 1 000 persons per year 
from disease and injury-related illness in the period 2001 2003; of these, 49 037 YLD (51.2 per cent of total) 
were recorded for males and 51 436 YLD (48.8 per cent) for females. It is estimated   on age and gender 
standardised rates for South Australia   that morbidity was responsible for 63.1 YLD per 1 000, down from  
64.0 YLD per 1 000 in the period 1999 2001.

chapter 2

Table 2.4.1  Leading causes of mortality burden (YLL) by gender and condition, South Australia 2001 2003

   Males     Females

Rank  Condition YLL Per cent Rank  Condition YLL Per cent

 1 Ischaemic heart disease 11 828 19.5  1 Ischaemic heart disease 8 496 16.7
 2 Lung cancer 4 092 6.7  2 Stroke 4 415 8.7
 3 Suicide and self-inflicted injuries 3 464 5.7  3 Breast cancer 3 805 7.5
 4 Stroke 3 161 5.2  4 Lung cancer 2 553 5.0
 5 Colorectal cancer 2 528 4.2  5 Colorectal cancer 2 167 4.3
 6 Road traffic accidents 2 490 4.1  6 Pneumonia 1 633 3.2
 7 Chronic obstructive     7 Chronic obstructive 
  pulmonary disease 2 216 3.6   pulmonary disease 1 542 3.0
 8 Prostate cancer 1 985 3.3  8 Dementia and Alzheimer's disease 1 470 2.9
 9 Pneumonia 1 384 2.3  9 Ovarian cancer 1 066 2.1
 10 Cirrhosis of the liver 1 257 2.1  10 Other cardiovascular disease 981 1.9
 11 Type 2 diabetes 1 218 2.0  11 Type 2 diabetes 952 1.9
 12 Other chronic respiratory diseases 1 122 1.8  12 Pancreatic cancer 906 1.8
 13 Brain cancer 1 018 1.7  13 Road traffic accidents 886 1.7
 14 Non-Hodgkin's lymphoma 1 010 1.7  14 Other chronic respiratory diseases 863 1.7
 15 Other cardiovascular disease 916 1.5  15 Suicide and self-inflicted injuries 820 1.6
 16 Other malignant neoplasms 892 1.5  16 Non-Hodgkin's lymphoma 796 1.6
 17 Leukaemia 892 1.5  17 Leukaemia 748 1.5
 18 Pancreatic cancer 884 1.5  18 Other endocrine and metabolic 744 1.5
 19 Stomach cancer 864 1.4  19 Other malignant neoplasms 651 1.3
 20 Oesophageal cancer 744 1.2  20 Brain cancer 647 1.3
  All other conditions 16 801 27.6   All other conditions 14 739 29.0

 Total  60 765 100.0 Total  50 882 100.0
 
Note:  Years of life lost (YLL) are uniform age weighted and 3 per cent per annum discounted.
 Conditions and categories allocated as per SA Burden of Disease study, www.health.sa.gov.au/burdenofdisease. 
Source: Australian Bureau of Statistics, Deaths data from Confidentialised Unit Record Files.



page 34 South Australia: Our Health and Health Services

chapter 2

Table 2.4.2  Leading causes of morbidity burden (YLD) by gender and condition, South Australia 2001 2003

   Males     Females

Rank  Condition YLD Per cent Rank  Condition YLD Per cent

 1 Adult-onset hearing loss 3 291 6.7  1 Depression 4 645 9.0
 2 Depression 2 929 6.0  2 Dementia and Alzheimer's disease 4 292 8.3
 3 Dementia and Alzheimer's disease 2 737 5.6  3 Osteoarthritis 3 167 6.2
 4 Chronic obstructive pulmonary disease 2 248 4.6  4 Asthma 2 414 4.7
 5 Ischaemic heart disease 2 233 4.6  5 Age-related vision disorders 1 914 3.7
 6 Alcohol dependence and harmful use 2 226 4.5  6 Generalised anxiety disorder 1 706 3.3
 7 Stroke 2 166 4.4  7 Type 2 diabetes 1 683 3.3
 8 Osteoarthritis 2 100 4.3  8 Stroke 1 596 3.1
 9 Type 2 diabetes 1 760 3.6  9 Breast cancer 1 554 3.0
 10 Asthma 1 683 3.4  10 Parkinson's disease 1 469 2.9
 11 Other nervous system disorders 1 178 2.4  11 Adult-onset hearing loss 1 432 2.8
 12 Parkinson's disease 979 2.0  12 Chronic obstructive pulmonary disease 1 392 2.7
 13 Prostate cancer 963 2.0  13 Ischaemic heart disease 1 352 2.6
 14 Generalised anxiety disorder 920 1.9  14 Other genitourinary diseases 1 003 1.9
 15 Borderline personality disorder 820 1.7  15 Alcohol dependence and harmful use 993 1.9
 16 Benign prostatic hypertrophy 791 1.6  16 Other nervous system disorders 963 1.9
 17 Peripheral arterial disease 733 1.5  17 Social phobia 789 1.5
 18 Other genitourinary diseases 726 1.5  18 Schizophrenia 663 1.3
 19 Attention-deficit hyperactivity disorder 680 1.4  19 Bipolar affective disorder 656 1.3
 20 Schizophrenia 674 1.4  20 Rheumatoid arthritis 594 1.2
  All other conditions 17 199 35.1   All other conditions 17 160 33.4

 Total  49 037 100.0  Total  51 436 100.0

Note:  Years Lost to Disability/Illness (YLD) are uniform age weighted and 3 per cent per annum discounted.
 Conditions and categories allocated as per SA Burden of Disease study, www.health.sa.gov.au/burdenofdisease. 
Source: SA Health, SA Burden of Disease study.



page 35South Australia: Our Health and Health Services

2.5  Mortality

South Australia s age adjusted death rate decreased by 32 per cent to 6.2 per 1 000 persons in the 20 years  
to 2005; by comparison, the Australian rate fell by 39 per cent to 6.0 per 1 000.6

The relative reductions in rate by sex were similar, with 33 per cent for both males and females. The age 
adjusted death rate for males in 2005 was 59 per cent higher than the female death rate; this difference  
is similar to the rate ratio 20 years earlier in 1985.

The absolute number of South Australian deaths each year increased by 6.7 per cent to 11 975 between  
1985 and 2005, with population increasing by 4.9 per cent. The largest increases in death numbers were  
in people aged 85+; this age group accounted for 34 per cent of all deaths by 2005, a 38 per cent increase 
from 1985.

Cardiovascular disease and malignant neoplasms were responsible for almost two-thirds of life lost to 
mortality. Cardiovascular disease (40 per cent), malignant neoplasms (21 per cent) and injury (18 per cent) 
together accounted for four of every five years of life lost among people aged between 25 and 64 years. 
Cardiovascular disease (particularly ischaemic heart disease and stroke), cancer (particularly lung cancer)  
and respiratory conditions (chronic obstructive pulmonary disease and pneumonia) contributed 44 per cent,  
23 per cent and 12 per cent respectively of total burden of disease in elderly people, aged 75+ years.

Mortality among young people makes up a small amount of overall burden; notwithstanding this, a high 
proportion of loss (68 per cent) among 15-to-24-years-olds is due to injury, particularly road traffic accidents 
and suicide/self-inflicted injuries.

chapter 2

19
85

19
86

19
87

19
88

19
89

19
90

19
91

19
92

19
93

19
94

19
95

19
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19
97

19
98

19
99

20
00

20
01

20
02

20
03

20
04

20
05

Ra
te

 p
er

 1
 0

00

0

2

4

6

8

10

12

14

Year

Males

Females

Graph 2.5.1  Deaths from all causes by gender, South Australia, 1985 2005

    1985 1990 1995 2000 2001 2002 2003 2004 2005

Males   11.6 10.7 9.7 8.8 8.4 8.3 8.3 7.7 7.8
Females   7.3 6.6 6.0 5.5 5.5 5.4 5.3 5.0 4.9
Persons   9.1 8.4 7.6 6.9 6.8 6.7 6.6 6.2 6.2

Note:   Deaths per 1 000, age adjusted to Australia 2001.
Source:   Australian Bureau of Statistics, Deaths Australia 2005.



page 36 South Australia: Our Health and Health Services

chapter 2

Table 2.5.1  Mortality burden (YLL) by category, South Australia, three-year averages 2001 2003

Rank  Category YLL Per cent Deaths  

 1 Malignant neoplasms 35 929 32.2 3 306
 2 Cardiovascular disease 34 280 30.7 4 618
 3 Unintentional injuries 6 181 5.5 367
 4 Chronic respiratory disease 6 180 5.5 748
 5 Intentional injuries 4 779 4.3 219
 6 Nervous system and sense organ disorders 4 387 3.9 554
 7 Diseases of the digestive system 3 775 3.4 396
 8 Acute respiratory infections 3 124 2.8 526
 9 Type 1 and Type 2 diabetes 2 597 2.3 295
 10 Infectious and parasitic diseases 1 917 1.7 189
 11 Genitourinary diseases 1 819 1.6 291
 12 Endocrine and metabolic disorders 1 428 1.3 145
 13 Mental disorders 1 278 1.1 77
 14 Congenital anomalies 1 149 1.0 49
 15 Neonatal causes 1 133 1.0 37
 16 Musculoskeletal diseases 631 0.6 74
 17 Other neoplasms 579 0.5 72
 18 Skin diseases 192 0.2 30
 19 Ill-defined conditions 159 0.1 9
 20 Nutritional deficiencies 108 0.1 18
 21 Maternal conditions 17 0.0 1
 22 Oral health 6 0.0 1

  Total 111 647 100.0 12 021

Note:  Years of life lost (YLL) are uniform age weighted and 3 per cent per annum discounted.
 Conditions and categories allocated as per SA Burden of Disease study, www.health.sa.gov.au/burdenofdisease. 
  Ill-defined conditions  is a term used within the ICD categories (The International Statistical Classification of Diseases 
 and Related Health Problems).
Source: Australian Bureau of Statistics, Deaths data from Confidentialised Unit Record Files.

 



page 37South Australia: Our Health and Health Services

chapter 2

Table 2.5.2  Mortality burden (YLL) by age, South Australia, three-year averages 2001 2003

Category 0 4 5 14 15 24 25 34 35 44 45 54 55 64 65 74 75+
 years years years years years years years years years

Acute respiratory infections 30 0 9 62 63 142 206 306 2 306
Cardiovascular disease 65 10 125 472 1 173 2 315 4 090 7 130 18 899
Chronic respiratory disease 0 39 48 62 170 333 779 1 756 2 993
Congenital anomalies 726 20 87 81 74 45 35 35 47
Type 1 and Type 2 diabetes 0 0 10 38 143 237 353 678 1 139
Diseases of the digestive system 0 0 39 45 331 593 769 675 1 325
Endocrine and metabolic disorders 123 19 39 36 57 198 181 276 499
Genitourinary diseases 0 0 0 24 34 37 103 236 1 385
Ill-defined conditions 144 0 0 0 0 0 0 0 15
Infectious and parasitic diseases 122 0 75 86 181 255 253 243 701
Intentional injuries 66 10 829 1 162 1 355 809 284 191 72
Malignant neoplasms 79 157 384 660 2 189 4 937 7 886 9 518 10 118
Maternal conditions 0 0 0 9 8 0 0 0 0
Mental disorders 0 0 101 411 354 121 76 72 142
Musculoskeletal diseases 0 10 0 18 57 61 34 153 298
Neonatal causes 1 123 10 0 0 0 0 0 0 0
Nervous system and sense organ disorders 118 89 106 222 211 336 429 631 2 243
Nutritional deficiencies 0 0 10 0 0 7 0 4 87
Oral health 0 0 0 0 0 0 0 3 3
Other neoplasms 21 10 0 0 8 68 71 88 313
Skin diseases 0 0 0 0 8 8 10 43 124
Unintentional injuries 278 294 1 342 1 132 853 794 483 397 609

Total 2 895 667 3 204 4 520 7 269 11 296 16 043 22 435 43 318

Note:  Years of life lost (YLL) are uniform age weighted and 3 per cent per annum, discounted.
 Conditions and categories allocated as per SA Burden of Disease study, www.health.sa.gov.au/burdenofdisease. 
Source: Australian Bureau of Statistics, Deaths data from Confidentialised Unit Record Files.

 



page 38 South Australia: Our Health and Health Services

2.6  Avoidable mortality

Deaths, and Years of life lost, can be categorised as potentially avoidable on the basis of existing health  
and social structures, and current understanding of lifestyle risks to health.1 A simple method for gauging the 
scope of potential gains in population health is to identify conditions as  potentially avoidable  and calculate 
the burden associated with these incidents.

Seventy per cent of YLL occurring in people aged less than 75 (43 per cent of YLL in all ages) was categorised 
as potentially avoidable in South Australia in the period 2001 2003. This rate has fallen from 71 per cent in 
the period 1999 2001 when South Australian reporting begins.13 South Australian rates are comparable to 
the 72 per cent figure for Australia in the period 1997 2001.1

Rates of loss of life were higher for males than females. The YLL rate for males was 41.8 per 1 000 which was 
61 per cent higher than the female rate of 25.9 per 1 000.

Almost one-third of avoidable YLL occurred in the 65 74 year age group. The 45 64 year age group bore  
40 per cent of avoidable mortality with the remaining 38 per cent distributed across the youngest age groups.

chapter 2

0

20

40

60

80

100

120

140

Y
LL

 p
er

 1
 0

00

0 4 5 14 15 24 25 34 35 44 45 54 55 64 65 74

Age groups (years)

Avoidable Not avoidable

Graph 2.6.1  Potentially avoidable mortality (0-74 years), South Australia, three-year averages 2001 2003

    Males       Females

  Avoidable   Not avoidable   Avoidable   Not avoidable

 YLL Per cent  Rate/ YLL Per cent  Rate/ YLL Per cent  Rate/ YLL Per cent  Rate/
  of total 1 000  of total 1 000  of total 1 000  of total 1 000 

 0 4 726 2.5 15.7 646 5.6 14.0 956 5.3 21.5 488 5.7 11.0
 5 14 196 0.7 1.9 205 1.8 2.0 128 0.7 1.3 139 1.6 1.4
 15 24 1 864 6.3 18.1 417 3.6 4.0 622 3.4 6.3 227 2.7 2.3
 25 34 2 496 8.5 23.9 622 5.4 6.0 911 5.0 9.0 345 4.0 3.4
 35 44 3 448 11.7 30.2 877 7.6 7.7 2 047 11.3 17.9 727 8.5 6.4
 45 54 4 820 16.4 45.7 1 766 15.3 16.7 3 174 17.6 29.4 1 395 16.3 12.9
 55 64 6 706 22.8 86.0 2 986 26.0 38.3 4 140 22.9 52.4 2 102 24.5 26.6
 65 74 9 169 31.2 166.0 3 988 34.7 72.2 6 088 33.7 101.5 3 139 36.7 52.4

 Total 29 425 100.0 41.8 11 505 100.0 16.3 18 065 100.0 25.9 8 561 100.0 12.3

Note:  Years of Life Lost (YLL) are uniform age weighted and 3 per cent per annum discounted.
 Categorisation of potentially avoidable deaths made as per Page, et al (2006)1.
 General conditions allocated as per SA Burden of Disease study, www.health.sa.gov.au/burdenofdisease. 
Source: Australian Bureau of Statistics, Deaths data from Confidentialised Unit Record Files.



page 39South Australia: Our Health and Health Services

Nine of the 10 leading causes of avoidable mortality were common to both sexes in the period 2001 2003, 
although the rankings differ; the exceptions were stomach cancer in males and breast cancer, the leading 
avoidable cause of mortality, in females.

chapter 2

Table 2.6.1  Leading causes of potentially avoidable mortality (YLL) by condition and gender, South Australia, 

     three-year averages 2001 2003

   Males     Females

Rank  Condition YLL Per cent Rank  Condition YLL Per cent
    of total     of total

 1 Ischaemic heart disease 6 498 22.1  1 Breast cancer 2 935 16.2
 2 Suicide and self-inflicted injuries 3 382 11.5  2 Ischaemic heart disease 2 349 13.0
 3 Lung cancer 2 723 9.3  3 Lung cancer 1 625 9.0
 4 Road traffic accidents 2 326 7.9  4 Colorectal cancer 1 259 7.0
 5 Colorectal cancer 1 811 6.2  5 Stroke 1 226 6.8
 6 Stroke 1 399 4.8  6 Road traffic accidents 819 4.5
 7 Chronic obstructive  1 102 3.7  7 Suicide and self-inflicted injuries 793 4.4
  pulmonary disease    8 Chronic obstructive 
 8 Cirrhosis of the liver 1 026 3.5   pulmonary disease 771 4.3
 9 Type 2 diabetes 720 2.4  9 Type 2 diabetes 418 2.3
 10 Stomach cancer 600 2.0  10 Cirrhosis of the liver 319 1.8
  All others 9 817 26.6   All others 5 753 30.7

   Total 31 406 100.0    Total 18 268 100.0

Note:  Years of life lost (YLL) are uniform age weighted and 3 per cent per annum discounted.
 Categorisation of potentially avoidable deaths made as per Page, et al (2006)1.
 General conditions allocated as per SA Burden of Disease study, www.health.sa.gov.au/burdenofdisease. 
Source: Australian Bureau of Statistics, Deaths data from Confidentialised Unit Record Files.

 



page 40 South Australia: Our Health and Health Services

2.7  Health inequalities

Potentially avoidable deaths offer one way to look at health inequalities within South Australia.  
YLL rates are higher in areas where relative socioeconomic disadvantage is higher.17 Areas of least 
disadvantage are concentrated in the inner suburbs of Adelaide and the eastern metropolitan area,  
with the most disadvantaged areas scattered across the northwest and southern suburbs, and the more 
remote areas of the state. There is a clear difference in YLL rates across levels of area disadvantage.  
The rate of potentially avoidable mortality is 86 per cent higher in the most disadvantaged areas  
compared to the least disadvantaged.

chapter 2

0

5

10

15

20

25

30

35

40

45

Y
LL

 p
er

 1
 0

00

Most
disadvantaged

2 3 4 Least 
disadvantaged

2001 Index of Relative Socioeconomic Disadvantage (IRSD) Quintiles

Graph 2.7.1  Potentially avoidable mortality (0-74 years) by Area Disadvantage quintile, South Australia, 

      three-year averages 2001 2003

Note:  Years of life lost (YLL) are uniform age-weighted and 3 per cent per annum discounted.
 Categorisation of potentially avoidable deaths made as per Page, et al (2006)1.
 General conditions allocated as per SA Burden of Disease study, www.health.sa.gov.au/burdenofdisease. 
 Rates are age- and sex-adjusted to the 2001 Australian population.
Source: Australian Bureau of Statistics, Deaths data from Confidentialised Unit Record Files.



page 41South Australia: Our Health and Health Services

Disability adjusted life years provide a fuller description of population health outcomes accounting for 
mortality and morbidity. DALYs also are used easily in statistical methods to adjust for confounding variables; 
this is useful because, in South Australia, and particularly in metropolitan Adelaide, residential aged care 
facilities tend to be concentrated in inner, relatively advantaged suburbs.13

The DALY rate for the most disadvantaged area in South Australia was 172.6 per 1 000 persons, around 80 
per cent greater than the DALY rate in the least disadvantaged area (94.9 DALYs per 1 000 persons).

An examination of the disease burden due to various risk factors offers another perspective on diseases  
and injuries that impact upon population health. The prevalence of risk factors is discussed in more  
detail in Chapter 4. Health outcomes attributed to exposure to discrete risk factors are considered here.  
DALY outcomes again can be expressed in terms of relative socioeconomic disadvantage.

chapter 2

Most 20 40 60 80 100 Least
disadvantaged                    disadvantaged

2001 Index of Relative Socioeconomic Disadvantage (IRSD) Rank

0

20

40

60

80

100

120

140

160

180

200

D
A

LY
 p

er
 1

 0
00

Graph 2.7.2  Health loss by Statistical Local Area Disadvantage and Health Region, South Australia, 

       three-year averages 2001 2003

Central Northern Adelaide Health Service

Southern Adelaide Health Service

Country Health SA

Note:  DALYs are uniform age-weighted and 3 per cent per annum discounted.
 Rates are age- and sex-adjusted to the 2001 Australian population. 
 Rates are further adjusted for high-care Residential Aged Care Facility (RACF) numbers. 
Source: SA Health, SA Burden of Disease study, www.health.sa.gov.au/burdenofdisease.



page 42 South Australia: Our Health and Health Services

As area disadvantage increases so too does health loss attributed to risk factors. The largest absolute 
differences between high and low disadvantage areas occurred in smoking (6.6 DALYs per 1 000 persons) 
followed by diabetes (6.0) and alcohol harm (3.5).

chapter 2

Most
disadvantaged

2 3 4 Least 
disadvantaged

0

2

4

6

8

10

12

14

16

18

D
A

LY
 p

er
 1

 0
00

2001 Index of Relative Socioeconomic Disadvantage (IRSD) Quintiles

Alcohol harm
Cholesterol
Hypertension
Inadequate fruit and vegetable
Obesity
Physical inactivity
Smoking
Diabetes

Graph 2.7.3  Health loss by selected risk factors by Area Disadvantage, South Australia, 

       three-year averages 2001 2003

   Area disadvantage

 Most disadvantaged 2 3 4   Least disadvantaged 
 40.8 32.3 30.7 24.3 22.0
 
Note:  Years of life lost (YLL) are uniform age-weighted and 3 per cent per annum discounted.
 Categorisation of potentially avoidable deaths made as per Page, et al. (2006)1.
 General conditions allocated as per SA Burden of Disease study, www.health.sa.gov.au/burdenofdisease. 
 Rates are age- and sex-adjusted to the 2001 Australian population.
 Additional data on risk factors of illicit drug use, occupation and unsafe sex are available on the web site above.
Source: Australian Bureau of Statistics, Deaths data from Confidentialised Unit Record Files.



page 43South Australia: Our Health and Health Services

The results of the 2006 07 SAMSS indicate that respondents in the most disadvantaged quintile were more 
likely to report their health as fair or poor (22.6 per cent) compared to those in the least disadvantaged 
quintile (13.1 per cent).

SAMSS also shows that respondents born in Australia were more likely to report their health as excellent, very 
good or good (84.5 per cent) than were those born in the United Kingdom or Ireland (79.7 per cent) or in 
other countries (77.2 per cent). There was a similar trend with respect to Aboriginal status, with respondents 
of non-Aboriginal or Torres Strait Islander origin more likely to report their health as excellent, very good or 
good (84.0 per cent) than were those of Aboriginal or Torres Strait Islander origin (77.2 per cent).

The graph above indicates that, with regard to some of the major chronic conditions, respondents born in  
the United Kingdom or Ireland were significantly more likely to have arthritis than were those born in Australia 
and other countries. There was a similar trend for osteoporosis or cardiovascular disease.

The SAMSS results also show that respondents born in Australia were more likely to have asthma than were 
those born outside the country. Respondents born outside of Australia, however, were more likely to have 
been told by a doctor that they had diabetes.

chapter 2

0

5

10

15

20

25

30

35

Arthritis Osteoporosis Asthma Cardiovascular
disease

Diabetes

Chronic condition

Pe
r 

ce
n

t

Australia

United Kingdom/Ireland

Other

Note:  These conditions are defined as respondents having been informed by a doctor that they had the condition.
Source: SA Health, South Australian Monitoring and Surveillance System (SAMSS), 16+ years.

Graph 2.7.4  Prevalence of chronic conditions, 16+ years, by country of birth, 2006 07



page 44 South Australia: Our Health and Health Services

2.8  Services and initiatives

SA Health seeks to improve the health status of South Australians and is committed to a primary health care 
approach that encompasses the social, economic, cultural, behavioural and biological determinants of health, 
from the well population to individuals with chronic disease, and from before birth to old age.

The main focus of services and initiatives offered by SA Health, in line with this approach, is aimed at 
promoting good health and wellbeing, and early intervention and management of health problems that 
individuals are experiencing. SA Health works collaboratively with a range of partners, both within and  
outside government, to ensure as much of the community as possible benefits from implementing effective 
programs of support.

Health and lifestyle programs are being developed and implemented to ensure healthy population outcomes 
and to prevent major health risk factors, supported by training for specific service providers, particularly in 
the areas of healthy weight and smoking. Advice and support are provided to populations and individuals 
to increase the effectiveness of the programs. Legislative and policy approaches are undertaken to reduce 
exposure to, and increase understanding of, risk factors.

Advice and support are given to people by providing access to coordinated and integrated health services,  
and through programs aimed at developing the ability of individuals to self-manage conditions. It is expected 
as a result that those with health-impairing conditions can enjoy the most participative community life,  
for as long as possible. GP Plus Health Care Centres increasingly will become the focal point in the community, 
where a range of primary health care service providers work together to improve coordinated delivery of care. 
SA Health also is working with private, local government, and non-government providers, including Aboriginal 
Community Controlled Services, to develop and implement more effective and appropriate services across  
the continuum of care in South Australia.

Increasing awareness and understanding of health conditions in the community, particularly in relation to 
mental health and chronic illness, is an important community outcome to enhance the capacity of individuals 
to live as fully in the community as possible. SA Health has a range of initiatives in place, and under 
development, to raise community awareness in providing support to those in need.

Aboriginal people experience more life risk factors, poorer health, and less acceptable outcomes in a range 
of life areas when compared to other South Australians. Aboriginal people as a result are among the most 
disadvantaged groups in the community. The SA Health approach is through a comprehensive, integrated 
primary health care focus to meet the complex needs of Aboriginal people. Strategies emphasise primary 
health care through healthy lifestyle programs, child and maternal health, and chronic disease management.

chapter 2



page 45South Australia: Our Health and Health Services

2.9  Notes
1.  A Page, M Tobias &amp; J Glover., Australian and New Zealand Atlas of Avoidable Mortality, Public Health 

Information Development Unit (PHIDU), Ministry of Health, 2006.

2.  Department of Human Services Victoria, Your Health: A report on the health of Victorians 2005,  
Department of Human Services, Melbourne, Victoria, 2005.

3.  Australian Bureau of Statistics 2006, National Health Survey: Summary of results 2004 05,  
Cat. no. 4364.0, ABS, Canberra.

4.  Australian Bureau of Statistics 2007, Self-assessed Health in Australia: A Snapshot, 2004 05,  
Cat no. 4828.0.55.001, ABS, Canberra.

5.  G Doblhammer and J Kytir,  Compression or expansion of morbidity? Trends in healthy-life expectancy  
in the elderly Austrian population between 1978 and 1998 , Social Science &amp; Medicine, vol. 52, no. 3, 
2001, pp. 385 91.

6. Australian Bureau of Statistics 2006, Deaths 2005, Cat. no. 3302.0, ABS,: Canberra.

7.  D Eayres and E S Williams,  Evaluation of methodologies for small area life expectancy estimation , 
Journal of Epidemiology &amp; Community Health, vol. 58, no. 3, 2004, pp. 243 9.

8.  C. Mathers, T Vos &amp; C Stevenson,  The burden of disease and injury in Australia , Bulletin World  
Health Organization, vol. 79, no. 11, 2001, pp. 1076 84.

9.  C J Murray, C J &amp; A D Lopez,(eds), Global Health Statistics, Vol. 2. 1996, Harvard School of Public Health: 
Cambridge, MA. 906.

10.  C Mathers, T Vos &amp; C Stevenson, The burden of disease and injury in Australia. 1999, Australian Institute  
of Health &amp; Welfare: Canberra. p. 245.

11.  S Begg, T Vos, B Barker, C Stevenson, L Stanley &amp; A Lopez, Burden of Disease and Injury in Australia 2003, 
Australian Institute of Health &amp; Welfare, Canberra, 2007.

12.  C Mathers, T Vos, &amp; C Stevenson, The Burden of Disease and Injury in Australia. Australian Institute  
of Health and Welfare, Canberra, 1999.

13.  Department of Health South Australia, Population Health in South Australia: Burden of Disease &amp; Injury 
estimates 1999 2001, Department of Health, Adelaide,2005.

14.  J Robine, C Mathers, M Bone &amp; I Romieu, (eds).  Calculation of Health Expectancies, Harmonization, 
Consensus Achieved and Future Perspectives , Colloque INSERM, vol. 226, 1993, John Libbey Eurotext 
and Les Editions INSERM, France.

15.  C J Murray, J A Salomon, C D Mathers &amp; A D Lopez, Health gaps: an overview and critical appraisal,  
in: C J Murray, J A Salomon, C D Mathers &amp; A D Lopez, Summary Measures of Population Health:  
Concepts, Ethics, Measurement and Application, World Health Organization, Geneva, 2002,  
pp. 233 244.

16.  J A Fox-Rushby, Disability adjusted life years (DALYs) for decision making? an overview of the literature,  
Office of Health Economics, London, 2002.

17.  Australian Bureau of Statistics, Census of Population and Housing: Socio-Economic Indexes for Areas (SEIFA), 
Australia, 2001, ABS, Canberra, 2003.

chapter 2



page 46 South Australia: Our Health and Health Services

3  Health priority areas

In this chapter

Injury  &gt;

Cardiovascular health, including stroke &gt;

Cancer  &gt;

Diabetes  &gt;

Asthma &gt;

Chronic respiratory conditions  &gt;

Renal disease/failure  &gt;

Arthritis and musculoskeletal conditions  &gt;

Living with chronic conditions &gt;

Services and initiatives &gt;

Summary

 Injury, domestic violence, cardiovascular conditions, cancer, diabetes, asthma, renal disease/failure  &gt;
and arthritis and musculoskeletal conditions together account for over 60 per cent of South Australia s 
 burden of disease , which measures both Years of life lost (YLL) due to premature death together 
with years of healthy life lost due to living with disease (YLD).

 The greatest opportunities for health improvements with these conditions at the population level continue  &gt;
to be with prevention strategies aimed at reducing the prevalence of modifi able risk factors, screening, 
and managing disease with advances in surgical techniques, pharmaceutical therapies and rehabilitation.

 Considerable evidence exists regarding the utility of interventions ameliorating these conditions,  &gt;
with implementation directed by South Australia s Health Care Plan 2007 2016. Surveillance systems provide 
essential information for epidemiological analyses to assist in identifying suitable interventions and 
monitoring their impact. 

 Injury is the leading cause of mortality in South Australians aged one to 44 years. Males are at higher risk  &gt;
than females, with lifestyle and behaviour playing a large role in determining risk. Risks are greatly modifi ed 
by the environment, and there is a strong inverse association with socioeconomic status. Falls remain the 
most prominent injury threat amongst older people.

 Domestic violence in 2002 03 was estimated to cost the Australian economy $8.1 billion, including direct  &gt;
and indirect costs.

 Mortality due to cardiovascular conditions including ischaemic heart disease, stroke, heart failure and  &gt;
peripheral vascular disease has declined over the past decades, but together these conditions remained 
the leading cause of death in South Australia in each of the fi ve years from 1999 2000 to 2003 04. 
The conditions accounted for 26 717 hospital admissions over 2006 07; of these, 1 714 angioplasties 
(with or without stent insertion) and 588 coronary artery bypass graft procedures were performed.

 About one in three people will have cancer during his or her life. There were 8 456 new cases of cancer  &gt;
diagnosed, and 3 302 deaths, in South Australia in 2005. Lung cancer remained the leading cause of cancer 
death in South Australian males, even though a steady decline was observed. Lung cancer, breast cancer 
and colorectal cancer all accounted for a similar proportion of cancer deaths in females in South Australia. 
The Statewide Cancer Control Plan 2006 2009 provides a comprehensive approach to screening and the 
appropriate management of different types of cancer, many of which have differing risk factors, natural 
histories and treatments.

chapter 3



page 47South Australia: Our Health and Health Services

 The prevalence of diabetes has been increasing in South Australia over recent decades. Survey data from  &gt;
the South Australian Monitoring and Surveillance System (SAMSS) show 6.8 per cent of South Australians 
aged 16+ years in the 2006 07 year reported having diabetes diagnosed by a doctor. Hospitalisations with 
Type 2 diabetes listed as a principal or secondary diagnosis progressively increased over the previous fi ve 
years by an average of 19 per cent annually to 16 107 in 2006 07. This escalation   together with the 
known ability to modify risk factors contributing to Type 2 diabetes   has prompted targeted interventions 
within chronic disease prevention strategies.

 SAMSS survey data indicate that current asthma was reported by 13.4 per cent of South Australians aged  &gt;
16+ years, and in 14.8 per cent of those aged 2 15 years. There was a downward trend around this disease 
over the past fi ve years, although the numbers were not statistically signifi cantly different.

 The SAMSS-reported prevalence of respiratory conditions of 4.9 per cent for South Australians aged  &gt;
16 years or more in 2006 07 had remained relatively stable over the previous fi ve years. There were 
22 825 hospitalisations over 2006 07 due to chronic respiratory conditions; 71 per cent of the patients 
hospitalised were 65 years and older.

 The number and rate of people in South Australia requiring kidney dialysis and/or transplantation has  &gt;
increased progressively over recent years, in common with the rest of Australia. This increase has been 
due predominantly to an increase in the number of new patients reaching end-stage kidney disease and 
beginning renal replacement therapy. The age of patients also is increasing. These circumstances have 
lead to a progressive increase over the previous fi ve years of hospital attendances for dialysis, from 41 148 
in 2002 03 to 55 152 in 2006 07. This increase is despite South Australia having the highest rate of 
therapy with a functioning kidney transplant.

 Twenty per cent of South Australians reported to SAMSS in 2006 07 that they had arthritis. Arthritis  &gt;
prevalence increases with increasing age, with 44 per cent of people reporting arthritis by age 60.

  &gt; South Australia s Strategic Plan Target T2.6 for chronic diseases aims to increase by fi ve percentage points 
the proportion of people living with a chronic disease whose self-assessed health status is good or better. 
Thirty-one percent of people over 16 in South Australia with at least one self-reported chronic disease rated 
their health status as good or better. South Australia will continue to build on current strategies with the 
release of a comprehensive Chronic Disease Management Plan.

chapter 3



page 48 South Australia: Our Health and Health Services

Introduction

This chapter provides details about South Australian mortality and morbidity attributable to the Health 
Priority Areas of injury, including domestic violence; cardiovascular health, including stroke; cancer; diabetes; 
asthma; renal disease/failure; and arthritis and musculoskeletal conditions. These diseases and injuries together 
account for over 60 per cent of South Australia s  burden of disease . These diseases   together with mental 
health which is discussed in Chapter 5   have been specifically identified, because their health impact can 
be improved considerably through targeted preventive interventions. They are all, apart from injuries, often 
considered collectively as  chronic conditions  in view of their considerable overlap with regard to risk factors 
and prevention strategies.

Collaborative preventive interventions use three principal modalities.  Primary prevention  targets risk factors 
to prevent these conditions occurring in the first place (see Chapter 4).  Secondary prevention  uses screening 
to detect and treat early disease or precursor conditions, such as hypertension or high cholesterol, in well 
people.  Tertiary prevention  aims to reverse the condition or halt the progression toward complications once 
the condition is established.

Monitoring of these conditions and the effectiveness of intervention programs occurs through a series 
of indicators collected by surveillance systems, including at both the population level and the program level, 
where interim indicators often are used. Population-level burden-of-disease information, survey results, 
hospitalisations and mortality are presented within each sub-chapter. Surveillance systems often are 
condition- and/or system-specific, with differing sources and validation mechanisms; as a consequence, 
differing time periods appear in this report. Health interventions usually are aimed at sustained or long-term 
improvement, so that it may take some years to have an effect on population level data and interim measures 
often are used to measure specific program outcomes. Programs and interventions are highlighted at the 
end of the chapter.

Observations based on key prevalence measures for chronic disease priority areas taken from departmental 
surveillance systems show:

 prevalence of asthma, chronic respiratory disease and, to a lesser extent, arthritis has generally  &gt;
reduced over time

osteoporosis and Type 2 diabetes prevalence generally has increased across the fi ve-year period &gt;

cardiovascular disease (including stroke) prevalence rates have remained relatively stable. &gt;

chapter 3

Table 3.1  Summary of prevalence measures for chronic disease priority areas

                   Prevalencea (per cent)

Priority DALY YLL 2002 03 2003 04 2004 05 2005 06 2006 07  
  (per cent) (per cent)  

Cardiovascular (including stroke) 11.3d 18.2d 7.8e 8.3e 7.7e 7.5e 7.6e

Cancer   21.5          
Type 2 diabetes 2.6   5.9e 6.4e 6.8e 6.2e 6.8e

Asthma 2.1 4.1 18.0b 18.4b 17.7b 16.5b 14.8b

Chronic respiratory 4.8       5.7e 5.4e 4.9e

Renal disease             11.5c

Arthritis      21.3e 21.3e 21.0e 20.8e 20.0e

Osteoporosis     3.2e 4.3e 4.4e 4.3e 3.9e

Source: SA Health, South Australian Monitoring and Surveillance System (SAMSS); b 2-15 years; c Source: Northwest Adelaide 
 Health Study, 2007; d Ischaemic Heart Disease; e 16+ years



page 49South Australia: Our Health and Health Services

Observations for hospitalisations and mortality for the chronic disease priority areas include:

 mortality across the fi ve years for the priority areas, where data was available, in general has reduced,  &gt;
excepting chronic respiratory disease where the trend has fl uctuated

cardiovascular disease, of the priority areas, has the highest number of deaths in any given year &gt;

hospitalisations for renal disease were almost triple that of any other priority area for 2006 07. &gt;

chapter 3

Table 3.2  Summary of hospitalisation and mortality for chronic disease priority areas

Priority Hospitalisations Mortality
  2006 07 1999 2000 2000 01 2001 02 2002 03 2003 04

Cardiovascular (including stroke) 14 792 4 608 4 723 4 596 4 517 4 507 
Cancer 17 083            
Type 2 diabetes 16 107 113 100 99 114 102 
Asthma 3 444 39 44 30 36 30
Chronic respiratory 22 825 450 456 440 476 460
Renal Disease 55 152     
Musculoskeletal 14 772 90 67 75 73 70
   (including arthritis/osteoporosis) 

Source:  Australian Bureau of Statistics, death data 1999 2004.

 



page 50 South Australia: Our Health and Health Services

chapter 3

3.1  Injury 

Injury   other than its association with youth   is a phenomenon with many similarities to other health 
issues. Males in South Australia, for example, are more at risk of injury than are females (as they are with 
cancer); lifestyle and behaviour play a large role in determining risk (as it does with diabetes); environments 
are crucial risk modulators (as pertains with communicable diseases); and there is a strong inverse association 
with socioeconomic status (as exists with mental illness).

Setting priorities in injury prevention is a matter of balancing three key parameters: frequency of event, 
severity of health effect and opportunity for intervention. It is naturally desirable to address hazards that 
commonly give rise to injury but, equally so, it is important to address the uncommon, even rare, events 
that may be associated with catastrophic consequences. Examples of the latter category involve cases of 
drowning and poisoning.

It must be acknowledged fundamentally that some hazards are susceptible to intervention, while others 
simply are not. Many playground injuries, for example, can be prevented by enforcing better design of play 
equipment. Some children nevertheless inevitably will be hurt by, for example, running into each other while 
distracted during play. Acknowledging the inevitability of some level of injury occurrence in the community, 
however, is not the same as concluding that injury is a random event, unresponsive to measures of prevention; 
in fact, quite the opposite is true. Injury control has been cited among all public health issues in Australia as 
a good example of long-term success. The table on the page opposite demonstrates the long-term declining 
rate of road accidents in South Australia expressed in terms of death and serious injury.

Young people of different ages in general experience injury in circumstances directly reflecting their 
developmental stage (for very young children) and their daily activities (for older children, youth and young 
adults). Children aged 1 4 years who are injured are proportionally more likely to be engaged in routine 
personal activities (washing, dressing, sleeping, et al.)   as might be expected   than those in other age 
groups. Children aged 12 15 years who are injured are proportionally more likely to be engaged in sporting 
activity than those in other age groups. Occupational injury is prominent among 16-29-year-olds while, 
from age five years onward, all the age groups through age 29 have approximately equal proportional 
representation in transport-related injury.



page 51South Australia: Our Health and Health Services

The age group after youth that is second-most susceptible to injury, however, is the elderly. Fall injury in 
particular is a threat, with nearly one-in-three people aged 70+ years reporting a fall each year. Not every 
fall results in a hospitalisation, fortunately, but as the population of elderly people increases rapidly in number, 
those requiring health care after a fall increases as well (see Chapters 8 and 11).

Domestic violence has a significant impact on the health and wellbeing of Australian families and 
communities. It was estimated that the total annual cost of domestic violence in 2002 03 to the Australian 
economy was $8.1 billion, including direct and indirect costs. Direct costs are those costs associated with 
providing resources, facilities and services to people as a result of being subjected to domestic violence. 
Indirect costs are those associated with the pain, suffering and fear experienced by partners and children 
who live with domestic violence.1 

The Federal National Data Collection Agency Annual Report shows that 5 250 women used domestic violence 
services in South Australia in 2002 03; based on Victorian survey results from 20005, the number of women 
affected by domestic violence would be closer to 105 000 within this state alone. Also within the Victorian 
survey is evidence that foetal morbidity as a result of domestic violence is more prevalent than gestational 
diabetes or pre-eclampsia, the two most commonly cited reasons for child death.

chapter 3

Fa
ta

lit
ie

s 
pe

r 
10

0 
00

0 
po

pu
la

ti
on

0

5

10

15

20

25

30

35

40

19
68

19
70

19
72

19
74

19
76

19
78

19
80

19
82

19
84

19
86

19
88

19
90

19
92

19
94

19
96

19
98

20
00

20
02

20
04

20
06

Year

0

50

100

150

200

250

300

350

400

Serious injuries per 100 000 population
Graph 3.1.1  Road accidents per 100 000 population, South Australia, 1968 2006

Fatalities

Serious Injuries

Source: SA Department for Transport, Energy &amp; Infrastructure, Transport Services Division.



page 52 South Australia: Our Health and Health Services

3.2  Cardiovascular health, including stroke

Ischaemic heart disease caused the greatest single disease burden in South Australia, accounting for 11.3 
per cent of Disability adjusted life years (DALYs) as measured by the burden of disease over 2001 2003 
and 18.2 per cent of the Years of life lost (YLL) due to premature mortality. Stroke additionally accounted for 
6.8 per cent of YLL and 5.3 per cent toward the total DALYs (see Chapter 2).3

The results of the 2006 07 SAMSS indicate that 7.6 per cent of respondents reported having cardiovascular 
disease. More males (8.5 per cent) reported having cardiovascular disease compared to females (6.7 per cent).3

More people aged 60+ years consistently reported having cardiovascular disease throughout the survey years 
than those in younger age groups.2

chapter 3

2002 03 2003 04 2004 05 2005 06 2006 07

Year

0

2

4

6

8

10

12

14

16

18

20

Pe
r 

ce
nt

Male

Female

Graph 3.2.1  South Australian prevalence of cardiovascular disease, by gender, 16+ years

 2002 03 2003 04 2004 05 2005 06 2006 07

Male 9.0 9.7 9.3 9.1 8.5
Female 6.7 7.0 6.2 6.0 6.7

Note:  Cardiovascular disease is defined as respondents having ever been told by a doctor that they have had any 
 cardiovascular problems such as heart attack, angina, heart disease or stroke.
Source: SA Health, South Australian Monitoring and Surveillance System (SAMSS), 16+ years.



page 53South Australia: Our Health and Health Services

There were 47 808 hospitalisations due to ischaemic heart disease (IHD), 12 741 due to stroke, and 14 371 
due to heart failure over the past five years to 2006 07. Analysis of these data demonstrates that males 
accounted for 64 per cent of IHD hospitalisations, 52 per cent for stroke and 53 per cent for heart failure. 
There were 9 341 IHD hospitalisations; 2 554 for stroke and 2 897 for heart failure in 2006 07.

An average for the period 1999 2000 to 2003 04 of 4 590 deaths per year can be attributed to 
cardiovascular conditions, comprising 2 459 for ischaemic heart disease, 258 for heart failure and 1 099 
each year for stroke. Cardiovascular conditions accounted for 39 per cent of deaths reported throughout 
this five-year period.

chapter 3

0

5

10

15

20

25

30

35

40

Pe
r 

ce
nt

16 19 20 29 30 39 40 49 50 59 60 69 70 79 80+

Age groups (years)

Graph 3.2.2  South Australian prevalence of cardiovascular disease, by age group, 16+ years, 2006 07

   16 19 20 29 30 39 40 49 50 59 60 69 70 79 80+ years
    years years years years years years years 

Cardiovascular disease  0.2 0.9 0.6 2.4 6.4 15.4 28.8 31.9

Note:  Cardiovascular disease is defined as respondents having ever been told by a doctor that they have had any 
 cardiovascular problems such as heart attack, angina, heart disease or stroke.
Source: SA Health, South Australian Monitoring and Surveillance System (SAMSS), 16+ years.

Cardiovascular condition 1999 2000 2000 01 2001 02 2002 03 2003 04

All cardiovascular conditions 4 608 4 723 4 596 4 517 4 507
Ischaemic heart disease  2 517 2 565 2 485 2 351 2 375
Heart failure 244 255 258 275 257
Stroke 1 082 1 159 1 067 1 082 1 105

Source:  Australian Bureau of Staistics, death data 1999 2004.

Table 3.2.1  Numbers of deaths in South Australia due to cardiovascular conditions



page 54 South Australia: Our Health and Health Services

3.3  Cancer 

There were 8 456 new cases of cancer diagnosed in South Australia in 2005, while there were 3 302 
cancer deaths; these figures represent 266 more new cases than reported in the previous year, and 53 more 
deaths. There was a trend until 2003 towards stable incidence rates for both males and females, but 2004 
and 2005 showed an increase in prostate cancer incidence which caused the overall cancers incidence rate 
for males to rise.

Annual cancer incidence and mortality data on the Central Cancer Registry are validated routinely and 
completed in the following year. Annual reports are produced that summarise the previous year s statistics. 
The population-based registry began collecting cancer statistics in 1977 and focuses on collecting data for 
all cancers that occur within South Australia. Six hospitals also collect more detailed information about specific 
cancers, enabling clinical units to monitor the care of their patients and the outcomes of this care.4

The most common cancers recorded in 2005 in South Australia for males and females, with lifetime risks 
and mortality, are listed in Table 3.3.1.

Cancer is predominantly a disease of older people in South Australia with 60 per cent of cancers in 2005 
occurring in the 65+ age group. Cancers in the 0 44 age group accounted for only 8 per cent of all cancers. 
Leukaemias (12 cases), lymphomas (10) and cancers of the central nervous system (9) accounted 
for 86 per cent of all cancers in people aged 0 14. Melanoma (123 cases), female breast (104), testes (45), 
non Hodgkin s lymphomas (37), thyroid (37), cervix (26) and central nervous system (25) were the most 
commonly reported cancer sites for people in the 15 44 age group. The most common cancers overall 
predominated in the 65+ age group, with prostate (995 cases), colorectal (757), lung (556), female breast 
(423) and melanoma (337) being the most commonly diagnosed cancers.

chapter 3

19
77

19
79

19
81

19
83

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Ca
nc

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at
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pe
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00
0

Year

Females incidence

Females mortality

Males incidence

Males mortality

Graph 3.3.1  Cancer incidence and mortality rates by time, South Australian males and females, 1977 2005 

Source:  SA Health, South Australian Central Cancer Registry.



page 55South Australia: Our Health and Health Services

There has been a decreasing mortality rate over the last 10 15 years for prostate cancer and female breast 
cancer. Lung cancer remained the leading cause of cancer death in South Australian males (23 per cent), 
even though lung cancer mortality is declining steadily. Prostate and colorectal   of the other cancers   were 
the higher number of deaths in males, accounting for a further 26.2 per cent. Lung cancer, breast cancer 
and colorectal cancer all accounted for a similar percentage of cancer deaths in females in South Australia; this 
has not always been the case, as lung cancer accounted for only 8 per cent of deaths in 1980. Other leading 
cancers were those of unspecified primary site, pancreas, non Hodgkin s lymphoma and ovary (see Table 3.3.1).

There were 82 912 hospitalisations over the past five years, between 2002 03 and 2006 07, of which 60 per 
cent were due to cancer in people 65+ years.

chapter 3

0

500

1 000

1 500

2 000

2 500

3 000

3 500

4 000

Ca
nc

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 r

at
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pe
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00
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65
 6

9

70
 7

4

75
 7

9

80
 8

4

85
+

Males incidence

Females mortality

Males mortality

Females incidence

Graph 3.3.2  Cancer incidence and mortality by age group, South Australian males and females, 2005

Source:  SA Health, South Australian Central Cancer Registry.

Table 3.3.1  New cases, lifetime risk and mortality rates   most common cancers in South Australia, 2005

Female site name  New Lifetime Mortality Male site name  New Lifetime Mortality
 cases risk rate  cases risk rate

Breast 1 010 1 in 12 23.7 Prostate 1 462 1 in 8 32.3
Colorectal 512 1 in 28 19.7 Colorectal 635 1 in 19 28.2
Melanoma 327 1 in 34 2.3 Lung 484 1 in 24 52
Lung 275 1 in 47 22.2 Melanoma 401 1 in 27 6.5
Non-Hodgkin's     Non-Hodgkin's 
Lymphoma 186 1 in 73 5.1 Lymphoma 187 1 in 59 9.9
Uterus 169 1 in 65 2.5 Unspecified 152 1 in 83 13
Unspecified 134 1 in 122 10.3 Kidney 149 1 in 71 5.4
Ovary 93 1 in 135 5.2 Bladder 132 1 in 119 8.3
Pancreas 80 1 in 239 8.3 Pancreas 100 1 in 120 11.4
Thyroid 80 1 in 129 0.4 Stomach 97 1 in 138 8.7
All cancers 3 96 1 in 4 135.9 All cancers 4 760 1 in 3 228.7

Note:  Rates are expressed per 100 000 and standardised to the Australian 2001 population. Lifetime risk is calculated to age 75.
 The 'All cancers' category refers to all cancers diagnosed in South Australia in 2005, not to the total of the column above.
Source:  SA Health, South Australian Central Cancer Registry.



page 56 South Australia: Our Health and Health Services

3.4  Diabetes 

South Australia s annual Health Omnibus Survey has shown a gradual increase in the age and gender 
standardised prevalence of diabetes in South Australia.7 

SAMSS survey data also showed no significant difference between males and females reporting diabetes, 
but the graph opposite clearly demonstrates the increasing prevalence of the disease with age.

chapter 3

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
0

1

2

3

4

5

6

7

8

Year

D
ia

be
te

s 
pr

ev
al

en
ce

 (p
er

 c
en

t)

Graph 3.4.1  Age-sex standardised prevalence of diabetes in South Australia 1991 2005

            

Source:  SA Health, Health Omnibus Surveys 1991 to 2005, ages 15+ years.



page 57South Australia: Our Health and Health Services

More than 83 000 South Australians were diagnosed with diabetes by the year 2003. This number is predicted 
to almost double by 2016, increasing to more than 150 000.7 The proportion of diabetes cases that are 
undiagnosed is estimated at approximately 15 per cent by the North West Adelaide Health Study8; suggesting 
that for every five new cases of diagnosed diabetes, there is another case that has not yet been found.

The prevalence of diabetes and associated risk factors is greater among Aboriginal and Torres Strait Islander 
communities.9 Risks also are exacerbated for people from lower socioeconomic groups, with South Australian 
surveillance data showing a prevalence of 11.9 per cent among people living in households where annual 
income is $20 000 or less, and 10.6 per cent among people from culturally and linguistically diverse 
backgrounds (CALD).10

There were 63 301 hospitalisations over the past five years, between 2002 03 and 2006 07, where Type 2 
diabetes was listed as a principal or secondary diagnosis, with 99 per cent of the patients being 35 years 
and older. Hospitalisations over these five years progressively increased by an average of 19 per cent annually 
from 9 080 in 2002 03 to 16 107 in 2006 07. There were 12 671 hospitalisations over the same five-year 
time period with Type 1 diabetes listed as a principal or secondary diagnosis.

Mortality attributed to diabetes as the condition directly leading to death has not changed significantly over 
the years 1999 2000 to 2003 04, with an average of 280 deaths reported annually; an average of 106 
of these deaths over this five-year period were directly attributed to Type 2 diabetes, another 31 deaths to 
Type 1 diabetes and a further 144 deaths were attributed to diabetes with no type specified. Diabetes (all types) 
conditions throughout this five-year period accounted for 2 per cent of deaths reported.

chapter 3

0

5

10

15

20

25

30

16 19 20 29 30 39 40 49 50 59 60 69 70 79 80+

Age groups (years)

Pe
r 

ce
nt

Graph 3.4.2  Prevalence of diabetes, by age groups, 16+ years, 2006 07

Note:  Diabetes is defined as respondents having ever been told by a doctor that they had diabetes.
Source:  SA Health, South Australian Monitoring and Surveillance System (SAMSS), 16+ years.

Condition 1999 2000 2000 01 2001 02 2002 03 2003 04

Type 1 diabetes 30 31 34 24 38
Type 2 diabetes 113 100 99 114 102
Diabetes unspecified 147 139 130 152 153
Total 290 270 263 290 293

Source:  Australian Bureau of Statistics, death data 1999 2004.

Table 3.4.1  Numbers of deaths due to diabetes in South Australia



page 58 South Australia: Our Health and Health Services

3.5  Asthma

SAMSS survey data for 2006 07 indicate that current asthma was reported by 13.4 per cent of South 
Australians aged 16+ years, and in 14.8 per cent of those aged 2 15 years. Prevalence over the past five years 
is trending downwards.3 

The 2006 07 SAMSS results indicate that females were significantly more likely (14.3 per cent) than males 
(12.5 per cent) to report having current asthma. Similar trends have been observed over time. There was little 
difference, however, among those aged 2 15 years in asthma prevalence between the genders, except in 
2004 05, when males were significantly more likely to report having current asthma.3

Asthma varied across age groups. Asthma in 11 to 15-year-olds was higher in 2006 07 than for the younger 
age groups, and those aged 6 10 years were least likely to have asthma. 

chapter 3

2 15 16+

Age groups (years)

0

5

10

15

20

25

30

Pe
r 

ce
nt

Male
Female

Graph 3.5.1  Prevalence of asthma, by gender, 2 15 years and 16+ years, 2006 07

Note:  Asthma is defined according to the ACAM definition2 of whether respondents had ever been told by a doctor that 
 they had asthma, and had experienced symptoms (wheeze, shortness of breath or chest tightness) of asthma in the 
 last 12 months or had taken treatment for asthma in the last 12 months.
Source:  SA Health, South Australian Monitoring and Surveillance System (SAMSS). Percentages are calculated separately for 
 the adult population from the 16 years and over dataset, and the child population from the 2 15 year dataset.



page 59South Australia: Our Health and Health Services

There were 17 792 hospitalisations attributed to asthma between 2002 03 and 2006 07, of which 
61 per cent of patients were under 15 years old, with two-thirds of these under 5 years old. Australia-wide 
comparisons indicate that hospitalisation rates for children under age 18 in 2002 03 were generally 
higher in South Australia than in other states and territories, yet age mortality rates were consistent with 
national rates.11

chapter 3

2 5 6 10 11 15 16 19 20 29 30 39 40 49 50 59 60 69 70 79 80+

Age groups (years)

0
2
4
6
8

10

12
14
16
18
20

Pe
r 

ce
nt

Graph 3.5.2  Prevalence of asthma, by age group, 2+ years, 2006 07



page 60 South Australia: Our Health and Health Services

3.6  Chronic respiratory conditions 

The 2006 07 SAMSS results indicate that 4.9 per cent of respondents aged 16+ years self-reported having 
a respiratory condition. Females were more likely (5.5 per cent) than males (4.3 per cent) to report having a 
respiratory condition, as were older people aged 70+ years.3

chapter 3

2004 05 2005 06 2006 07

Year

0

1

2

3

4

5

6

7

8

9

10

Pe
r 

ce
nt

Male
Female

Graph 3.6.1  Prevalence of chronic respiratory conditions, by gender, 16+ years

Note:   Chronic respiratory conditions are defined as respondents having ever been told by a doctor that they have any other 
 respiratory problems such as bronchitis, emphysema, or chronic lung disease that had lasted six months or more.
Source:  SA Health, South Australian Monitoring and Surveillance System (SAMSS), 16+ years.



page 61South Australia: Our Health and Health Services

There were 114 421 hospitalisations over the past five years to 2006 07 due to chronic respiratory conditions, 
of which 73 per cent were aged 65+ years and 99 per cent were aged 35+ years. Hospitalisations over the 
past five years ranged from 21 435 in 2002 03 to 24 203 in 2005 06.

The number of deaths directly attributed to chronic respiratory conditions did not change significantly 
during the period 1999 2000 to 2003 04, averaging 456 deaths per annum. Chronic respiratory conditions 
were 4 per cent of the total deaths reported during these years, with all respiratory conditions accounting 
for 10 per cent.

chapter 3

16 19 20 29 30 39 40 49 50 59 60 69 70 79 80+

Age groups (years)

0

1

2

3

4

5

6

7

8

9

10

Pe
r 

ce
nt

Graph 3.6.2  Prevalence of chronic respiratory conditions, by age groups, 16+ years, 2006 07

Note:   Chronic respiratory conditions is defined as respondents having ever been told by a doctor that they have any other 
 respiratory problems such as bronchitis, emphysema, or chronic lung disease that had lasted six months or more.
Source:  SA Health, South Australian Monitoring and Surveillance System (SAMSS), 16+ years.



page 62 South Australia: Our Health and Health Services

3.7  Renal disease/failure 

Kidney disease has an important impact on the health system at two levels. First, the requirements of 
people with the most severe degree of kidney damage   end-stage renal disease (ESRD)   for dialysis 
and transplantation has a major effect on individuals, hospitals and the broader health system. Dialysis and 
transplantation collectively are referred to as  renal replacement therapy , as they allow ongoing survival 
by replacing the body s own kidney function. Second, milder degrees of kidney disease (various stages 
of  chronic kidney disease ) are surprisingly common, and have been associated with higher rates of 
cardiovascular disease, hospital admission and death.12, 13

Chronic Kidney Disease (CKD) is categorised into five stages; stages 1 and 2 require the presence of blood 
or protein in the urine, or a radiological indicator of kidney disease, and stages 3 to 5 are based upon reduced 
calculated glomerular filtration rate (GFR).14  The Northwest Adelaide Health Study included some information 
on the prevalence of CKD in the South Australian community. The structure of the study did not allow 
exact calculation of stages 1 and 2, as haematuria (blood in urine) was not collected; however, abnormal 
albuminuria (protein in urine) was present in 5.5 per cent of participants. The prevalence of chronic kidney 
disease is shown in Table 3.7.1. Stage 3, 4 or 5 CKD was present in 11.4 per cent of participants, with 0.4 
per cent having Stage 4 CKD and 0.1 per cent with Stage 5 CKD.

There are national-level data from the AusDiab study (conducted around Australia) about the prevalence 
of CKD in the community. The national data have been published in both the medical literature15 and in 
the form of information sheets (available from &lt;www.kidney.org.au&gt;).

Glomerulonephritis was listed as the cause for 27 per cent of the 173 South Australians diagnosed with 
end-stage renal disease in 2005, and was the most common cause. Diabetic nephropathy (23 per cent) 
was the next most common single cause of ESRD, followed by hypertension (13 per cent), polycystic kidney 
disease (10 per cent), reflux nephropathy (5 per cent) and analgesic nephropathy (2 per cent). The cause was 
uncertain in 6 per cent of people, and a variety of conditions accounted for a further 13 per cent.

chapter 3

 Stage 2
 Number Per cent

No kidney damage, or Stage 1 or Stage 2 chronic kidney disease 2 816 88.6
Stage 3 CKD 348 11.0
Stage 4 CKD 12 0.4
Stage 5 CKD 3 0.1

Total 3 179 100.0

Source:  SA Health, Northwest Adelaide Health Study, 2007.

Table 3.7.1  Prevalence of chronic kidney disease



page 63South Australia: Our Health and Health Services

chapter 3

There were 240 588 hospital admissions in the past five years, between 2002 03 and 2006 07, for renal 
dialysis in South Australian hospitals, of which 43 per cent of patients were aged 65+ years, and 91 per cent 
of them were aged 35+ years. The age pattern in 2006 07 was similar, with 55 152 hospital attendances; 
over the previous five years, this increased 8 per cent annually from 41 148 in 2002 03.

The number and rate of people in South Australia requiring renal replacement therapy has increased 
progressively over recent years, in common with the rest of Australia. This increase has been due 
predominantly to an increase in the number of new patients reaching end-stage kidney disease 
(patients beginning renal replacement therapy). The age of patients also is increasing. A small part of this 
increase is due to the ageing of the population and the increase in numbers within the older age groups. 
The trends in South Australia are very similar to the rest of Australia. 

South Australia differs from all other states in Australia, in that most people with end-stage kidney failure 
actually received the renal replacement therapy with a functioning kidney transplant rather than dialysis; this 
is due to the higher rate of transplantation in South Australia, which in turn demonstrates the higher rates 
of both deceased organ donation and living donor transplantation. The proportion of transplant from living 
donors in particular   and, more recently, living unrelated donors   has increased over recent years.

0 4

5 9

10 14
15 19

20 24

25 44

45 64
65 74

75+

Graph 3.7.1  Number of patients requiring renal replacement therapy, by year 

19
90

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Data for patients treated at 31 December each year

N
um

be
r

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5 000

10 000

15 000

0

500

1 000

1 500

Australia (excluding South Australia) South Australia

Source:  ANZDATA Registry.



page 64 South Australia: Our Health and Health Services

chapter 3

Graft

Automated Peritoneal Dialysis (APD) 

Satellite haemodialysis (HD)

Home HD

Continuous Ambulatory Peritoneal Dialysis (CAPD)

Hospital HD

South AustraliaAustralia (excluding South Australia)

Data for prevalent patients 31 Dec 2006; ANZDATA Registry

Graph 3.7.2  Distribution of renal replacement therapy for South Australians and the remainder of Australians, 

       at 31 December 2006 



page 65South Australia: Our Health and Health Services

3.8  Arthritis and musculoskeletal conditions 

Osteoarthritis was rated as the third leading cause of morbidity in South Australia, accounting for 5.3 per cent 
of Years of healthy life lost to disability (YLD) on average over 2001 2003 (see Chapter 2).2

The proportion of adults in South Australia who have arthritis has not changed in recent years based on the 
South Australian Monitoring and Surveillance System (SAMSS). The prevalence of arthritis of 20.0 per cent 
for people aged 16+ years in South Australia in 2006 07 was not significantly different to prevalence 
estimates of 21.3 per cent in 2002 03. The proportion of adults reporting osteoporosis, however, was 
significantly lower in 2002 03 compared to recent years.3

Females were significantly more likely (24.2 per cent) than males (15.6 per cent) to report having arthritis 
for the year 2006 07, and this also was evident with osteoporosis, where 6.7 per cent of females reported 
having the condition compared to 1.1 per cent of males. This pattern was evident in all the surveys. 

Arthritis and osteoporosis both are much more prevalent in the older age groups.3

chapter 3

 2002 03 2003 04 2004 05 2005 06 2006 07

Arthritis 21.3 21.3 21.0 20.8 20.0
Osteoporosis 3.2 4.3 4.4 4.3 3.9

Note:  Arthritis is defined as respondents having ever been told by a doctor that they had arthritis, including osteoarthritis, 
 rheumatoid arthritis, juvenile rheumatoid arthritis (JRA), or any other type of arthritis. Osteoporosis is defined as 
 respondents having ever been told by a doctor that they had osteoporosis.
Source:  SA Health, South Australian Monitoring and Surveillance System (SAMSS), 16+ years.

Table 3.8.1  Prevalence of arthritis and osteoporosis in South Australia, 16+ years

2002 03 2003 04 2004 05 2005 06 2006 07

Year

0

10

20

30

40

50

60

Pe
r 

ce
nt

Arthritis male

Arthritis female

Osteporosis male

Osteporosis female

Graph 3.8.1  Prevalence of arthritis and osteoporosis, by gender, 16+ years

  2002 03 2003 04 2004 05 2005 06 2006 07

Arthritis Male 18.4 17.3 18.1 17.2 15.6
 Female 24.0 25.1 23.9 24.2 24.2
Osteoporosis Male 0.5 1.4 1.3 1.8 1.1
 Female 5.8 7.1 7.4 6.8 6.7

Note:  Arthritis is defined as per Table 3.8.1 above.
Source:  SA Health, South Australian Monitoring and Surveillance System (SAMSS), 16+ years.



page 66 South Australia: Our Health and Health Services

There were 71 238 hospitalisations due to musculoskeletal conditions over five years between 2002 03 and 
2006 07. Nearly 90 (88) per cent of these hospitalisations related to persons who were 35 years and older. 
Hospitalisation numbers ranged from 13 835 in 2004 05 to 14 772 in 2006 07.

chapter 3

16 19 20 29 30 39 40 49 50 59 60 69 70 79 80+

Age groups (years)

0

10

20

30

40

50

60

70

Pe
r 

ce
nt

Arthritis
Osteoporosis

Graph 3.8.2  Prevalence of arthritis and osteoporosis, by age group, 16+ years, 2006 07

 16 19 20 29 30 39 40 49 50 59 60 69 70 79 80+ years
 years years years years years years years  

Arthritis 1.0 2.4 5.0 12.5 27.4 43.4 49.6 50.6
Osteoporosis 0.0 0.0 0.7 0.5 3.0 8.4 14.6 19.7

Note:  Arthritis is defined as respondents having ever been told by a doctor that they had arthritis, including osteoarthritis, 
 rheumatoid arthritis, juvenile rheumatoid arthritis (JRA), or any other type of arthritis. Osteoporosis is defined as 
 respondents having ever been told by a doctor that they had osteoporosis.
Source:  SA Health, South Australian Monitoring and Surveillance System (SAMSS), 16+ years.



page 67South Australia: Our Health and Health Services

chapter 3

3.9  Living with chronic conditions

South Australia s Strategic Plan Target T2.6 for chronic diseases aims to increase by five percentage points 
the proportion of people living with a chronic disease whose self-assessed health status is good or better. 
The South Australian Monitoring and Surveillance System (SAMSS) has been used to monitor this target 
and has identified that the proportion is decreasing, reaching 31.1 per cent in 2006 07. A breakdown by 
gender over the past five years is presented in Graph 3.9.1.

Females (34.5 per cent) were significantly more likely than males (27.5 per cent) to report having good 
or better health, of those respondents (2006 07 SAMSS) with at least one chronic health condition. 
People aged 50+ years with at least one chronic health condition also were significantly more likely than those 
in younger age groups to report having good or better health. 

The number of people requiring treatment for chronic conditions is expected to rise in South Australia, 
driven partly by the ageing population and partly through increased risk factors. The following graph shows 
the projected growth in hospital demand for patients with chronic conditions if steps are not taken to prevent 
people from developing chronic disease or if those people with chronic conditions are not better managed.

0

5

10

15

20

25

30

35

40

45

50

Pe
r 

ce
nt

2002 03

Year

2003 04 2004 05 2005 06 2006 07

Male
Female

Graph 3.9.1  Prevalence of at least one chronic disease/condition for people whose self-assessed 

      health status was good or better, by gender, 16+ years

Note:  Multiple health conditions were derived by the accumulation of five chronic health conditions. 
 These included diabetes, asthma, cardiovascular disease, arthritis, and osteoporosis.
Source: SA Health, South Australian Monitoring and Surveillance System (SAMSS), 16+ years.



page 68 South Australia: Our Health and Health Services

The risk factors associated with a number of chronic diseases overlap considerably as represented 
in Table 3.9.1. Programs targeting a reduction in risk factors for one condition also will often effect 
a reduction in other chronic diseases.

Data from SAMSS indicated that in South Australia there are approximately 396 300 adults with a single 
risk factor, 222 300 adults with two or more risk factors, and 92 800 adults with three or more risk factors 
for chronic disease.

chapter 3

20
01

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35 000

40 000

45 000

50 000

Se
pa

ra
ti

on
s

Cardiovascular disease

Chronic respiratory disease

Musculoskeletal disease

Diabetes

Malignant neoplasms

Graph 3.9.2  Estimates of growth in chronic disease hospitalisations in South Australia

Source:   SA Health, Integrated South Australian Activity Collection.

Disease Poor Physical Tobacco Alcohol Excess High blood High
 diet inactivity use misuse weight pressure cholesterol 

Heart disease X X X X X X X
Stroke X X X X X X X
Lung cancer     X        
Diabetes X X     X    
Asthma     X   X    

Table 3.9.1  Relationship between chronic diseases, conditions and risk factors16



page 69South Australia: Our Health and Health Services

3.10  Services and initiatives

Chronic disease is a high priority in South Australia and a key focus of many services initiatives aimed 
at reducing the burden of these health priority conditions. SA s Health Care Plan 2007 2016 focuses on 
improving the coordination of care   and access to appropriate care   for people with these conditions. 
Primary prevention strategies focus on risk factors that contribute to developing all these conditions 
and are further described in Chapter 4. 

There has been a significant reduction in road accident fatalities and injuries over the past 30 years 
as dedicated road accident research findings have been translated into legislation and practice. 
Injury surveillance units continue to intervene for improved outcomes, using evidence from various injury 
and trauma surveillance systems. Interventions address not only hazards commonly giving rise to injuries 
but, importantly, also more rare events or hazards that may be associated with catastrophic consequences, 
such as drowning and poisoning.

Many initiatives address chronic diseases collectively, due to the overlap in risk factors and management 
principles, with current and future initiatives encompassed in a Chronic Disease Management Plan for 
South Australia being developed during 2007 08, and the implementation of The Statewide Cancer Control 
Plan 2006 2009. SA s Health Care Plan 2007 2016 provides details on how health services will be coordinated 
better with the support of community and individual initiatives, and new models of early intervention 
provided through GP Plus Health Care Centres; hospitals will provide access to networks of generalist 
and specialist care. This methodology also is assisted by the formation of eight clinical networks, including 
those of cardiology, cancer, renal and orthopaedics.

GP Plus Health Care Centres are being established on the basis of approximately one centre per 100 000 
population, and incorporate chronic disease programs and initiatives, based on the service delivery models 
for existing Centres at Aldinga and Woodville. The GP Plus Practice Nurse Initiative aims to reduce workforce 
pressure on general practice in areas of high demand or areas with significantly high rates of chronic 
conditions in metropolitan Adelaide. The Nurse Case Management program will start in 2008 with nurses 
appointed to the program providing case management that aims to keep out of hospital frail elderly people 
with complex health conditions.

The Chronic Disease Community Program targets people identified at hospital discharge, or by a general 
practitioner, as being at risk of hospitalisation because of health deterioration due to a chronic disease. 
The program has demonstrated a 40 67 per cent reduction in hospital readmission rates for people with 
chronic disease in metropolitan Adelaide. Teams work in partnership with patients to develop care plans, 
and provide tailored and targeted care packages. The Metro Home Link service provides care in their place 
of residence (including residential care facilities) to patients of all ages in the Adelaide metropolitan area 
at risk of hospital admission or readmission. Care packages incorporate home-supported discharge, 
avoidance of hospital admission and access to equipment.

Chronic Disease Self Management programs assist people to take an active role in the ongoing management 
of their chronic disease. A telehome remote monitoring program will be piloted in South Australia in 2008. 
Remote monitoring enables home-based daily monitoring of people with a diagnosis of one or more chronic 
disease, to build capacity and confidence in self-management, adherence to care plans, and better access 
to community and hospital-based services.

A Health Call Centre service for South Australia began operation in July 2007. Statewide implementation 
by June 2008 will contribute to more integrated health care and improve access to appropriate health advice. 
HealthConnect is implementing a statewide web-based care planning system to support the care planning 
and management of people with chronic conditions; implementation through to primary health care providers 
is due by June 2008. The Risk Factor Register Scoping Study will examine the development of registers for 
chronic diseases and risk factors following the success of The Gestational Diabetes Mellitus Recall Register.17

The Statewide Cancer Control Plan 2006 2009 provides a comprehensive approach to screening and 
the appropriate management of different types of cancer, many of which have differing risk factors, 
natural histories, screening opportunities and treatments.

chapter 3



page 70 South Australia: Our Health and Health Services

SA Health also is committed, with respect to domestic violence, to implementing the Women s Safety Strategy 
and the Family Safety Framework, both of which will work towards providing better safety outcomes for the 
whole family. The Family Safety Framework (FSF) is a cross government information-sharing model that aims 
to increase the safety of families in high-risk domestic violence situations through integrated service responses 
and better agency awareness of risk factors.18 FSF currently is being trialled in Holden Hill South Australian 
Police (SAPOL) Local Service Area (LSA), Noarlunga LSA and Pt Augusta LSA. Key representatives from 
SA Health participate on the Women s Safety Strategy Whole of Government Reference Group and the 
Family Safety Framework Implementation Committee.

The South Australian Government released the South Australian Women s Health Policy in March 2005, 
which aims to improve the health of all women in South Australia. The Women s Health Policy committed the 
South Australian health system to developing and implementing annual plans. The Women s Health Action 
Plan for 2006 2007 was developed in consultation with key stakeholders and comprises 12 initiatives, of which 
three focus on women s safety. These initiatives involve developing and implementing:

accessible, coordinated and integrated services in response to women s safety &gt;

 standards of best practice that will be used in providing services for women who have been raped and/or  &gt;
sexually assaulted

 evidence based recovery-focused models of service delivery using an holistic approach that recognises  &gt;
the links between women s experience of domestic violence and/or sexual assault, and women s physical 
and mental health.5

The Department of Health, and the Department for Families and Communities, in 2007 launched the 
document Keeping Them Safe, Health and Families SA, Child Protection Information Sharing Protocol, Practice 
Guidelines 2006. This initiative focuses on the key principle that the child s right to safety overrides the adult s 
right to privacy. The guidelines facilitate the release and exchange of relevant information between the two 
departments to enhance the safety and wellbeing of children, and acknowledges the impact of domestic 
violence in the family.6

chapter 3



page 71South Australia: Our Health and Health Services

3.11  Notes

1  Access Economics, The cost of domestic violence to the Australian economy: part 2, Office of the Status 
of Women, Canberra, 2004.

2  Department of Health, South Australian burden of disease, Department of Health, Adelaide, 2007, 
viewed 25 October 2007, &lt;http://www.health.sa.gov.au/burdenofdisease/DesktopDefault.aspx&gt;

3  Population Research and Outcome Studies Unit, Department of Health, Population research 
and outcome studies, Department of Health, Adelaide, 2007, viewed 12 November 2007, 
&lt;http://www.health.sa.gov.au/PROS&gt;

4   South Australian Cancer Registry, The South Australian Cancer Registry, the Registry, Department 
of Health, 2007, viewed 30 October 2007, &lt;http://www.health.sa.gov.au/pehs/branches/branch-
cancer-registry.htm&gt;

5  The South Australian Women s Health Action Plan: Initiatives for 2006 2007, Government of South Australia, 
Adelaide, 2007.

6  Office of Health Reform and Families SA Child Protection Directorate, Keeping Them Safe, Health and 
Families SA, child protection information sharing protocol, practice guidelines, Government of South 
Australia, Adelaide, 2006.

7  C R Chittleborough, J F Grant, P J Phillips &amp; A W Taylor  The increasing prevalence of diabetes in 
South Australia: the relationship with population ageing and obesity , Public Health vol. 121, no. 2. 
2007; pp. 92-99.

8  J Grant, C Chittleborough, E Dal Grande &amp; A Taylor, North West Adelaide Health Study. baseline 
biomedical and self-report data, Population Research and Outcome Studies Unit, Department of Health, 
Adelaide, 2005.

9  Z Wang, W E Hoy,  Hypertension, dyslipidemia, body mass index, diabetes and smoking status in 
Aboriginal Australians in a remote community , Ethnicity and disease, vol. 13, no. 3, 2003, pp. 324-30.

10  Population Research and Outcome Studies Unit, A profi le of diabetes in South Australia 2005 2006. 
Population research and outcome studies brief report no. 2006-18. Department of Health, Adelaide, 2006.

11  Australian Centre for Asthma Monitoring and Woolcock Institute of Medical Research, Asthma in 
Australia 2005, AIHW asthma series 2, AIHW cat. no. ACM 6, Australian Institute of Health and Welfare, 
Canberra, 2005.

12  A S Go, G M Chertow, D Fan, C E McCulloch &amp; C-y Hsu,  Chronic kidney disease and the risks of death, 
cardiovascular events, and hospitalisation.  New England Journal of Medicine, vol., 351, no. 13, 2004, 
pp. 1296-1305.

13  D S Keith, G A Nichols, C M Gullion, J B Brown &amp; D H Smith,  Longitudinal follow-up and outcomes 
among a population with chronic kidney disease in a large managed care organisation.  Archives of 
Internal Medicine, vol. 164, no. 6, 2004, p. 659-663.

14  National Kidney Foundation,  Part 4. Definition and classification of stages of chronic kidney disease.  
American Journal of Kidney Diseases, vol. 39, no. 2, suppl.1, 2002, pp. S46-S75.

15  S J Chadban, E M Briganti, P G Kerr, D W Dunstan, T A Welborn, P Z Zimmet &amp; R C Atkins,  Prevalence 
of kidney damage in Australian adults: the AusDiab Kidney Study.  Journal of the American Society of 
Nephrology, vol. 14, no. 7, suppl. 2, 2003, pp. S131-138.

16  Australian Institute of Health and Welfare. Chronic diseases and associated risk factors in Australia, 2001, 
AIHW cat. no. PHE 33, AIHW, Canberra, 2002.

17  Chittleborough C, Caudle L, Taylor A. The Gestational Diabetes Mellitus (GDM) Recall Register Pilot Project 
Evaluation Report. Diabetes Clearing House, Population Research and Outcome Studies, Department of 
Health, Adelaide, South Australia, June 2005.

18  Office for Women, Family safety framework: strategic overview; an initiative of the women s safety strategy, 
Government of South Australia, 2007.

chapter 3



page 72 South Australia: Our Health and Health Services

chapter 4

4  Risk factors for health

In this chapter

Smoking &gt;

Diet and nutrition &gt;

Alcohol abuse &gt;

Overweight and obesity &gt;

Physical activity/inactivity &gt;

High blood pressure &gt;

High blood cholesterol &gt;

Sexually transmitted diseases &gt;

Blood-borne diseases &gt;

Environment &gt;

Immunisation rates &gt;

Screening &gt;

Services and initiatives &gt;

Summary

 Nearly 21 per cent (20.7) of people aged 15+ years self-reported being current smokers. People aged 20 49  &gt;
years were signifi cantly more likely to report being current smokers than were people in other age groups. 
Males were signifi cantly more likely than females to report being current smokers.

 About 90 per cent (90.7) of people surveyed aged 19+ years were not eating the recommended fi ve  &gt;
serves of vegetables per day. People aged 80+ years were signifi cantly more likely to be consuming fewer 
than the recommended fi ve serves of vegetables per day compared to people in other age groups.

 Just over 28 per cent (28.4) of people surveyed in 2006 07 aged 16+ years, were classifi ed as being at  &gt;
risk of harm from alcohol in the short term. People aged 50 69 years were signifi cantly more likely to be 
classifi ed as at risk of harm from alcohol in the short term than were people in other age groups.

 The 2006 07 survey indicates that 56.7 per cent of people aged 18+ years were classifi ed as overweight or  &gt;
obese. People aged 40 69 years were signifi cantly more likely to be classifi ed as overweight or obese than 
people in other age groups. Males (64.8 per cent) were signifi cantly more likely than females (48.7 per cent) 
to be classifi ed as overweight or obese.

 Just over 53 per cent (53.3) of people surveyed were undertaking suffi cient levels of physical activity. The  &gt;
proportion of adults (aged 16+ years) in South Australia undertaking suffi cient levels of physical activity has 
signifi cantly increased in 2006 07 (52.9 per cent).

 The proportion of adults aged 16+ years in South Australia with high blood pressure has not changed  &gt;
in recent years. Just over 18 per cent (18.1) of those surveyed aged 16+ years self-reported having current 
high blood pressure. There was no signifi cant difference between males and females, but older people 
(aged 50+ years) were signifi cantly more likely to report having current high blood pressure than were 
younger people.

 Slightly over 14 per cent (14.3) of people aged 16+ years self-reported having high cholesterol. There was  &gt;
no signifi cant difference between males and females, but older people (aged 50+ years) were signifi cantly 
more likely to report having current high cholesterol than were younger people.



page 73South Australia: Our Health and Health Services

chapter 4

 Notifi cations of chlamydia infections (in both males and females) increased quite considerably between  &gt;
calendar year 2002 (1806 cases) and calendar year 2006 (3123 cases). 

 The number of Hepatitis C Virus incident cases (infections acquired in past 12 months) has slightly  &gt;
increased from 44 cases in calendar year 2002, to 53 cases in calendar year 2006. Of the 53 cases in 2006, 
38 (71 per cent) were for males, while 15 (29 per cent) were for females.

 There were 222 130 doses of infl uenza vaccine distributed in 2005 06, an increase on 2004 05.  &gt;
Almost 84 per cent of people aged 65+ years received annual infl uenza vaccination.

 South Australia maintained immunisation coverage above 90 per cent for children aged 12 15 months  &gt;
and 24 27 months (that is, 91 per cent and 92.2 per cent respectively) with both cohorts being at or above 
Australian levels.

 The coverage in June 2006 for meningococcal C vaccine in South Australia was 84.7 per cent for children  &gt;
aged 1 5 years compared to Australia overall at 83.9 per cent.

 The year 2005 06 has seen a marked increase in the numbers of notifi ed cases of gonorrhoea, chlamydia  &gt;
and syphilis.

 There were 865 447 screening mammograms provided to 232 764 individual women across South Australia  &gt;
from 1 July 1988 to 30 June 2006. A total of 4 472 breast cancers were diagnosed by BreastScreen SA 
from 1 January 1989 to 31 December 2005.

 The participation rate of women screened for cervical cancer in the target population (aged 20 69 years)  &gt;
was 66 per cent in 2004 05; the projected target for the current reporting period (2005 06) was 68 per cent.



page 74 South Australia: Our Health and Health Services

chapter 4

Introduction

A recent World Health Organization (WHO) report identified that much of the burden of disease in 
developed countries can be attributed to seven risk factors.1 Those seven factors were identified as tobacco 
smoking, high blood pressure, alcohol use, high cholesterol, overweight, low fruit and vegetable intake, 
and physical inactivity. 

Lifestyle factors influence the health status and health-risk profile of individuals. Tobacco smoking, 
for example, increases the risk of a range of diseases including cardiovascular disease and certain types 
of cancer. Lifestyle factors contribute significantly to the burden of disease in South Australia, yet they are 
largely modifiable, providing considerable scope for health gain. 

This section of the report presents a series of indicators profiling a variety of lifestyle behaviours that have 
an effect on health. The data presented have been derived largely from population health surveys and include 
the most recent results available for South Australia. 

These seven primary risk factors, while significant, are not the only ones that can impinge on a population s 
health; broader physical and social environmental determinants often can underpin the lifestyle choices of 
individuals and set the basic preconditions for poor health.

Key observations with regards to risk factors over the past five years are: 

 the proportion of persons surveyed who indicated being current smokers has reduced from 24.1 per cent  &gt;
in 2002 03 to 20.7 per cent in 2006 07

 slight increases in the proportion of persons reporting high blood pressure, high cholesterol and  &gt;
overweight/obesity

relatively stable proportions across the years for other risk factors. &gt;

Key observations with regards to risk factors across age groups for 2006 07 from the results include: 

 people aged 20 49 years were signifi cantly more likely to report being current smokers than were people  &gt;
in other age groups

 there is a dramatic increase in the proportion of persons reporting high cholesterol and high blood pressure  &gt;
for their age group for persons 50+ years

 overweight or obese, and insuffi cient or no activity, are more common risk factors in the elderly, although  &gt;
the proportion of overweight or obese reduces signifi cantly in the 80+ age group.

Risk factor 2002 03 2003 04 2004 05 2005 06 2006 07

Current Smokerd 24.1 23.6 21.9 19.1 20.7
Fewer than 5 serves of vegetables per dayb 93.0 91.9 89.5 88.1 90.7
Fewer than 2 serves of fruit per dayb 57.7 60.4 58.8 57.1 58.1
Short-term   risky/high-risk alcohola 29.1 28.9 29.5 29.9 28.4
Long-term   risky/high-risk alcohola 4.0 4.0 3.9 3.3 3.7
Overweight or obesec 54.5 54.6 55.1 55.7 56.7
Underweighta 2.5 2.4 2.2 1.8 2.2
Insufficient activity / no activitya   49.0 50.2 48.7 47.1
High blood pressurea   17.1 18.6 18.1 18.1
High cholesterola   13.2 14.3 13.5 14.3

Note:  a 16+ years; b 19+ years; c 18+ years; d 15+ years
Source: SA Health, South Australian Monitoring and Surveillance System (SAMSS)2.
 The Cancer Council South Australia, SA Health Omnibus Survey (Current smoker).

Table 4.1  Summary of risk factors across the past five years



page 75South Australia: Our Health and Health Services

chapter 4

Risk factor                Age group

 16 19  20 29  30 39  40 49  50 59  60 69  70 79  80+ 

Current Smokerd 13.9 29.1 26.1 25.3 19.7 15.1 8.6 4.0
Fewer than 5 serves of vegetables per dayb 95.2 92.0 91.8 90.8 88.5 88.5 89.1 95.1
Fewer than 2 serves of fruit per dayb 54.5 62.6 63.9 62.3 54.0 50.4 50.3 54.7
Short-term   risky / high risk alcohola 23.3 26.2 23.3 29.4 32.0 34.3 31.3 27.3
Long-term   risky / high risk alcohola 2.0 4.7 3.7 4.7 4.1 3.7 2.6 0.7
Overweight or obesec 23.3 44.0 52.8 65.8 66.6 65.3 59.0 39.4
Underweightc 7.1 4.1 2.5 1.0 0.7 0.7 1.3 5.9
Insufficient activity / no activitya 28.6 31.9 47.9 45.7 50.6 49.7 61.3 78.4
High blood pressurea 0.2 0.6 3.6 9.1 23.1 38.4 53.1 56.2
High cholesterola 0.4 1.3 3.5 7.7 21.1 31.6 39.2 29.8

Note:  a 16+ years; b 19+ years; c 18+ years; d 15+ years
Source: SA Health, South Australian Monitoring and Surveillance System (SAMSS)2.
 The Cancer Council South Australia, SA Health Omnibus Survey (Current smoker).

Table 4.2  Summary of risk factors by age group for 2006 07 



page 76 South Australia: Our Health and Health Services

chapter 4

4.1  Smoking

The results of the 2006 07 Health Omnibus Survey indicate that 20.7 per cent of respondents aged 15+ 
years self-reported being current smokers. Males (24.5 per cent) were significantly more likely than females 
(17.2 per cent) to report being current smokers.

The 2004 05 National Health Survey produced by the Australian Bureau of Statistics (ABS) shows that the 
percentage of current smokers in South Australia aged 18+ years was 22.5 per cent compared to 23.2 
per cent nationally.15

0

10

20

30

40

50

60

70

80

90

100

2002 03 2003 04 2004 05 2005 06 2006 07

Financial year

Pe
r 

ce
nt

Graph 4.1.1  Prevalence of current smoking, 15+ years

Current smoker

Ex- or non-smoker

 2002 03 2003 04 2004 05 2005 06 2006 07

Current smoker 24.1 23.6 21.9 19.1 20.7
Ex- or non-smoker 75.9 76.4 78.1 80.9 79.3

Source: The Cancer Council South Australia, SA Health Omnibus Survey, 15+ years.



page 77South Australia: Our Health and Health Services

chapter 4

4.2  Diet and nutrition

The results of the 2006 07 SAMSS indicate that 9.3 per cent of respondents aged 19+ years were eating the 
recommended (five) serves of vegetables per day. People aged 80+ years were more likely to be consuming 
fewer vegetables than were people in other age groups. Males (92.7 per cent) were eating fewer vegetables 
than were females (88.7 per cent). 

Respondents in the 50 59 and 60 69 age groups were marginally better with their vegetable intake than 
were other age groups. The younger and more elderly were the lowest consumers of vegetables.

Just over 40 (41.9) per cent of respondents aged 19+ years were consuming the recommended two fruit 
serves per day, according to the 2006 07 SAMSS. Further breakdowns by age suggest that people aged 
20 49 years were significantly more likely to eat less than the recommended daily intake of fruit, whereas 
higher consumption levels were observed for older people (50+ years). Males (65.2 per cent) were significantly 
more likely than were females (51.3 per cent) to not consume the recommended serves of fruit per day.

0

10

20

30

40

50

Pe
r 

ce
nt

19
years

20 29
years

30 39
years

40 49
years

50 59
years

60 69
years

70 79
years

80+
years

Age groups (years)

Vegetable consumption
(5 or more serves per day)

Fruit consumption
(2 or more serves per day)

Graph 4.2.1  Fruit and vegetable consumption by age groups, 19+ years, South Australia

Note: Adequate consumption of vegetables was based on NH&amp;MRC guidelines for the recommended daily intake of 
 vegetables according to age.3,4 Adequate consumption of fruit was based on NH&amp;MRC guidelines for the recommended 
 daily intake of fruit according to age.3,4

Source: SA Health, South Australian Monitoring and Surveillance System (SAMSS)2, 19+ years.



page 78 South Australia: Our Health and Health Services

chapter 4

The proportion of adults (aged 19+ years) in South Australia consuming fewer than the recommended 
two serves of fruit per day has changed slightly over time. A smaller proportion of people were consuming 
the recommended serves of fruit in 2003 04 (39.6 per cent), compared to 42.9 per cent in 2005 06. 

2002 03 2003 04 2004 05 2005 06 2006 07

Years

0

10

20

30

40

50

Pe
r 

ce
nt

Vegetable consumption
(5 or more serves per day)

Fruit consumption
(2 or more serves per day)

Graph 4.2.2  Fruit and vegetable consumption, 19+ years, South Australia

Note: Adequate consumption of vegetables was based on NH&amp;MRC guidelines for the recommended daily intake of 
 vegetables according to age.3,4 Adequate consumption of fruit was based on NH&amp;MRC guidelines for the recommended 
 daily intake of fruit according to age.3,4

Source: SA Health, South Australian Monitoring and Surveillance System (SAMSS)2, 19+ years.



page 79South Australia: Our Health and Health Services

chapter 4

4.3  Alcohol abuse

The results of the 2006 07 SAMSS indicate that 28.4 per cent of respondents aged 16+ years were classified 
as being at risk of harm from alcohol in the short-term. People aged 50 69 years were significantly more likely 
to be classified as at risk than were people in other age groups. Males (34.3 per cent) were more likely than 
females (22.8 per cent) to be classified as at risk of harm from alcohol in the short-term.

The results of the 2006 07 SAMSS indicate that 3.7 per cent of respondents aged 16+ years were at risk of 
harm from alcohol in the long term. People aged 40 49 years were more likely to be at risk of harm from 
alcohol in the long term, while people aged 16 19 years, or 80+ years were significantly less likely to be at risk 
of harm from alcohol in the long-term. Males (4.3 per cent) reported higher levels of alcohol intake than did 
females (3.1 per cent), predisposing themselves to long-term harm.

The proportion of adults (aged 16+ years) in South Australia at risk of harm from alcohol in the long-term 
has remained consistent over the years. There also have not been any significant differences in the proportion 
of males and females at risk of harm from alcohol in the long-term. 

The 2004 05 ABS National Health Survey states that the 14.5 per cent of South Australians aged 18+ years 
were at risk or at high risk of harm from alcohol, compared to 13.5 per cent nationally.15

0

10

20

30

40

50

60

70

80

90

100

16 19 20 29 30 39 40 49 50 59 60 69 70 79 80+

Age groups (years)

Pe
r 

ce
nt

Graph 4.3.1  Prevalence of short-term alcohol risk, by age groups, 16+ years

Risky/high risk

Non-drinker/low risk

Note:  Calculations were based on an Australian Standard Drink and according to NH&amp;MRC guidelines5 
 and World Health Organization's International Guide for Monitoring Alcohol Consumption and Related Harm6.
Source: SA Health, South Australian Monitoring and Surveillance System (SAMSS)2, 16+ years.

 16 19 20 29 30 39 40 49 50 59 60 69 70 79 80+
 years years years years years years years years

Per cent risky/high risk 2.0 4.7 3.7 4.7 4.1 3.7 2.6 0.7
Per cent non-drinker/low risk 98.0 95.3 96.3 95.3 95.9 96.3 97.4 99.3

Note:  Calculations were based on an Australian Standard Drink and according to NH&amp;MRC guidelines5 
 and World Health Organization s International Guide for Monitoring Alcohol Consumption and Related Harm6.
Source: SA Health, South Australian Monitoring and Surveillance System (SAMSS)2, 16+ years.

Table 4.3.1  Prevalence of long-term alcohol risk by age groups, 16+ years



page 80 South Australia: Our Health and Health Services

chapter 4

4.4  Overweight and obesity

The proportion of adults aged 18+ years in South Australia classified as overweight or obese according 
to body mass index (BMI) has increased slightly in recent years based on indicative data from SAMSS. 

South Australia s Strategic Plan8 Target T2.2 Healthy Weight aims to increase by 10 percentage points, 
by 2014, the proportion of South Australians 18+ years with healthy weight. Just over 40 per cent (41.5) 
of respondents aged 18+ years in the SAMSS for 2006 07 were classified in the healthy weight range 
according to BMI.

The 2006 07 SAMSS results indicate that 56.7 per cent of respondents were classified as overweight 
or obese. Males (64.8 per cent) and people aged 40 69 years were significantly more likely to be classified 
as overweight or obese than were people in other age groups. These trends were consistent over time.

The ABS National Health Survey for 2004 05 states the percentage of South Australians aged 18+ years who 
are overweight or obese is 49.7 per cent compared to 49.3 per cent nationally.15

0

10

20

30

40

50

60

70

80

90

100

Pe
r 

ce
nt

2002 03 2003 04 2004 05 2005 06 2006 07

Financial year

Graph 4.4.1  Prevalence of overweight and obesity, 18+ years

Overweight or obese

Healthy weight

Underweight

 2002 03 2003 04 2004 05 2005 06 2006 07

Overweight or obese 54.5 54.6 55.1 55.7 56.7
Healthy weight 43.0 42.9 42.7 42.5 41.5
Underweight 2.5 2.4 2.2 1.8 2.2

Note: Self-reported height and weight measurements were used to determine categories of body mass index (BMI) 
 using criteria and guidelines from the World Health Organisation7.
Source: SA Health, South Australian Monitoring and Surveillance System (SAMSS)2, 18+ years.



page 81South Australia: Our Health and Health Services

chapter 4

18 19 20 29 30 39 40 49 50 59 60 69 70 79 80+

Age groups (years)

0

10

20

30

40

50

60

70

80

90

100

Pe
r 

ce
nt

Graph 4.4.2  Prevalence of overweight or obesity, by age groups, 18+ years

Overweight or obese

Healthy weight

Underweight

   18 19 20 29 30 39 40 49 50 59 60 69 70 79 80+
    years years years years years years years  years

Overweight or obese  23.3 44.0 52.8 65.8 66.6 65.3 59.0 39.4
Healthy weight  69.6 51.9 44.7 33.2 32.7 34.0 39.6 54.7
Underweight   7.1 4.1 2.5 1.0 0.7 0.7 1.3 5.9

Note:  Self-reported height and weight measurements were used to determine categories of body mass index (BMI) 
 using criteria and guidelines from the World Health Organisation7.
Source: SA Health, South Australian Monitoring and Surveillance System (SAMSS)2, 18+ years.



page 82 South Australia: Our Health and Health Services

chapter 4

4.5  Physical activity/inactivity

The proportion of adults (aged 16+ years) in South Australia undertaking sufficient levels of physical activity 
has increased in 2006 07 (52.9 per cent). A lower proportion of people was undertaking sufficient levels of 
activity in 2004 05 (49.8 per cent). The goal of South Australia s Strategic Plan Target T2.3 Sport and Recreation 
is to exceed the Australian average for participation in sport and physical activity by 2014.

The results of the 2006 07 SAMSS indicate that 52.9 per cent of all respondents were undertaking sufficient 
levels of physical activity. Younger people (aged 16 29 years) were significantly more likely to be undertaking 
sufficient levels of physical activity than older people. Males (55.5 per cent) were more likely than were 
females (51.3 per cent) to be undertaking sufficient levels of physical activity.

The 2004 05 ABS National Health Survey shows the percentage of people in South Australia aged 
18+ years who exercise at moderate or high levels is the lowest in the country at 27.1 per cent; levels were 
29.6 per cent nationally.15 

0

10

20

30

40

50

60

70

80

90

100

Pe
r 

ce
nt

16 19 20 29 30 39 40 49 50 59 60 69 70 79 80+

Age groups (years)

Graph 4.5.1  Prevalence of sufficient physical activity by age groups, 16+ years, 2006 07

Sufficient physical activity

Activity but not sufficient

No activity

   16 19 20 29 30 39 40 49 50 59 60 69 70 79 80+
    years years years years years years years  years

Sufficient activity  71.4 68.1 52.0 54.3 49.4 50.3 38.6 21.6
Activity but not sufficient  18.2 24.3 32.1 30.5 30.9 30.4 33.8 36.1
No activity   10.4 7.6 15.8 15.2 19.7 19.3 27.5 42.3

Note:  Physical activity questions were adopted from the Active Australia Survey9. Sufficient Physical Activity is defined by the 
 Australian Institute of Health and Welfare as    the completion of 150 minutes of walking, moderate or vigorous 
 physical activity (when vigorous is weighted by a factor of two to account for its greater intensity) in the past week. 10

Source: SA Health, South Australian Monitoring and Surveillance System (SAMSS)2, 16+ years.



page 83South Australia: Our Health and Health Services

chapter 4

4.6  High blood pressure

The results of the 2006 07 SAMSS indicate that close to one-fifth (18.1 per cent) of respondents aged 
16+ years self-reported having current high blood pressure. There was no significant difference between 
males and females, but more older people (aged 50+ years) reported having current high blood pressure 
than younger people.

The proportion of adults aged 16+ years in South Australia with current high blood pressure has not changed 
in recent years. The prevalence (18.1 per cent) of current high blood pressure (for people aged 16+ years) in 
South Australia in 2006 07 was not significantly different compared with prevalence estimates (17.1 per cent) 
in 2003 04.

The proportions of males and females in South Australia with high blood pressure have remained consistent 
in recent years, although there were significant differences in the proportion of people reporting high blood 
pressure by age group over time. Respondents aged 50+ years were more likely in all years to report having 
high blood pressure than were younger respondents.

 2003 04 2004 05 2005 06 2006 07

High blood pressure 17.1 18.6 18.1 18.1
No/don t know 82.9 81.4 81.9 81.9

Note:  High blood pressure is defined as respondents having been told by a doctor that they have current high blood pressure 
 and/or they are on antihypertensive medication.
Source: SA Health, South Australian Monitoring and Surveillance System (SAMSS)2, 16+ years.

Table 4.6.1  Prevalence of current high blood pressure, 16+ years

16 19 20 29 30 39 40 49 50 59 60 69 70 79 80+

Age groups (years)

0

10

20

30

40

50

60

70

80

90

100

Pe
r 

ce
n

t

Graph 4.6.1  Prevalence of current high blood pressure by age groups, 16+ years, 2006 07

High blood pressure

No/don't know

   16 19 20 29 30 39 40 49 50 59 60 69 70 79 80+
    years years years years years years years  years

High blood pressure  0.2 0.6 3.6 9.1 23.1 38.4 53.1 56.2
No/don t know  99.8 99.4 96.4 90.9 76.9 61.6 46.9 43.8

Note:  High blood pressure is defined as respondents having been told by a doctor that they have current high blood pressure 
 and/or they are on antihypertensive medication.
Source: SA Health, South Australian Monitoring and Surveillance System (SAMSS)2, 16+ years.



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4.7  High blood cholesterol

The results of the 2006 07 SAMSS indicate that 14.3 per cent of respondents aged 16+ years self-reported 
having current high cholesterol. There was no significant difference between males and females, but older 
people (aged 50+ years) were significantly more likely to report having current high cholesterol than were 
younger people.

The proportion of adults aged 16+ years in South Australia with high cholesterol has not changed in recent 
years. The proportions of males and females in South Australia with high cholesterol also have remained 
consistent over time. 

 2003 04 2004 05 2005 06 2006 07

High cholesterol 13.2 14.3 13.5 14.3
No/don t know 86.8 85.7 86.5 85.7

Note:  High cholesterol is defined as respondents having been told by a doctor that they have current high cholesterol 
 and/or they are on medication for high cholesterol.
Source: SA Health, South Australian Monitoring and Surveillance System (SAMSS)2, 16+ years.

Table 4.7.1  Prevalence of current high cholesterol, 16+ years



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4.8  Sexually transmitted diseases

Sexually transmitted diseases (STDs) are infections that can be transmitted from person-to-person through 
direct body contact or contact with infected body fluids.13

4.8.1 Chlamydia
There has been an increase in the number of cases of chlamydia reported each year, following the introduction 
of chlamydial tests in the mid-1900s.12

Notifications of chlamydia infections (in both males and females) have increased quite considerably between 
calendar year 2002 (1 806 cases) and calendar year 2006 (3 123 cases).12 

4.8.2 Gonorrhoea
The number of gonococcal infections reported annually in South Australia has increased noticeably between 
calendar year 2002 (208 cases) and calendar year 2006 (503 cases).12 This increase is due mainly to the 
increased numbers of homosexual men in the state, as well as to the introduction of screening programs 
within remote Aboriginal communities.

Three-hundred-and-nine (61 per cent) of the 503 medical notifications reported in 2006 were for males 
and 194 (39 per cent) for females.12

4.8.3 Syphilis
The incidence of infectious syphilis notifications jumped in calendar year 2006 (42 cases), compared with 
the previous year (13 cases). The increase was due predominantly to an increase in cases in homosexual men. 
Thirty-five of the 42 cases were males and seven were females.12

0

500

1 000

1 500

2 000

2 500

3 000

N
um

be
r 

of
 n

ot
if

ic
at

io
ns

2002 2003 2004 2005 2006

Years

Chlamydia Gonorrhoea Syphilis

Graph 4.8.1  Sexually transmitted diseases, South Australia

Source: STD Services.12



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4.9  Blood-borne diseases

Blood-borne diseases are pathogens carried in, and spread from one person to another through the exchange 
of contaminated blood.14

4.9.1  Human immunodefi ciency virus (HIV)/Acquired immune defi ciency 
syndrome (AIDS)

South Australia remains a state with a relatively small HIV/AIDS epidemic compared to the Eastern states of 
Australia, but the changes that have occurred interstate have been seen in South Australia. New infections   
mainly through male-to-male sex   have increased again since 2002 after reaching a low plateau in the early- 
to mid-1990s. There has been a steady increase in diagnosed HIV infections from 32 in calendar year 2002 
to 61 in calendar year 2006, of which 85 per cent were for males.12 The availability and success of treatments 
means that more people living with HIV/AIDS are living longer and healthier lives, and rates of AIDS deaths 
are declining. 

Increasing new infections and decreasing death rates result in growing numbers of people living with HIV/AIDS 
in South Australia. A growing number of long-term survivors now present with HIV-related brain injuries 
and require very high-level and intensive individual care and support.

0

10

20

30

40

50

60

70

80

N
um

be
r 

of
 n

ot
if

ic
at

io
ns

2002 2003 2004 2005 2006

Years

Hepatitis C (incident)

Human immunodeficiency virus (HIV)

Acquired immune deficiency syndrome (AIDS)

Graph 4.9.1  Blood-borne diseases, South Australia

Note: Newly diagnosed cases only.
 Includes individuals whose HIV infection may have been diagnosed interstate.
Source: STD Services.12



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4.9.2 Hepatitis C Virus (HCV)

It is estimated that the peak of the hepatitis C epidemic in South Australia occurred about 15 20 years ago, 
long before its existence was known. An overall estimate of 15 000 17 000 people in South Australia live 
with HCV infection (1 1.5 per cent of the population). The number of HCV-incident cases (infections acquired 
in past 12 months) has slightly increased over the years, Thirty-eight (71 per cent) of the 53 cases in 2006 
were for males, while 15 (29 per cent) were for females.12 Efforts to increase testing among populations most 
at risk of having contracted HCV have resulted in declining numbers of notifications of existing  old  infections. 
New HCV infections increased from 44 cases in calendar year 2002 to 53 cases in calendar year 2006, 
and were acquired almost exclusively through sharing injecting equipment.

Hepatitis C is a slowly progressing disease; the long-term health effects are only now beginning to have 
an impact on the health system. Only a proportion of people infected with hepatitis C will develop severe 
long-term liver damage (including cirrhosis and hepatocellular carcinoma); however, the numbers are 
significant and already make up the majority of people in need of liver transplants. A treatment for hepatitis C 
is now available, but its success rate (between 50 and 80 per cent) depends on the virus type.



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4.10  Environment

A healthy environment is fundamental to healthy living. It is well understood that the condition of the 
physical environment is a key determinant of health.

The Environmental Protection Authority (EPA) produces a State of the Environment Report at least every 
five years pursuant to its statutory obligations. The EPA noted in its most recent report (2003) several 
environmental challenges facing South Australia. The report stated:

On the whole the news is not good. Many aspects of the environment have not improved signifi cantly 
and in some cases have deteriorated. Resource consumption is rising as is the amount of waste we generate. 
Around one tonne of solid waste per person went to landfi ll in South Australia in 2002, an increase of 
14 per cent over 1998 levels. Our energy consumption is rising each year; we are using water resources 
unsustainably; and our greenhouse gas emissions continue to rise.8

Since that report, however, more recent trends have shown improvements. The Recycling Activity in South 
Australia Report 8, for example, noted that total waste per capita going to landfill had fallen to 678 kilos by 
2005 06. The authors also noted that South Australians  recycling activity was above the national average.

The greenhouse gas impacts of greater recycling efforts also was noted in the report. South Australia s 
recycling efforts in 2005 06 prevented the equivalent of approximately 1.24 million tonnes of CO2 entering 
the atmosphere, up from 1.16 million in 2004 05, because of substituting secondary-use materials for virgin 
materials. This increase is equivalent to about 21 per cent of the annual CO2 emissions from the entire 
South Australian transport sector (2002 transport sector figures), and equates to taking 287 500 passenger 
cars off the road.

The EPA has identified environmental goals for South Australia which include:

clean and healthy air &gt;

water that meets agreed environmental values &gt;

communities protected from unacceptable noise &gt;

sustainable land use. &gt;

Further information on progress towards these goals can be found in the EPA s annual report.

Other health-related environmental factors of note include safe drinking water supplies, safe food supply, 
local environmental health management, mosquito management and waste water management.

4.10.1 Drinking water
Water quality in drinking water supplies is monitored through two mechanisms: regular reporting and 
incident reporting in accord with criteria established through the Water/Wastewater Incident Notification 
and Communication Protocol. SA Water provides routine monthly reports summarising compliance data 
for all water supplies. Compliance is measured against guideline values provided in the Australian Drinking 
Water Guidelines. Results are summarised in the following figures.

 2004 05 2005 06

Metropolitan 99.7% 100%
Country 99.6% 99.9%

Table 4.10.1  Customer tap samples free from E. coli

 2004 05 2005 06

Metropolitan 100% 100%
Country 99.9% 99.8%

Table 4.10.2  Per cent of samples compliant with Australian Drinking Water Guidelines  health parameters



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4.10.2  Food safety
The Communicable Disease Control Branch of SA Health conducts epidemiological investigations into 
food-borne disease outbreaks, in conjunction with local government Environmental Health Officers and 
SA Health s Food Policy and Programs Branch. The Food Policy and Programs Branch and local government 
Environmental Health Officers provide food technology and environmental investigation expertise, 
and perform environmental and food premise investigations. Primary Industry and Resources South Australia 
(PIRSA) staff also assist in trace back investigations, which is the process of determining the source or point 
of food contamination. 

Epidemiological and environmental information including reports of on-site visits to premises, food history 
questionnaires of cases, and laboratory results of stool and food samples is collated and used to provide 
a descriptive and analytical picture of the outbreak. Epidemiological analysis may demonstrate a statistical 
association between illness and the consumption of a particular food item. Microbiological evidence can 
suggest an association when a very similar or identical microorganism is found in both cases and a food 
vehicle suspected on epidemiological grounds. The specific food vehicle or source of an outbreak is difficult 
to identify; often there is no remaining food at the start of the investigation as food may have been consumed 
from anywhere between one day and up to 90 days before the illness. Faecal samples from affected persons, 
furthermore, are not always provided for analysis.

The investigations undertaken in the period from July 2005 to June 2006 are summarised in the figure below.

Number Month of Organism People Location Number ill Cases  Transmission Evidence
 outbreak  at risk   positive mode

1 October 2005 L.monocytogenes  Unknown Health care  4 3 Cold meats D and M
  serotype 01  facilities and in 
    the community

2 November 2005 Campylobacter Unknown School 36 14 Unknown D and S

3 December 2005 Norovirus Unknown Restaurant 22 7 Unknown D

4 January 2006 STM 108 50 Private residence 7 3 Home-made  D and M
       dessert topping

5 February 2006 Salmonella Anatum Unknown Restaurant 12 12 Unknown D

6 May 2006 STM 108 Unknown Community 23 23 Ravioli D, S and M

7 June 2006 STM 9 Unknown Hotel/restaurant 4 4 Vegetable and  D and S
       cheese salad 

These data refer to outbreaks where investigations have been substantially completed. Data are subject to revision.
M (microbiological):  identification of an organism of the same type from cases and the suspect vehicle, vehicle ingredient(s), 
 detection of toxin in faeces or food.
D (descriptive): other evidence, usually descriptive or local investigations indicating the suspect vehicle or mode of transmission. 
S (statistical): a significant statistical association between consumption of the suspect vehicle(s) and a case of STM PT   
 Salmonella Typhimurium phage type.

Source:                   SA Health, Food Act Report. Year ending 30 June 2006.
 

Table 4.10.3  Summary of food-borne or suspected food-borne disease in South Australia, 

       during the period from July 2005 to June 2006



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4.10.3  Insanitary conditions
The Public and Environmental Health Act 1987 (the Act) is the centrepiece of public health legislation in 
South Australia. The Act is administered jointly by the Department of Health and local councils, who assume 
the role of the public health authority within their jurisdictions. The Act consists of two key operational 
components, the first relating to sanitation and the second relating to control of notifiable diseases.

The Act confers a statutory obligation on local councils to promote proper standards of public and 
environmental health within their areas. The Act provides that premises are in an insanitary condition if:

a) the condition of the premises gives rise to a risk to health; or &gt;

b) the premises are so fi lthy or neglected that there is a risk of infestation by rodents or other pests; or &gt;

c) the condition of the premises is such as to cause justifi ed offence to the owner of any land in the vicinity; or &gt;

d) offensive material or odours are emitted from the premises; or &gt;

e) the premises are for some other reason justifi ably declared by the authority to be in an insanitary condition. &gt;

Local government reported the following activities related to insanitary conditions under the Act in the 
2005 06 period:

1 671 complaints were received by 43 councils &gt;

70 notices were served by 24 councils requiring remediation of the insanitary condition &gt;

5 expiation notices were issued. &gt;

The Department of Health through the Applied Environmental Health Branch provides support to local 
government in administering the Act as it relates to insanitary conditions. The Public and Environmental 
Health Council hears appeals of notices served under the Act.

4.10.4 Mosquito management
SA Health is involved in a number of mosquito management initiatives to reduce the incidence of 
mosquito-borne disease and mosquito-related nuisance. Mosquito-borne Ross River and Barmah Forest 
arboviruses (RRV and BFV respectively) notifications in South Australia over previous years suggest a 
general pattern of epidemics occurring every three to four years. RRV and BFV notifications over summer 
2005 06 were the first in epidemic proportion since 2000 01. This increase emphasises the importance 
of a combination of surveillance, control of mosquito breeding sites and effective community education 
to reduce mosquito-related public health risks.

4.10.5 Waste water management
SA Health   through the Waste Water Management Section (Applied Environmental Health Branch) together 
with local government   administers matters relating to wastewater for the 400 000 South Australians not 
connected to the SA Water sewer infrastructure.

South Australia presently has over 160 septic tank effluent disposal (STED) schemes and a small number 
of private sewers. SA Health assesses all installation applications for these schemes, as well as extensions 
to existing systems. The section processed over 40 applications in the year 2005 06, for new collection, 
treatment and reuse schemes to serve entire towns as well as extensions to existing communal systems.



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4.10.6 Recycled water

Approximately 100 000 megalitres of sewage are collected and treated each year by SA Water. Just over 
18 (18.1) per cent of metropolitan and 17.2 per cent of rural treated sewage was recycled in 2005 06. 
Recycled water schemes are regulated under the Public and Environmental Health (Waste Control) Regulations. 
SA Health provides formal approval for recycled water schemes involving treated sewage and also a 
consultancy for proponents, and undertakes risk assessments, identifies risk management options and 
requirements, and issues approvals. The largest schemes either are operated or supplied with recycled water 
from the SA Water Waste Water treatment plants at Bolivar, Glenelg and Christies Beach. Recycled water 
quality is monitored   as is the quality of drinking water supplies   through routine monthly reports and 
incident reporting. SA Water provides routine monthly reports on recycled water quality to SA Health.



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4.11  Immunisation rates

The Vaccine Distribution Centre, within the South Australian Immunisation Coordination Unit, distributed 
a total of 662 619 doses of vaccine in the period June 2005 to June 2006 for all vaccination programs, 
including the Childhood Immunisation Program.

Four Commonwealth-funded vaccines (diphtheria, tetanus, whooping cough and hepatitis B) are offered 
annually in South Australia to Year 8 students through local government. South Australia has the highest 
vaccine coverage rates in Australia for this age group. Eighty-six (86) per cent of Year 8 students received 
a booster vaccine for diphtheria, tetanus and whooping cough in 2005 and are fully immunised for 
hepatitis B. Coverage for hepatitis B for the same group in Victoria, by comparison, is 56 per cent and, in 
New South Wales, 48 per cent. Queensland has no school program in place and can only estimate coverage, 
believed to be around 30 per cent.

4.11.1 National Infl uenza Vaccination Program
Over 220 000 doses (222 130) of influenza vaccine were distributed in 2005 06, an increase on 2004 05. 
Almost 84 per cent of people aged 65+ years received annual influenza vaccination. There was a 
significant increase in health care worker influenza vaccine coverage following the start of the Health Care 
Worker Influenza Program in 2006, with 24 852 doses distributed   an increase of 9 196 doses over the 
previous year.

4.11.2 Childhood Immunisation Program
South Australia maintained immunisation coverage above 90 per cent for children aged 12 15 months 
and 24 27 months (that is, 91 per cent and 92.2 per cent respectively), with both cohorts being at or above 
the Australian level of coverage. The four-year-old coverage in South Australia is lower at 82.8 per cent, 
despite increased promotion by SA Health in collaboration with Local Immunisation Coordinators in the 
Divisions of General Practice. This lower coverage also is evident in the Australian national coverage of 
84 per cent. The childhood program was extended in November 2005 to include inactivated polio delivered in 
combination vaccines, the introduction of varicella vaccine at 18 months of age, and for Indigenous children, 
hepatitis A at 18 months and two-years-of-age.

4.11.3 National Meningococcal C Vaccination Program
The Australian Childhood Immunisation Register indicated coverage for meningococcal C vaccine in June 
2006 in South Australia was 84.7 per cent for 1 5 year old children compared to the Australian coverage of 
83.9 per cent. Nearly 38 000 doses (37 857) of meningococcal C vaccine were distributed. The meningococcal 
C program, originally due for completion in June 2006, was extended to June 2007. The collaborative 
meningococcal C program offered by local government through schools was completed at the end of 2005.

4.11.4 National Pneumococcal Vaccination Program for Older Australians
The Vaccine Distribution Centre distributed 41 283 doses of pneumococcal vaccine for older Australians, 
with funding from the Australian Government.

4.11.5 National Indigenous Vaccination Programs
South Australia s immunisation coverage for Aboriginal and Torres Strait Islander children aged 12 15 
months and 24 27 months was 78.6 per cent and 87.3 per cent respectively in June 2006. This coverage 
is low compared to the overall coverage.

4.11.6 School Immunisation Program
The Vaccine Distribution Centre distributed 32 220 doses of adult hepatitis B and 10 602 doses of 
diphtheria, tetanus and whooping cough dTpa (Boostrix) for the School Immunisation Program. The 2005 06 
immunisation coverage for both hepatitis B and dTpa (Boostrix) was 86 per cent. Varicella vaccine was 
included in the schools program at the beginning of 2006.



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4.12  Screening

4.12.1 BreastScreen SA
BreastScreen SA provides free screening mammograms (breast x-rays) at two-yearly intervals, primarily for 
women aged 50 69, with the aim of reducing deaths from breast cancer in this target group, through early 
detection of the disease. Women over the age of 40 years are eligible to be screened. There were 865 447 
screening mammograms provided from 1 July 1988 to 30 June 2006 to 232 764 individual women across 
South Australia. A total of 4 472 breast cancers were diagnosed by BreastScreen SA from 1 January 1989 
to 31 December 2005.

Key statistics for 2005 06

69 107 screening mammograms were performed &gt;

4 223 new clients in the target age group were screened &gt;

77.6 per cent of the total number of women screened were in the target age group 50 69 &gt;

 28.9 per cent of the total screening mammograms provided were performed in the three mobile  &gt;
screening units

 2.7 per cent (1 900) of women screened were recalled for assessment of a screen-detected  &gt;
breast abnormality

waiting times reduced from screening to assessment since March 2006, exceeding national targets &gt;

567 fi ne needle aspiration biopsies and 372 core biopsies were performed. &gt;

4.12.2 The South Australian Cervix Screening Program
One of the main tasks of the SA Cervix Screening Program is to encourage women to have a Pap smear every 
two years in line with the national policy. Recruitment activities target the general population of women 
aged 18 70 years and sub-groups of the population known to be under-represented in program participation; 
these include women from low socioeconomic areas, Aboriginal and Torres Strait Islander women, and women 
from some culturally and linguistically diverse (CALD) communities.

The participation rate of women screened for cervical cancer in the target population (aged 20 69 years) 
was 66 per cent in 2004 05, with the projected target for the current reporting period (2005 06) being 
68 per cent. The incidence of cervix cancer has fallen approximately 40 per cent over the past 25 years with 
a 69 per cent reduction in the mortality rate for the same period, according to SA Cancer Registry data.



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4.13  Services and initiatives

4.13.1 Alcohol
There are a variety of services in South Australia aimed at reducing the burden of alcohol and other substance 
abuse in the community. Some of the services provided include rehabilitation, withdrawal, detoxification, 
counselling and case management services, as well as education, information and referral services.

Drug and Alcohol Services South Australia (DASSA) has responsibility for running the Alcohol. Go Easy campaign. 
This campaign is an alcohol education program that aims to reduce problems associated with harmful 
alcohol consumption in the community. The campaign s objectives are to: decrease community acceptance 
of harmful alcohol consumption and related problems, and to increase the ability of communities to reduce 
harmful alcohol consumption and provide support for safer drinking environments. Communities need to 
work together to achieve long-term prevention of alcohol-related harm. The campaign is likely to be more 
effective if it is supported by the community. An important part of this program will be to help communities 
by providing information about strategies that work to reduce problems associated with harmful alcohol 
consumption. The campaign is not about stopping people from drinking alcohol altogether; rather, it is about 
reducing the problems that arise from the harmful consumption of alcohol.

4.13.2 Tobacco
The South Australian Government has initiated the South Australian Tobacco Strategy. The goal of the strategy 
is to improve the health of South Australians by reducing the harm caused by tobacco smoking, especially 
among high prevalence groups. The government has funded targeted public awareness campaigns to achieve 
this, made changes to legislation (including reducing the number of public places where people can legally 
smoke) and provided grants for innovative approaches to help reduce tobacco consumption in communities 
with a high prevalence of smoking. Particular efforts will focus on reducing harm caused by tobacco in three 
priority groups: young people; people living with mental illness; and Aboriginal people. Seven strategy areas 
have been identified for concerted action; these are:

reduce smoking by addressing the social determinants of health &gt;

strengthen smoke-free legislation, regulations and policies &gt;

 strengthen regulation to minimise commercial conduct that promotes tobacco products;  &gt;
advertising and promotion; product toxicity; active surveillance and enforcement

increase knowledge about the health effects of smoking and community support for tobacco control &gt;

conduct quit promotions led by mass media &gt;

support cessation support and relapse prevention &gt;

undertake research, evaluation and monitoring. &gt;



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4.13.3 Nutrition and physical activity
The South Australian Government launched the Eat Well Be Active Strategy (2006 2010) in March 2006. 
The strategy aims to improve the health and wellbeing of South Australians by working towards achieving 
the target identified in South Australia s Strategic Plan to reduce the percentage of South Australians who are 
overweight or obese by 10 per cent within 10 years. The strategy recognises that the goal of Eat Well Be Active 
requires coordinated effort across government and community. It focuses on developing partnerships amongst 
industry, other government agencies, schools, workplaces and communities, and focuses on prevention and 
the reduction of inequalities.

Progress was made around a number of strategies for Eat Well Be Active in 2006, including:

 mandatory healthy food guidelines were developed to be introduced into all government schools  &gt;
and preschools in 2007

 communities were supported to eat well and be active through  &gt; Eat Well Be Active Community Programs 
in Murray Bridge and Morphett Vale

 the Premier s  &gt; be active Challenge was developed and introduced for Reception to Year 9 students from 2007

 cycling was encouraged by providing grants to South Australian councils through the State Bicycle Fund  &gt;
to develop bicycle lanes and paths, and by providing on-line maps of Adelaide s Bikedirect bicycle networks

 bicycle safety was improved through the  &gt; State Black Spot Program: Cycling Projects, the Arterial Road Bicycle 
Facilities Improvement Program and the Bike Ed Program, a program conducted in primary schools for 9 12 
year-olds that teaches safe bicycle riding

 active modes of transport were promoted, such as walking, cycling and catching public transport, &gt;
through TravelSmart

 community road safety was promoted for children travelling to school, including walking and cycling,  &gt;
through the Safer and Smarter Route to Schools Program

 the use of parks that are managed by the Department of Environment and Heritage was encouraged,  &gt;
through the Healthy Parks Healthy People Program

physical activity in workplaces was promoted &gt;

  &gt; Fundamental Movement Skills programs were run for educators to support them in teaching basic skills, 
such as balancing, running, throwing and catching to young children

 support was provided for parents to encourage children to eat healthy food and engage in physical activity  &gt;
and play

 nutrition in childcare services was improved through the  &gt; Start Right Eat Right Childcare Nutrition Award Scheme 
for child care services

women were encouraged and supported to breastfeed their babies &gt;

 people were encouraged to eat two serves of fruit and fi ve serves of vegetables a day, through the  &gt;
Go for 2 and 5  campaign

staff in health care services were supported in promoting healthy eating and physical activity &gt;

 training was provided for staff in early years education and childcare services on healthy eating  &gt;
and physical activity

the community was informed about practical ways to be active through &lt;www.beactive.com.au&gt;. &gt;



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4.13.4 South Australian Integrated Mosquito Management Strategy 
SA Health released the South Australian Integrated Mosquito Management Strategy (SAIMMS) in 2007 aimed 
at promoting and integrating mosquito management practices throughout the state to ensure that these 
programs are as effective, efficient and environmentally sensitive as possible.

The SAIMMS framework provides a means to encourage ongoing communication and collaborative action 
between agencies. The framework also identifies a series of guiding principles and provides models to 
facilitate the balancing of often competing environmental, economic and public health considerations. 

One promotional activity under the framework is the Fight the Bite campaign. SA Health actively promotes 
this campaign aimed at encouraging personal and household protection against mosquitoes to prevent the 
spread of mosquito-borne arbovirus. Fight the Bite pamphlets and posters are distributed widely throughout 
South Australia. The campaign additionally is underpinned by advertisements in the Sunday Mail and other 
local print press.

4.13.5 Screening and immunisation
BreastScreen SA is the fully accredited South Australian component of BreastScreen Australia, the national 
breast cancer screening program for women without breast cancer symptoms or signs. BreastScreen SA is 
a part of the Central and Northern Adelaide Health Service and incorporates nine screening clinics including 
three mobile screening units.

The South Australian Cervix Screening Program is a partner of the National Cervical Screening Program, 
and aims to reduce the incidence of cancer of the cervix by increasing the proportion of women screened at 
two-yearly intervals and by promoting high-quality screening and follow-up services.

SA Health works collaboratively with Divisions of General Practice, local government and other immunisation 
providers to provide a high quality immunisation program for South Australians.

4.13.6 The Cause of the Causes
The seven risk factors stated at the beginning of this chapter do not exist in isolation. They very often 
interact with each other and, more frequently than not, are experienced in high-risk combinations by 
individuals. These risk factors similarly themselves are caused by a complex web of determinants in social, 
environmental and economic conditions that have an impact on the health of individuals and whole 
communities. These determinants include having access to good housing, clean safe water, safe food, 
adequate transport, educational opportunities, employment and training, and social supports, and living 
in well-designed safe suburbs.

South Australia s Strategic Plan (SASP) is designed to be the central strategy of the State Government 
and the community of South Australia to build a state that is prosperous, environmentally rich, culturally 
stimulating, offering its citizens every opportunity to live well and succeed. The plan aims across its 98 targets 
to grow prosperity, improve wellbeing, attain sustainability, foster creativity and innovation, build communities 
and expand opportunities. SA Health   together with the Department of the Premier and Cabinet   has 
been working throughout 2007 to apply a  Health Lens  over the plan. The aim of the Health Lens is to help all 
government agencies identify the health effects of the plan s objectives, how health can be promoted 
across government, and how potential negative effects can be reduced or eliminated. The aim of the 
Health Lens also has been to identify where a healthier population can contribute to achieving the objectives 
of South Australia s Strategic Plan. This work was greatly assisted by Adelaide s Thinker-in-residence for 2007, 
Professor Ilona Kickbusch.



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4.14  Notes

1.  WHO World health report 2002: Reducing Risks Promoting Healthy Life Geneva 
&lt;http://www.who.int/whr/2002/en/&gt;

2.  Population Research and Outcome Studies Unit. The South Australian Monitoring and Surveillance System 
(SAMSS). Adelaide: Department of Health. 2002. Available at &lt;http://www.health.sa.gov.au/pros/
portals/0/BR%202002-20%20SAMSS.pdf&gt;

3.  NH&amp;MRC. Dietary Guidelines for children and adolescents in Australia: incorporating the Infant Feeding 
Guidelines for Health Workers. Commonwealth of Australia 2003. [Online] 
Available at &lt;http://www.nhmrc.gov.au/publications/nhome.htm&gt;

4. NH&amp;MRC. Dietary Guidelines for Australia Adults. Commonwealth of Australia 2003. [Online] 
 Available at &lt;http://www.nhmrc.gov.au/publications/nhome.htm&gt;

5. NH&amp;MRC. Australian Alcohol Guidelines - Health Risks and Benefi ts. Commonwealth of Australia 2001.

6.  World Health Organization Department of Mental Health and Substance Dependence 
Noncommunicable Diseases and Mental Health Cluster. International Guide for Monitoring Alcohol 
consumption and Related Harm. WHO, 2000.

7.  World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO 
consultation on obesity. 1997, World Health Organization: Geneva.

8.  Creating Opportunity     South Australia s Strategic Plan. Department of the Premier and Cabinet, 
Government of South Australia, March 2004.

9.  NSW Health. The Active Australia / International Year of Older Persons public education campaign to promote 
physical activity among older people: NSW evaluation report. 2000 NSW Health Department.

10.  T Armstrong, A Bauman &amp; J Davies, Physical Activity Pattern of Australian Adults. Results of the 1999 
National Physical Activity Survey. August 2000 Australian Institute of Health and Welfare, Canberra. 
AIHW Cat No. CVD 10.

11. EPA State of the Environment Report 2003.

12.   Government of South Australia, Sexually Transmitted Diseases in South Australia in 2006, Epidemiologic 
Report No. 20, Royal Adelaide Hospital, retrieved 19 February 2008, &lt;http://www.stdservices.on.net/
publications/pdf/annual_report_2006.pdf&gt;

13.   Government of South Australia, Sexually Transmitted Diseases Defi ned, Royal Adelaide Hospital, 
retrieved 19 February 2008, &lt;http://www.stdservices.on.net/std/definition.htm&gt;

14.   State Government of Victoria, Blood Borne Diseases, Department of Human Services, 
retrieved 19 February 2008, &lt;http://www.health.vic.gov.au/ideas/diseases/gr_blood&gt;

15.  Australian Bureau of Statistics, National Health Survey: Summary of results, 2004 05, cat. no. 4364.0, 
viewed 27 February 2008, &lt;http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4364.02004 
05?OpenDocument&gt;



page 98 South Australia: Our Health and Health Services

chapter 5

5  Mental illness

In this chapter

Psychological distress &gt;

Current mental health conditions &gt;

Burden of disease &gt;

Hospitalisation (public hospitals) &gt;

Community mental health contacts &gt;

Mental health-related encounters with general practitioners &gt;

Suicide deaths &gt;

Services and initiatives &gt;

Summary

 The level of psychological distress in South Australia   as determined by the Kessler Psychological Distress  &gt;
10 item scale (K10), that measures anxiety and depressive disorders in the general population   has 
decreased from 10.6 per cent to 9.5 per cent between 2002 03 and 2006 07 for people 16+ years. 
People in the age groups 16 19 years (12.7 per cent) and 20 29 years (12.8 per cent) were more likely 
to have higher levels of psychological distress than were other age groups. The proportion of females 
in South Australia experiencing psychological distress has been consistently higher over time than the 
proportion of males. Some 14 per cent of people aged 16+ years self-reported having a current doctor-
diagnosed mental health condition. The age group in 2006 07 with the highest self-reported diagnosed 
mental illness was 50 59 years.

 Mental illness accounted for 9.4 per cent of the total burden of disease in South Australia as measured  &gt;
by Disability adjusted life years (DALYs). The DALYs were 8 333 for males and 11 644 for females. 
The burden of disease was 12.3 per cent if alcohol and substance use illnesses are included; this compares 
with the national average of 13.3 per cent. The highest ranked burden of disease in the mental health 
category was depression, which accounted for 35.2 per cent for males and 40.0 per cent for females.

 South Australia in 2006 07 had 16 429 hospital separations for mental health-related illnesses based on  &gt;
the patient s principal diagnosis. This fi gure represented some 4.2 per cent of all public hospital separations. 
The most common principal diagnosis for mental health hospital separations for both males and females 
was depression, while schizophrenia accounted for the most patient days in hospital. Mental health hospital 
separations increased by 3.1 per cent between 2002 03 and 2006 07.

 There were 382 304 community mental health contacts during 2006 07, of which approximately  &gt;
52 per cent were for males and 48 per cent for females. Schizophrenia, schizotypal and delusional disorders 
accounted for 41.1 per cent of the service contacts. Community mental health service contacts increased 
by 21.7 per cent over the period 2002 03 and 2006 07.



page 99South Australia: Our Health and Health Services

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 The results from the  &gt; Bettering the Evaluation and Care of Health (BEACH) survey for mental health 
encounters with general practitioners for the period April 2005 to March 2007 showed that 80 per cent 
of the encounters related to depression, sleep disturbance and anxiety, with depression the highest at 
42.5 per cent.

 The standardised death rate from suicide in South Australia was 10.7 per 100 000 population in 2006  &gt;
(16.7 for males and 4.9 for females). This fi gure is higher than the national average of 8.6 per 100 000 
population (13.6 for males and 3.8 for females).



page 100 South Australia: Our Health and Health Services

chapter 5

Introduction

Good mental health is fundamental to the wellbeing of individuals, their families, and the whole population. 
Mental health problems and mental illness are among the greatest causes of disability, diminished quality 
of life, and reduced productivity.3

Mental health is a state of emotional and social wellbeing in which the individual can cope with the normal 
stresses of life and achieve his or her potential.2 Mental illness and mental health problems refer to the range 
of cognitive, emotional and behavioural disorders that interfere with the lives and productivity of people; they 
can include short-term anxiety and depression as well as longer term conditions such as anxiety disorders, 
chronic depression and schizophrenia.3 These conditions and others are significant in terms of prevalence and 
disease burden, and have far-reaching impacts for families, carers and others in the community.1

Mental health problems also interfere with a person s cognitive, emotional or social abilities, but to a lesser 
extent than a mental illness does. Mental health problems are more common mental health complaints and 
include the mental ill health temporarily experienced as a reaction to life stressors. Mental health problems are 
less severe and of shorter duration than mental illnesses, but may develop into mental illness. The distinction 
between mental health problems and mental illness is not well defined, and is made on the basis of severity 
and duration of symptoms.1

Mental ill health is the third leading burden of disease for the Australia population after cardiovascular disease 
and cancer, as well as being one of the leading causes of non-fatal burden of disease and injury in Australia. 
Mental ill health also is associated with higher rates of health risk factors, poorer physical health, and higher 
rates of deaths from many causes, including suicide.3

The diagnosis of mental illness generally is made according to classification systems such as the International 
Classification of Diseases, Tenth Edition (ICD-10) that refer to a wide range of mental and physical disorders.

This chapter uses a number of information sources to describe the psychological distress, prevalence of mental 
health conditions, burden of disease, hospitalisation, community mental health contacts, mental health-related 
encounters with general practitioners, and suicide deaths in regard to the South Australia community.

The chapter also describes the initiatives planned and being implemented for a number of historic mental 
health reforms.

Outcomes for mental health also are reported in other chapters of this report and these sections relate to 
burden of disease; mothers, babies and children; older people; and Aboriginal people.



page 101South Australia: Our Health and Health Services

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5.1  Psychological distress

The goal of South Australia s Strategic Plan Target T2.7 Psychological Wellbeing is for this state to be equal to 
or lower than the Australian average for psychological distress by 2014.

The results of the 2006 07 SAMSS indicate that 9.5 per cent of respondents aged 16+ years had psychological 
distress as determined by the K10. Females (11.8 per cent) were more likely than males (7.1 per cent) to have 
psychological distress. People aged 16 19 years (12.7 per cent) or 20 29 years (12.8 per cent) reported the 
highest levels of psychological distress. The prevalence of psychological distress lessens with age.

 2002 03 2003 04 2004 05 2005 06 2006 07

Psychological distress 10.6 10.7 10.1 8.9 9.5
No psychological distress 89.4 89.3 89.9 91.1 90.5

Note:  The level of psychological distress experienced by respondents was determined using the Kessler Psychological Distress 10 
 item scale (K10)7,8,9, that measures anxiety and depressive disorders in the general population.
Source: SA Health, South Australian Monitoring and Surveillance System (SAMSS), 16+ years.

Table 5.1.1  Prevalence of psychological distress, 16+ years

0
10

20
30
40
50

60
70
80

90
100

Pe
r 

ce
n

t

16 19 20 29 30 39 40 49 50 59 60 69 70 79 80+

Age groups (years)

Graph 5.1.1  Prevalence of psychological distress, by age groups, 2006 07

Psychological distress

No psychological distress

  16 19 years 20 29 years 30 39 years 40 49 years 50 59 years 60 69 years 70 79 years 80+ years

Psychological distress  12.7 12.8 10.6 8.3 9.9 7.3 6.2 4.8
No psychological distress  87.3 87.2 89.4 91.7 90.1 92.7 93.8 95.2

Note:  The level of psychological distress experienced by respondents was determined using the Kessler Psychological Distress 10 
 item scale (K10)8,9,10, that measures anxiety and depressive disorders in the general population. 
Source:  SA Health, South Australian Monitoring and Surveillance System (SAMSS), 16+ years.



page 102 South Australia: Our Health and Health Services

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5.2  Current mental health conditions

The results of the 2006 07 SAMSS survey indicate that 14.0 per cent of respondents aged 16+ years 
self-reported having a current doctor diagnosed mental health condition. Females (17.9 per cent) were 
more likely than males (9.9 per cent) to report having a current doctor diagnosed mental health condition. 
People aged 50 59 years (18.1 per cent) were more likely than others to report having a current diagnosed 
mental health condition.

The proportion of adults aged 16+ years in South Australia who have a self-reported current diagnosed mental 
health condition has not changed in recent years. The prevalence (14.0 per cent) of current diagnosed mental 
health conditions (for people aged 16+ years) in South Australia, in 2006 07 was not significantly different 
compared with prevalence estimates in 2002 03 (13.5 per cent).

 2002 03 2003 04 2004 05 2005 06 2006 07

Current diagnosed mental health condition 13.5 14.2 14.9 13.4 14.0
No/don t know 86.5 85.8 85.1 86.6 86.0

Note:  Current diagnosed mental health condition is determined if the respondent was diagnosed with a mental health 
 condition such as anxiety, depression, a stress-related problem, or any other mental health problem in the last 12 months, 
 or was currently receiving treatment for a mental health condition.
Source: SA Health, South Australian Monitoring and Surveillance System (SAMSS), 16+ years.

Table 5.2.1  Prevalence of current diagnosed mental health condition, 16+ years

16 19 20 29 30 39 40 49 50 59 60 69 70 79 80+

Age groups (years)

0
10
20

30
40
50

60
70

80
90

100

Pe
r 

ce
n

t

Graph 5.2.1  Prevalence of current diagnosed mental health condition, by age groups, 2006 07

No/don't knowCurrent diagnosed 
mental health condition

  16 19 years 20 29 years 30 39 years 40 49 years 50 59 years 60 69 years 70 79 years 80+ years

Current diagnosed 
mental health condition  8.9 14.1 14.6 14.7 18.1 13.8 10.5 9.8
No/don t know  91.1 85.9 85.4 85.3 81.9 86.2 89.5 90.2

Note:  Current diagnosed mental health condition is determined if the respondent was diagnosed with a mental health 
 condition such as anxiety, depression, a stress-related problem, or any other mental health problem in the last 12 months, 
 or was currently receiving treatment for a mental health condition.
Source:  SA Health, South Australian Monitoring and Surveillance System (SAMSS), 16+ years.



page 103South Australia: Our Health and Health Services

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5.3  Burden of disease

Mental illness accounted for approximately 9.4 per cent of the total disease burden in South Australia 
in 2001 2003. The definition of mental illness in this segment excludes alcohol and substance illnesses; 
if these two categories were included, the total burden of disease would have been 12.3 per cent, 
which is below the national figure of 13.3 per cent.4

The measure to determine total disease burden is Disability adjusted life years (DALY) which describes the 
amount of years of life lost due to premature death coupled with years of  healthy  life lost due to disability.

The total burden of disease for mental illness (excluding alcohol and substance illnesses) for all South 
Australians account for 8 333 DALYs for males and 11 644 for females. Depression and anxiety disorder 
dominated the burden of mental health disorders.

It also should be noted that, in addition to the mental health illness DALYs, there were 4 303 DALYs recorded 
for intentional injuries (suicides) of which 3 475 were for males and 828 were for females.

The following graph depicts the burden of disease for DALY for both males and females in South Australia. 
Mental health problems can result in increased exposure to health risk factors, poorer physical health, 
and death, from causes such as suicide.

0 1 000 2 000 3 000 4 000 5 000 6 000 7 000 8 000

Agoraphobia

Anorexia nervosa

Att-deficit hyperactivity disorder

Bipolar affective disorder

Borderline personality disorder

Bulimia nervosa

Depression

Generalised anxiety disorder

Obsessive-compulsive disorder

Mental retardation

Other eating disorders

Other mental disorders

Panic disorder

Post-traumatic stress disorder

Schizophrenia

Separation anxiety disorder

Social phobia

Disability adjusted life years (DALYs)

Total Females Males

Graph 5.3.1  The burden of mental illness (DALYs) by disorder and gender, South Australia, 2001 2003

Source: SA Health, South Australia Burden of Disease and Injury Estimates Study, 2001 2003.
 



page 104 South Australia: Our Health and Health Services

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5.4  Hospitalisation (public hospitals)

The National Health Survey in 2001 as cited in Australia s Health3 concluded that people with mental or 
behavioural problems are more likely to be hospitalised than those without these problems. The proportion 
of people with mental or behavioural problems admitted to hospital in the two weeks before the survey was 
19.1 per cent compared to 11.5 per cent for people without such problems. Those with very high levels of 
psychological distress also were more than twice as likely to be admitted to hospital (28.9 per cent) as those 
with low levels (11.7 per cent).

There were 16 429 hospital separations in South Australia in 2006 07 where a mental health-related principal 
diagnosis was recorded (includes behavioural disorders due to alcohol or substance use) and these are detailed 
in the following table. Mental health-related hospital separations represented 4.2 per cent of total public 
hospital separations.

The percentage of mental health hospital separations and length of stay (in days) was relativity similar 
between males and females. The most common principal diagnosis codes based on separations were 
depressive disorders (23.4 per cent), neurotic, stress-related and somatofam disorders (16.6 per cent) and 
schizophrenia (13.2 per cent). The diagnoses with the highest number of patient days were schizophrenia 
(22.4 per cent), depressive disorders (19.7 per cent) and other schizophrenic, schizotypal delusional disorders 
(16.7 per cent).



page 105South Australia: Our Health and Health Services

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Principal diagnosis Female   separation Female   average Male   separation Male   average Per cent of 
  length of stay  length of stay separations

Dementia 274 20.8 267 21.3 3.3

Other organic mental disorders 184 13.9 152 12.6 2.0

Mental behavioural disorders due to alcohol 637 3.2 1 355 3.6 12.1

Mental behavioural disorders due to other 
psychoactive substance use 287 4.8 522 4.9 4.9

Schizophrenia 571 18.6 1 594 16.0 13.2

Other schizophrenic, schizotypal, 
delusional disorders 747 17.8 927 14.7 10.2

Manic episode 33 13.5 40 8.9 0.4

Bipolar effective disorders 787 13.6 502 14.4 7.8

Depressive disorders 2 248 8.5 1 594 7.8 23.4

Other mood (affective) disorders 72 7.3 55 6.7 0.8

Neurotic, stress-related and somatofam  1 590 4.3 1 137 5.1 16.6

Eating disorders 191 19.4 13 10.5 1.2

Other behavioural syndromes associated with 
physiological disturbances, physical factors 35 5.9 9 3.4 0.3

Disorders of adult personality and behaviour 292 5.1 142 5.3 2.6

Mental retardation 11 6.6 16 9.1 0.2

Disorders of psychological development 29 4.8 31 1.6 0.4

Disorders onset usually occurring in childhood

Adolescence 29 7.0 52 3.9 0.5

Mental disorder not otherwise specified 0 0.0 5 2.8 0.0

Totals 8 017 9.9 8 412 9.7 100.0

Source: SA Health, Integrated South Australian Activity Collection (ISAAC).

Table 5.4.1  Hospitalisations for mental health conditions, 2006 07



page 106 South Australia: Our Health and Health Services

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5.5  Community mental health contacts

Government operated services provide specialised mental health care to patients in community settings 
as well as in the hospital setting. There were 382 304 contacts in 2006 07 (includes behavioural disorders 
due to alcohol or substance use) of which about 52 per cent were males and 48 per cent were females.

Schizophrenia, schizotypal and delusional disorders accounted for 41.1 per cent of service contacts for 
which a principal diagnosis was reported; this compares with the national result of 46.5 per cent as published 
in the Mental Health Services Report 2004 05.5 Details of the South Australian results are in the following 
table. Other commonly reported diagnoses were neurotic, stress-related and somatofam disorders, and 
depressive disorders.

ICD-10-AM  Principal diagnosis 2006 07 2006 07 2006 07 2006 07
code  males females  total per cent of total

F00 F03 Dementia 966 1 654 2 620 0.7

F04 F09 Other organic mental disorders 645 918 1 564 0.4

F10 Mental behavioural disorders due to alcohol 1 446 631 2 007 0.5

F11 F29 Mental behavioural disorders due to other 
 psychoactive substance use 2 975 1 088 4 063 1.1

F20 Schizophrenia 76 300 31 253 107 553 28.1

F21 F29 Other schizophrenic, schizotypal, 
 delusional disorders 26 380 23 207 49 587 13.0

F30 Manic episode 764 1 560 2 324 0.6

F31 Bipolar effective disorders 9 143 17 570 26 713 7.0

F32 F33 Depressive disorders 15 741 27 944 43 687 11.4

F34 F39 Other mood (affective) disorders 2 371 2 547 4 919 1.3

F40 F49 Neurotic, stress-related and somatofam  21 752 26 644 48 396 12.7

F50 Eating disorders 27 525 552 0.1

F51 F59 Other behavioural syndromes associated with 
 physiological disturbances, physical factors 43 88 131. 0.0

F60 F69 Disorders of adult personality and behaviour 4 769 10 218 14 994 3.9

F70 F79 Mental retardation 357 208 565 0.1

F80 F89 Disorders of psychological development 3 297 961 4 258 1.1

F90 F98 Disorders onset usually occurring in childhood
 Adolescence 12 098 6 515 18 613 4.9

F99 Mental disorder not otherwise specified 16 659 12 737 44 711 11.7

 Other 2 350 2 626 4 977 1.3

Totals  198 083 168 894 382 304 100

Note: Unknown sex included in total for  mental disorder not otherwise specified 
Source: SA Health, Community Based Information System (CBIS); Country Consolidation CME (CCC); 
 Child Adolescent Mental Health System (CAMHS)

Table 5.5.1  Community mental health contacts, 2006 07



page 107South Australia: Our Health and Health Services

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5.6  Mental health-related encounters with general practitioners

Nearly 7 per cent (6.7) of all general practice encounters in the two-year period April 2005 to March 
2007 were considered to be mental health-related (Table 5.6.1). The encounters exclude drug and 
substance problems.

The main mental health-related problems managed were depression, sleep disturbance and anxiety. 
These problems accounted for almost 80 per cent of the mental health encounters, with depression the 
highest at 42.5 per cent.

The results from this survey are very similar to data published in the Mental Health Services in Australia 
(2004 05) report in which depression, sleep disturbance and anxiety constituted 2.5 per cent, 1.1 per cent 
and 1.2 per cent respectively of all general practitioner encounters.

Problem managed Per cent total of mental Per cent of all
 health-related problems health problems

Depression 42.5 2.8
Sleep disturbance 19.5 1.3
Anxiety 17.8 1.2
Dementia (including senility and Alzheimer s disease) 7.6 0.5
Acute stress reaction 6.3 0.4
Schizophrenia 6.2 0.4
Totals 100 6.7

Source:  Family Medicine Research Centre, BEACH (Bettering the Evaluation and Care of Heath) survey of general practice activity.

Table 5.6.1  Managed mental health-related problems, BEACH-GP patient encounters in South Australia, 

      April 2005 to March 2007



page 108 South Australia: Our Health and Health Services

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5.7  Suicide deaths

The figures presented in this section are from the Australian Bureau of Statistics and relate to the number 
of deaths from suicide in the year registered; in some cases, this may not be in the year of occurrence. 
The rate of suicide can vary considerably from year to year, especially in small population groups.

The standardised death rate from suicide in South Australia was 10.7 per 100 000 population in 2006 
(16.7 for males and 4.9 for females). This figure is higher than the national average of 8.6 per 100 000 
population (13.6 for males and 3.8 for females). 

Generally, the suicide rate was nearly four times greater in males than females. This difference is thought to 
be due to the propensity of males to use more lethal methods compared to females since the difference in 
rates at which males and females attempt suicide is much smaller.6

Graph 5.7.1 presents data on suicides as a percentage of all deaths, using a three year moving average. 
The percentages for South Australia and Australia are quite similar, with South Australia s percentage 
increasing marginally in later years. 

2000 2001 2002 2003 2004 2005 20061999

1.5

1.0

0.5

0.0

2.0

2.5

3.0

3.5

4.0

4.5

5.0

Pe
r 

ce
nt

South Australia male

South Australia female

South Australia total

National male

National female

National total

Graph 5.7.1  Suicide as a percentage of all deaths by gender totals (3 year moving average) 

Source:  Australian Bureau of Statistics   Deaths, Australia, 2006 (cat 3302.0   table 1.4).
 Australian Bureau of Statistics   Causes of Death, Australia, 2006 (cat 3303.0   table 4.5).



page 109South Australia: Our Health and Health Services

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5.8  Services and initiatives

The South Australia Government requested the Social Inclusion Board in August 2005 to prepare a report on 
how to reform South Australia s mental health system. The Social Inclusion Board undertook a wide-ranging 
consultation process and its research culminated in the acceptance by the government on 20 February 2007 
of its report, Stepping Up: A Social Inclusion Action Plan for Mental Health Reform 2007 2012. The report made 
41 recommendations that focused on:

implementing a stepped system of care with community mental health teams at the centre &gt;

 tackling the crisis in acute psychosis care by having a targeted response for approximately 800 people  &gt;
with chronic and complex needs

aligning the South Australian Mental Health System with the COAG National Mental Health Action Plan &gt;

redeveloping the Glenside Hospital Campus as a centre for specialist mental health services. &gt;

The centrepiece of the report was the  stepped care  model, which seeks to fill the current gap in 
South Australia between community care and hospital care. The stepped system contained different 
graduating levels of care, including:

 support across the community, including community mental health centres, and care and support provided  &gt;
by non-government organisations

24-hour supported accommodation &gt;

community recovery centres &gt;

intermediate care beds &gt;

acute care beds &gt;

secure care beds. &gt;

These steps were designed to provide people with the most appropriate type of care for their mental health 
needs at any given time.

The government committed an initial $43.6 million funding package over five years following the release 
of the report, to begin the reform process, comprising:

90 new intermediate care beds   60 at four centres across Adelaide and 30 in country hospitals &gt;

an extra 73 beds in 24-hour supported accommodation across Adelaide &gt;

the provision of a smooth change over between the current system and the new fi ve tiers &gt;

eight mental health nurse practitioners in regional areas over the next four years &gt;

 priority access to services for about 800 people with chronic and complex needs, including those who  &gt;
also have drug and alcohol problems, a history of homelessness or who may be involved in the criminal 
justice system.

The 2007 08 State Budget included a further $50.5 million over four years for the following initiatives:

 non-clinical community-based support services to be delivered through non-government organisations (NGOs) &gt;

early intervention for young people with a mental illness &gt;

construction of six community mental health centres across the metropolitan area. &gt;

The government released the Concept Master Plan for the Glenside Campus in September 2007. 
The plan outlines the development of:

 a new world-class 129-bed hospital for mental illness and substance abuse, called SA Specialist  &gt;
Health Services

a residential area incorporating affordable housing and supported accommodation &gt;

a major public cultural hub for the people of the state &gt;

 environmental initiatives to maintain the open spaces of the campus and enhance biodiversity and  &gt;
water capture

a village shopping centre with shops and cafes to integrate services and residences into one community &gt;

a commercial development fostering employment opportunities in this near-city location. &gt;



page 110 South Australia: Our Health and Health Services

chapter 5

The new SA Specialist Health Services will comprise:

40 secure rehabilitation beds &gt;

six mother and infant acute beds &gt;

23 rural and remote acute beds &gt;

20 acute adult beds &gt;

10 psychiatric intensive care beds &gt;

30 drug and alcohol acute beds. &gt;

The Glenside site will accommodate a 15-bed Intermediate Care Facility and 40 supported accommodation 
places in addition to the 129-bed hospital.

New models of care have been developed for a number of key service areas to begin the modernisation 
of mental health care in South Australia. The new models of care comprise:

acute care &gt;

psychiatric intensive care &gt;

aged mental health care &gt;

intermediate care &gt;

supported accommodation &gt;

community mental health care &gt;

secure rehabilitation &gt;

perinatal mental health care &gt;

non-government psychosocial services. &gt;

The government released the Mental Health Bill 2007 for public comment in October 2007. The new mental 
health legislation will affirm the rights, dignity and civil liberties of mental health consumers and their carers, 
and balance these rights with the community s legitimate expectations that it be protected from harm. 
This legislation will establish clear principles enabling mental health consumers to receive appropriate services 
in a variety of settings. It is the aim of government to provide a modern, innovative and ethical legislative 
framework for people affected by mental illness as well as ensuring that the needs of carers are addressed, 
while conforming with the national privacy principles.

General practitioners (GPs) are at the frontline in the delivery of primary health care services to the community. 
The delivery of mental health services in a GP-setting is becoming more demanding, given the often complex 
needs of these consumers; in recognition of this, the government provided some $9.7 million in funding over 
four years for 30 allied-health workers   such as psychologists, occupational therapists, nurses and social 
workers   to work in GP clinics across the state to assist people with mental illness, and also to provide much 
needed additional support for South Australian GPs.

Early intervention services for children and young people are critical to reduce the social, health and economic 
impact of mental illness; in recognition of this, the government provided $10.2 million over four years for 
an additional 23 community workers and three psychiatrists to assist in reducing waiting times for children 
and adolescents for mental health services. The funds also will be used to increase the mental health service s 
capacity to provide outreach and primary care services for adolescents with mental illness and substance use 
issues, and incorporates funding for two specialist mental health workers and a consultant psychiatrist.



page 111South Australia: Our Health and Health Services

chapter 5

5.9  Notes

1   DoHA (Department of Health and Ageing) 2003, National Mental Health Plan 2003 08, Australian Health 
Ministers, July 2003, Canberra.

2  World Health Organization s, Strengthening Mental Health Promotion, WHO Fact Sheet No.220. Geneva: 
World Health Organization, 1999.

3  AHIW (Australian Institute of Health and Welfare) 2006, Australia s Health 2006, AHIW cat.no. AUS 73, 
Canberra.

4  AHIW (Australian Institute of Health and Welfare), The Burden of Disease and Injury in Australia 2003, 
AHIW cat.no, PHE 82, Canberra 2007; School of Population Health, The University of Queensland, 
Brisbane 2007.

5  AHIW (Australian Institute of Health and Welfare), Mental Health Services in Australia 2004 05, AIHW cat.
no. HSE 47, Canberra 2007.

6  OECD, (Organisation for Economic Co-Operation and Development), 2007, Health at a glance: OECD 
indicators 2007, Paris.

7  Kessler R &amp; Mroczek D. Final versions of our non specifi c psychological distress scale. Michigan: Institute for 
Social Research, University of Michigan, 1994.

8  Saunders D &amp; Daly A. 2000 Collaborative Health and Wellbeing Survey: Psychological distress in the Western 
Australian population. Health Department of Western Australia, June 2001.

9  K10 Symptom Scale. Clinical Research Unit for Anxiety and Depression. A WHO Collaborating Center. 
School of Psychiatry, University of NSW, 2000. (Online, accessed: 30/3/2001). Available at: 
&lt;http://www.crufad.unsw.edu.au/K10/k10info.htm&gt;



page 112 South Australia: Our Health and Health Services

chapter 6

6  Oral health

In this chapter

Children s oral health &gt;

Oral health of adults &gt;

Dental services in South Australia &gt;

Services and initiatives &gt;

Summary

 Dental caries is the second most commonly occurring condition after upper respiratory tract infections.  &gt;
Oral diseases also are associated with signifi cant rates of avoidable hospitalisation.

 Around 40 per cent of the population experiences pain from teeth, gums or dentures in a 12-month period.  &gt;
Oral disease also affects the ability to eat certain foods, impacts on social interactions and, in the case of 
oral cancer, leads to considerable morbidity and even death.

 There has been more than a 50 per cent increase in the prevalence of dental decay among South Australian  &gt;
children since the late 1990s, paralleling a similar national trend. Forty per cent of children by fi ve years 
of age have decay experience and 60 per cent of this caries are untreated.

 Children who are from country areas, lower socioeconomic backgrounds, CALD (culturally and linguistically  &gt;
diverse) populations or communities, or who are Aboriginal, have more dental decay experience than the 
rest of the community.

 The proportion of South Australian adults who have had all their teeth extracted (edentulous) has fallen  &gt;
by 60 per cent over the past 30 years.

 The decay experience of low-income adults attending public dental clinics has increased by 12 per cent  &gt;
since the cessation of the Commonwealth Dental Health Program in 1997 and the amount of decay that 
is untreated has increased by 50 per cent.

 Aboriginal and Torres Strait Islander adults have fewer teeth with dental decay experience and less gum  &gt;
disease than do other concession card holders attending public dental clinics.

 There are 54.8 practising dentists per 100 000 population in South Australia compared with the national  &gt;
average of 46.9 per 100 000. There are far more dentists in Adelaide (64.6 per 100 000) than in the rest of 
the state (28.1 per 100 000); this contrast leads to severe problems of access to dental care in some areas.

 Ninety-nine per cent of primary school-aged children, and 97 per cent of secondary-school-aged children,  &gt;
receive dental care within a two-year period through a combination of the School Dental Service and 
the private dental sector. Attendance at the dentist reduces for adults once eligibility for the School Dental 
Service stops at 18 years, and is lowest at 71 per cent among those aged 25 44 years old.

 Additional funding from the State Government since 2002, and effective prioritisation of resources,  &gt;
has seen waiting lists reduce from 82 000 people (49 months) to 42 051 people (23 months) by June 2007. 
The waiting list for dentures decreased during the same period from 8 892 (44 months) to 6 378 
(41 months) while the waiting list for specialist dental services increased from 2 373 (17 months) 
to 3 077 (27 months).



page 113South Australia: Our Health and Health Services

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Introduction

Dental caries is the second most commonly occurring condition after upper respiratory tract infections.1 
Oral diseases also are associated with high rates of avoidable hospitalisation, particularly in young children.2

Diseases of the oral cavity have a significant impact on the lives of Australian people. Around 40 per cent 
of the population experiences pain from teeth, gums or dentures in a 12-month period.2 Oral disease 
also affects the ability to eat certain foods, impacts on social interactions2 and, in the case of oral cancer, 
leads to considerable morbidity and even death.3

Many diseases and chronic conditions are associated with oral symptoms and disease; for example:

diabetes directly affects the tissues of the gum that support the teeth &gt; 2

 disease of the gums (periodontal disease) may contribute to cardiovascular disease, pre-term birth  &gt;
and low birth weight in babies, aspiration pneumonia, hepatitis C, HIV infection, infective endocarditis, 
and nutritional defi ciencies in children and older adults.2

These effects are found more frequently among the more disadvantaged groups in the population, often 
represented among those in receipt of government assistance.3

Oral diseases also are a major financial cost to the South Australian community, representing 4.9 per cent 
of total health expenditure in the state in 2001 02. (Private expenditure formed 71 per cent of the total 
$243 million spent on dental care in South Australia in 2001 023). Almost one in six adults takes time off 
work for a dental problem in a 12-month period.4

This chapter presents details on the oral health of South Australians.



page 114 South Australia: Our Health and Health Services

chapter 6

6.1  Children s oral health

The major oral health condition for children is dental decay. Forty per cent of children by five years of age 
have decay experience and 60 per cent of these caries are untreated.5 Most young children have healthy 
gums and, although the figure for untreated caries falls to 37 per cent by age 15 years, most of this 
periodontal disease is of the mildest variety5 and is of limited public health significance.

South Australia ranked second-best among all Organisation for Economic Co-Operation and Development 
(OECD) countries by the late 1990s for the level of dental decay in its children.6 

There has been a greater than 50 per cent increase in the prevalence of dental decay among South Australian 
children in recent years, paralleling a similar national trend.7 Reasons for this increase in dental caries include 
increased use of low fluoride toothpastes8, increased consumption of non-reticulated (non-fluoridated) water9, 
and changes in diets.

0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

Te
et

h 
w

it
h 

de
ca

y 
ex

pe
ri

en
ce

Year

1998 1999 2000 2001 2002

dmft 5 years
DMFT 12 years

Graph 6.1.1  Average number of teeth with decay experience, South Australia 1998 2002. Mean dmft/DMFT

Note:  (dmft= the average number of decayed(d) plus missing(m) plus filled(f) deciduous teeth; 
 DMFT=the average number of decayed(D) plus missing(M) plus filled(F) adult teeth.)
Source:  Australian Institute of Health and Welfare (AIHW), Child Dental Health Surveys.5

 



page 115South Australia: Our Health and Health Services

chapter 6

The decay experience of 12-year-old children in South Australia in 2001 (the last year for which national 
comparisons are available) was the lowest in Australia.5 Data for New South Wales are not available because 
of the very low coverage of its School Dental program.

Some groups of children have significantly poorer oral health than the community average:

 children in the Mount Gambier area   the only major centre in South Australia without water  &gt;
fl uoridation   had 78 per cent more dental decay in their adult teeth in 2004 than did children in 
Adelaide and 40 per cent more than did children in the Riverland7

 children from lower socioeconomic areas have approximately 40 per cent more dental decay experience  &gt;
than those from more advantaged areas7

 children from CALD backgrounds have 80 per cent more decay experience in their deciduous teeth and  &gt;
30 per cent more decay experience in the adult teeth7

 Aboriginal and Torres Strait Islander children in South Australia experience 70 per cent more dental caries  &gt;
than non-Indigenous children and have more teeth with untreated dental decay5

 children in country areas of the state experience, on average, up to 30 per cent more dental caries than  &gt;
do children in Adelaide.7

0

0.20

0.40

0.60

0.80

1.00

1.20

1.40

1.60

M
ea

n 
D

M
FT

 (t
ee

th
 w

it
h 

ca
ri

es
 e

xp
er

ie
nc

e)
 

Location

New
South
Wales

Victoria Queensland Western
Australia

South
Australia

Tasmania Australian
Capital
Territory

Northern
Territory

Australia

Not
available

Graph 6.1.2  Dental caries in children, 2001. 

       Average number of adult teeth with decay experience, 12-year-old mean DMFT

Note:  DMFT= the average number of decayed(D) plus missing(M) plus filled(F) adult teeth.
Source:  Australian Institute of Health and Welfare (AIHW), Child Dental Health Survey, 2002.5



page 116 South Australia: Our Health and Health Services

chapter 6

6.2  Adult oral health

There has been a dramatic fall over the past 30 years in the number of adult South Australians who have had 
all their teeth extracted.

The level of total tooth loss, however, among older South Australian adults is above the national average11, 
probably reflecting patterns of dental treatment after the Second World War.

0

5

10

15

20

25

Pe
r 

ce
nt

 o
f 

ad
ul

ts

1979 1987 1994 2002

Year

Graph 6.2.1  Per cent adults edentulous (no natural teeth), South Australia, 1979 2002

Source:  Australian Institute of Health and Welfare (AIHW), National Oral Health Survey 1987 1988 and National Dental 
 Telephone Interview Survey in Oral Health in South Australia 2004.10



page 117South Australia: Our Health and Health Services

chapter 6

The decay experience of adults attending public dental clinics has increased by 12 per cent since 1995 96 for 
all aged groups except 20-24-year-olds.3 The amount of decay that is untreated, however, has increased by 
50 per cent3, following the loss of the Commonwealth Dental Health Program in 1996.

45 54

Age groups (years)

55 64 65 74 75+ years

0

10

20

30

40

50

Pe
r 

ce
nt

 e
de

nt
ul

ou
s

Australia

South Australia

Graph 6.2.2  Total loss of natural teeth, per cent endentulous by age group, 2002

Source:  Australian Institute of Health and Welfare (AIHW), National Dental Telephone Interview 200311

-

2

4

6

8

10

12

14

16

18

20

M
ea

n 
D

M
FT

20 24

Age groups (years)

25 44 45 64 65+ years

1995 96

2001 02

Graph 6.2.3  Average number of teeth with decay experience for adults attending public clinics, 

      South Australia, 1995 96 and 2001 02

Source:  Australian Institute of Health and Welfare (AIHW), Australian Research Centre for Population Oral Health 20053



page 118 South Australia: Our Health and Health Services

chapter 6

The proportion of adults attending public dental clinics who had healthy gums decreased from 12 per cent 
to 10 per cent between 1995 96 and 2001 02, and the percentage with calculus (tartar) on their teeth 
increased from 28 per cent to 45 per cent3.

Concession cardholders are more likely to have had all their natural teeth extracted (that is, to be edentulous) 
than the rest of the community.

Aboriginal and Torres Strait Islander adults aged 25 44 years have fewer teeth with dental decay experience 
(8.7 teeth) compared with non-Aboriginal concession card holders attending public dental clinics in South 
Australia (12.9 teeth).3

More Aboriginal adults (21 per cent) have healthy gums than non Aboriginal adult concession card 
holders attending public dental clinics (10 per cent)3. More of the periodontal disease present has progressed 
to a severe stage in Aboriginal adults, however, possibly related to the presence of systemic conditions 
such as diabetes.3

Periodontal diseases and oral cancers are more prevalent among older people.2 Many older people on 
medications suffer additionally from a dry mouth, which can cause significant difficulties eating and speaking2 
as well as predisposing the individual to dental disease. People with cognitive impairment are at particular 
risk of oral disease; for those living in the community, the difficulties of maintaining oral hygiene lead to high 
levels of dental caries and periodontal diseases.12 The deterioration is rapid and ongoing once such people are 
admitted to residential care.13

The poor oral health of older people also increases the cost and complexity of medical and aged care services. 
Tooth loss, for example, undermines the quality of nutrition, contributing to loss of body weight12 and 
accumulation of dental plaque is linked to aspiration pneumonia.14

0

5

10

15

20

25

30

35

40

45

50

Pe
r 

ce
nt

 o
f 

ad
ul

ts
 

Age groups (years)

45 64 65+ years

Cardholder

Non-cardholder

Graph 6.2.4  Total tooth loss, per cent of adults who are endentulous, by age, 2002

Source:  Australian Institute of Health and Welfare (AIHW), Oral Health in South Australia 200410



page 119South Australia: Our Health and Health Services

chapter 6

6.3  Dental services in South Australia

There were 821 dentists, 128 dental therapists, 109 dental hygienists and 27 prosthetists practising in 
South Australia in 20003. The figure for dentists represents 54.8 practising dentists per 100 000 population 
compared with 46.9 per 100 000 for the rest of Australia. There are far more dentists in Adelaide 
(64.6 per 100 000) than in the rest of the state (28.1 per 100 000)3, providing country people with significant 
barriers to access to dental care.

The majority of South Australians receive and pay for their own oral health services on a private basis 
(with the exception of children), with or without the assistance of dental insurance. Over 80 per cent 
of adults with natural teeth who received dental care in a previous 12-month period attended a private 
dental practice.11

6.3.1 Attendance at a dentist
The School Dental Service offers a comprehensive dental care program to all children until their 18th birthday. 
Participation is high in the School Dental Service, with 87 per cent of primary, 45 per cent of secondary and 
16 per cent of pre-school-aged children (0 4 years) enrolling in the program and receiving regular care.7

Ninety-nine per cent of 5-11-year-olds and 97 per cent of secondary-school-aged children receive dental care 
within a two-year period through a combination of the School Dental Service and the private dental sector.3 
This level of coverage is high indeed, compared with older age cohorts in South Australia. Attendance for 
adults reduces once eligibility for the School Dental Service ceases at 18 years and is lowest among those aged 
25 44 years old.3

0

20

40

60

80

100

Pe
r 

ce
nt

 o
f 

pe
op

le

5 11

Age groups (years)

12 17 18 24 25 44 45 64 65+ years

Per cent of people 

Graph 6.3.1  Per cent of people with natural teeth attending a dentist within two years,

       South Australia dental attendance 2002

Source:  Australian Institute of Health and Welfare (AIHW), National Dental Telephone Interview Survey11



page 120 South Australia: Our Health and Health Services

chapter 6

6.3.2 Emergency and general dental care for disadvantaged adults
The Community Dental Service provides publicly subsidised emergency and general dental services to 
adults who are the holders of a Concession Card, either through public dental clinics, or by dentists contracted 
through the private dental sector.

More than 82 000 Concession Card holders were waiting for an average 49 months in mid-2002 for 
restorative dental care; since that time, additional funding from the State Government and effective 
prioritisation of resources has seen waiting lists reduced by June 2007 to 42 051 people (or 23 months).7

The waiting list for prosthetic dental services (dentures) decreased since 2002 from 8 892 people (44 months) 
to 6 378 (waiting an average of 41 months).7

6.3.3 Specialist dental care for disadvantaged adults
Publicly funded specialist dental services are provided on referral from general public dental providers. 
The South Australian Dental Service provides a limited range of these more complex specialist dental services 
for Concession Card holders, mostly at the Adelaide Dental Hospital, performed by staff specialists and 
postgraduate students undergoing specialist training.

The table below presents average waiting times for specialist dental services at the Adelaide Dental Hospital 
as of June 2007.

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 June
2007

0

6

12

18

24

30

36

42

48

W
ai

ti
ng

 p
er

io
d 

(m
on

th
s)

End year

Graph 6.3.2  Average wait for restorative dental care, South Australia 1995 2007

Source:  SA Dental Service Unpublished Data.7

 June 2002 June 2007

Speciality Number Average waiting time Number Average waiting time
  (in months)  (in months)

Oral Surgery 779 8 1 125 14
Orthodontics 1 594 21 1 249 48
Specialist restorative - - 703 12

Table 6.3.1  Waiting lists for specialist dental services, June 2002 and June 20077



page 121South Australia: Our Health and Health Services

chapter 6

6.4  Services and initiatives

6.4.1 Oral health for older people still living in the community
A pilot program was developed in 2003 04 under the direction of a multi-sector Steering Committee to 
assist older people living in the community to achieve good oral health as a contributor to maintaining their 
independence. This project, based in the inner southern metropolitan area of Adelaide, integrates a simple 
question-based oral health screen of people living in the community, who are aged over 75 years, into their 
annual health assessments by medical practitioners. Concession Card holders who are assessed as  at risk  
through this process are referred to a public dental clinic where they bypass the waiting lists to receive publicly 
funded dental care.

Evaluation of this program by Australian Research Centre for Population Oral Health demonstrated that early 
assessment and interventive dental care can improve the quality of life and general wellbeing of older people 
and their ability to go about their day-to-day activities.15

A modified version of this program was extended in 2006 07 to the northern suburbs of Adelaide. 
The oral health assessment in this enhanced program is undertaken by Domiciliary Care SA, including Aged 
Care Assessment Teams. Those older people identified as  at risk  are given a functional assessment for 
maintaining good oral hygiene in the home, in addition to priority access to dental treatment.

6.4.2 Managing demand for  emergency  dental care
About 70 per cent of the clinical resources of the Community Dental Service were consumed in 2001 02 
responding to  emergency  appointments from adult Concession Card holders7; as a result, little clinical time 
was available for the treatment of people on waiting lists.

Collaborative research undertaken by the South Australian Dental Service and the Australian Research Centre 
for Population Oral Health showed that some of these  emergencies  really did not require priority access 
to dental care. A further outcome of the research was a suite of questions that provided a more accurate 
assessment of the true urgency of the case. This suite of questions was converted into a computer-assisted 
dental emergency triaging tool called the Relative Needs Index, which was implemented in all Community 
Dental Service Clinics from November 2006.

Twenty-five per cent of adult Concession Card holders seeking priority dental care were assigned a lower 
priority as a result of the Relative Needs Index and were not offered an early appointment.7 This change 
in assessment has freed significant public dental resources for the treatment of additional patients on waiting 
lists and has contributed to the reduction of average waiting times to 23 months.7

6.4.3 The Aboriginal Liaison Dental Program
The Aboriginal Liaison Dental Program was initiated in response to an identified need to improve oral health 
outcomes for Aboriginal people. Discussion with the people who provide services for Aboriginal and Torres 
Strait Islander people provided an insight into the oral health needs and expectations of the community, 
and an opportunity to investigate barriers to dental care. One of the barriers to care identified initially was 
the two-year waiting list for general dental care at Community Dental Clinics. A number of priority general 
courses continue to be made available as a result, for eligible Aboriginal and Torres Strait Islander adults.

Adult Aboriginal people attending diabetes camps in the northern Adelaide suburbs, Muna Paiendi 
Community Health Service, the Noarlunga Health Service and the Parks Community Health Service during 
2007 08 received an oral health assessment. One-hundred-and-thirty-three of the 142 Aboriginal people 
who received an oral health assessment were identified as needing a dental visit; of these, 96 have begun 
a course of care.7

This program will be extended progressively across the state over the next two years.



page 122 South Australia: Our Health and Health Services

chapter 6

6.5  Notes

1.  Australian Institute of Health and Welfare, Australia s Health 2000: the seventh biennial health report of 
the Australian Institute of Health and Welfare, AIHW cat. no. 19, AIHW, Canberra, 2000.

2.  Australian Health Ministers  Advisory Council, Steering Committee for National Planning for Oral Health, 
Oral health of Australians: national planning for oral health improvement: fi nal report, Department of Human 
Services, Adelaide, 2001.

3.  A Ellershaw, A J Spencer &amp; G D Slade, Oral Health in South Australia 2004, Population oral health series 
no;4, AIHW cat. no. POH 4, AIHW, Canberra, 2005.

4.  M S T Yanga Mabunga,  The social impact of oral disease and disorders among Filipino and Australian 
workers , MSciDental Thesis, University of Adelaide, 1998.

5.  J M Armfield &amp; G D Slade, The child dental health survey, South Australia 2002, AIHW cat. no. DEN 159, 
The University of Adelaide, Adelaide, 2006.

6.  A J Spencer, What options do we have for organising, providing and funding better public dental care?, 
Australian Health Policy Institute commissioned paper series 2001 02, Australian Health Policy Institute 
at the University of Sydney, Sydney, 2001.

7. SA Dental Service Evaluation Unit, unpublished data.

8.  Australian Research Centre for Population Oral Health,  The use of fluorides in Australia: guidelines , 
Australian Dental Journal, vol. 51, no. 2, 2006, pp.:195 99.

9.  J M Armfield &amp; A J Spencer,  Consumption of non-public water: implications for children s caries 
experience , Community Dentistry and Oral Epidemiology, vol. 32, no. 4, 2004 pp. 283 96.

10.  A Ellershaw, AJ Spencer &amp; GD Slade, Oral Health in South Australia 2004, Population oral health series 
no.4, AIHW cat. no. POH 4, AIHW, Canberra, 2005.

11.  K D Carter &amp; J F Stewart, National dental telephone interview survey 2002, AIHW cat. no. DEN 128, 
AIHW Dental Statistics and Research Unit, Adelaide, 2003.

12.  J M Chalmers, C P Hodge, J M Fuss, A J Spencer &amp; K D Carter, The Adelaide dental study of nursing 
homes 1998, AIHW cat. no. DEN 83, Dental statistics and research series no. 22, AIHW Dental Statistics 
and Research Unit, Adelaide, 2000.

13.  J M Chalmers, C P Hodge, J M Fuss, A J Spencer &amp; K D Carter, The Adelaide dental study of nursing 
homes one year follow-up 1999, AIHW cat. No. DEN 84, Dental statistics and research series no. 23, 
Dental Statistics and Research Unit, Adelaide, 2001. 

14.  W J Loesche, D E Popatin, Interactions between periodontal disease, medical diseases and immunity in 
the older individual, Periodontology 2000; vol. 16, no. 1, 1998, pp. 80 105.

15.  G D Slade, Oral health for older people. evaluation of the South Australian Dental Service project, 
Population oral health series no. 6, AIHW cat.no. POH 6, AIHW, Canberra, 2007.



page 123South Australia: Our Health and Health Services

chapter 7

7  Mothers, babies, children and youth

In this chapter

Child-bearing in South Australia: trends in fertility &gt;

Infant mortality &gt;

Maternal deaths &gt;

Interventions in childbirth: caesarean section &gt;

Teenage pregnancy &gt;

Terminations of pregnancy &gt;

Hospital services for children and adolescents &gt;

Immunisations &gt;

Mental heath and wellbeing of young people in South Australia &gt;

Children and adolescents with physical disabilities &gt;

Services and initiatives &gt;

Summary

 Around 19 000 women give birth in South Australia each year and, after more than a decade of decline,  &gt;
this number is now increasing. The fertility of women under the age of 30 is declining, while that of women 
over 30 is increasing.

 Infant mortality in South Australia is currently around 4.4 per 1 000 live-births (between 65 and 90 infant  &gt;
deaths per year in the period 2000 2006) which compares very favourably with other developed countries. 
Much of the improvement in the last decade can be attributed to the fall in cases of Sudden Infant Death 
Syndrome (SIDS).

 Maternal deaths in South Australia, at 8.5 per 100 000 confi nements, (corresponding to 9 deaths over  &gt;
the period 2001 to 2006), are very low by international standards; however the rate in Aboriginal women 
(45.9 deaths per 100,000 confi nements   corresponding to just 12 deaths across the whole of Australia 
for the period 2000 2002), is still 5.4 times higher.

 Medical interventions in childbirth   such as induction of labour and caesarean section   are controversial.  &gt;
The proportion of women giving birth by caesarean section in South Australia is now 32.9 per cent 
overall and rising. Around 28 per cent of women who birth in public hospitals have sections, but this fi gure 
is 42 per cent for women birthing in private hospitals.

 Around 3.6 per cent of South Australia s 50 000 teenage girls (15 19 year-olds) became pregnant in 2006; &gt;
this number has declined by 1 percentage point over the past decade. Around half these teenage 
pregnancies are terminated.

 Nearly 5 000 (4 712) pregnancies were terminated among women of all ages in 2005; this number has  &gt;
been declining steadily since 2001.

 There are around 53 000 separations to hospital each year of children and adolescents aged 0 17 years.  &gt;
Major medical reasons for admission are asthma and bronchitis,  croup , and gastroenteritis; and nearly all 
these conditions are treated in public hospitals. The most common surgical procedures are tonsillectomy/
adenoidectomy and myringotomy (insertion of tubes to drain fl uid from the ear); with at least half of these 
procedures occurring in private hospitals.



page 124 South Australia: Our Health and Health Services

chapter 7

 Ninety-three per cent of children in South Australia have had all the immunisations recommended by the  &gt;
National Immunisation Program by the age of two years. Cases of rubella have fallen to extremely low 
levels over the past 10 years. Cases of whooping cough continue to decrease in 0 4-year-olds, but a rising 
incidence of this disease in adults is a potential threat to this improvement.

 Around 14.1 per cent of South Australia s 4 17-year-olds have mental health problems, but only 29 per cent  &gt;
of them receive any services. Around 50 per cent of parents of children who have the strongest indicators 
for requiring mental health services say that help is too expensive, or that they don t know where to get it.

 Around 4 000 children aged 0 17 years in South Australia may have physical disabilities suffi ciently severe  &gt;
that they require rehabilitation services.



page 125South Australia: Our Health and Health Services

chapter 7

Introduction

This chapter examines the health needs, health behaviours and health service requirements of the mothers 
and children living in South Australia.

The South Australian female population of reproductive age (considered to be 15?44 years) was 317 315 
as at 30 June 2007, which was 20 per cent of total population. There has been a slight decrease in this group 
as a percentage of the population over the last 20 years. 

Around 19 000 women give birth in South Australia each year and, after more than a decade of decline, 
this number is now increasing. The birthrate appears to have been accelerated by the Federal Government s 
maternity cash payment introduced in July 2004, as well as by low unemployment rates. The fertility of 
women under the age of 30 is declining, while that of women over 30 is increasing. The proportion of women 
giving birth by caesarean section in South Australia is now 32.9 per cent overall and rising.

The number of children and adolescents (0?17-year-olds) in South Australia had been declining slowly over 
30 years until June 2005; since then, it has increased slightly to be 350 783 at June 2007. This group made 
up only 22.1 per cent of the total population as at June 2007, down from 24 per cent 10 years ago.

Children s health is strongly influenced by the family and cultural environment, local communities and, 
at an even broader level, by social, political, economic and environmental factors. Major medical reasons for 
children and adolescents being admitted to hospital are asthma and bronchitis,  croup , and gastroenteritis. 
The most common surgical procedures are tonsillectomy/adenoidectomy and myringotomy.

Infant mortality and maternal death rates in South Australia compare very favourably with other developed 
countries. Immunisations rates also are high with 93 per cent of children in South Australia having had all 
the immunisations recommended by the National Immunisation Program by the age of two years.



page 126 South Australia: Our Health and Health Services

chapter 7

7.1  Child bearing in South Australia: trends in fertility

The term fertility within a population health context refers simply to the number of live births per 1 000 
women per annum. The term is sometimes used (for example, in reference to  fertility programs ) as a 
synonym for fecundity, which is defined as the potential for reproduction and is determined by reproductive 
processes such as gamete production, fertilisation, and the ability to carry a pregnancy to term.

The number of live births per annum per 1 000 women of reproductive age (considered to be 15 44 years)  
is often referred to as the General Fertility Rate (GFR). South Australia s GFR in 2005 was approximately  
58.5 births per 1 000 women. Graphs 7.1.1 and 7.1.2 show clearly that, over the 16 years from 1991 to 
2006, the fertility of South Australian women within specific age-bands under the age of 30 years has been 
in steady decline, while the fertility of women aged 30 or more has increased substantially. These trends 
demonstrate clearly that women in South Australia are deferring child-bearing until the later years of their 
reproductive age-span. The drivers of this trend almost certainly include career aspirations, and a growing 
desire to stay longer in the workforce to be able to afford housing. The current trend toward deferring  
child-bearing to later ages almost certainly will have an effect on future demands for reproductive services, 
such as In-vitro fertilisation (IVF), since fecundity decreases with increasing age.

19
91

19
92

19
93

19
94

19
95

19
96

19
97

19
98

19
99

20
00

20
01

20
02

20
03

20
04

20
05

20
06

Year

Bi
rt

hs
 p

er
 1

 0
00

 w
om

en
   

140

0

20

40

60

80

100

120

Age &lt;20 yrs

Age 20 24 yrs

Age 25 29 yrs

Graph 7.1.1  Fertility of South Australian women aged under 30 years

Source:  SA Health, Pregnancy Outcome Unit, Epidemiology Branch.



page 127South Australia: Our Health and Health Services

chapter 7

The fertility of women 30+ years, however, has been increasing. The following graph shows the change in 
rates since 1991.

100

120

140

0

20

40

60

80

19
91

19
92

19
93

19
94

19
95

19
96

19
97

19
98

19
99

20
00

20
01

20
02

20
03

20
04

20
05

20
06

Year

Bi
rt

hs
 p

er
 1

 0
00

 w
om

en

Age 30 34 years

Age 35 39 years

Age 40+ years

Graph 7.1.2  Fertility of South Australian women aged 30+ years

Source:  SA Health, Pregnancy Outcome Unit, Epidemiology Branch.



page 128 South Australia: Our Health and Health Services

chapter 7

The number of babies born in South Australia had been declining steadily until 2004, and health care planners 
were predicting decreased requirements for paediatric services in the near future. This trend appears to have 
reversed, however, in 2005 and 2006 (see Graph 7.1.3 below).

The Federal Government introduced a maternity cash payment or  baby bonus  in July 2004, worth $3 000 
(increased to $4 000 in July 2006) which, coupled with low unemployment, appears to have accelerated the 
birthrate not only in South Australia, but also nationally.

19
91

19
92

19
93

19
94

19
95

19
96

19
97

19
98

19
99

20
00

20
01

20
02

20
03

20
04

20
05

20
06

Year

17 000

17 500

18 000

18 500

19 000

19 500

20 000

20 500

Bi
rt

hs
   

 

Graph 7.1.3  Annual births in South Australia

Source:  SA Health, Pregnancy Outcome Unit, Epidemiology Branch.



page 129South Australia: Our Health and Health Services

chapter 7

7.2  Infant mortality

Babies who are born live at 20 or more weeks gestation, with a birth weight of at least 400g, but who die 
before reaching the age of 1 year (including those who died in the neonatal period of 1 28 days) are counted 
as  infant deaths . Infant mortality is used to compare the health and wellbeing of populations across 
and within countries and varies from around 3 7 deaths per 1 000 live births in developed countries to 100 
or more in developing countries such as those in the African sub-continent and Afghanistan.

South Australia s infant mortality rate is the lowest in Australia at 4.0 deaths per 1 000 live births over 
2003 2005. The average rate for all Australians over the same period, in comparison, was 4.8 deaths 
per 1 000 live births.

The infant mortality rate in South Australia has decreased from an average of 5.6 infant deaths per 1 000 
live births in 1991 1993 (around 111 infant deaths per year) to an average of 4.4 per 1 000 live births in 
2004 2006 (or around 79 infant deaths per year).

These figures from SA Health are derived using a slightly different approach to the ones shown in the graph 
above. The Australian Bureau of Statistics (ABS) data (graph) include births only where the mother s post 
code is within South Australia. The SA Health data include all births in South Australia irrespective of place 
of residence. The ABS births and deaths data also are based on the time when the events are registered, 
where the SA Health data are based on when the events occur.

0

2

4

6

8

10

Ra
te

 (p
er

 1
 0

00
 li

ve
 b

ir
th

s)

New
South
Wales

Queensland South
Australia

State

Victoria Western
Australia

Tasmania Australian
Capital
Territory

Northern
Territory

Graph 7.2.1  Infant mortality rate, three-yearly average, 2003 2005

Source:  Australian Bureau of Statistics (ABS), Deaths 2005, Australia, Cat. no. 3302.0, AusInfo, Canberra; 
 and ABS (various years), Births 2005, Australia, Cat. no. 3301.0, AusInfo, Canberra.



page 130 South Australia: Our Health and Health Services

chapter 7

Ninety infant deaths were recorded in South Australia in 2005. The Maternal, Perinatal and Infant Mortality 
Committee (2006), in reviewing these and other recent infant deaths, expressed concern about the number 
of deaths in which adverse factors were present, such as smoking, alcohol and substance abuse, bed-sharing 
while intoxicated, physical abuse and poor social circumstances.1

An examination of the trends in infant deaths in the post-neonatal period (29-days-to-1-year) demonstrates 
that much of the decrease in infant deaths in this age category can be attributed to the fall in cases of 
Sudden Infant Death Syndrome (SIDS) following the introduction of campaigns advocating that babies sleep 
on their backs (or supine) instead of in the face-down or  prone  position (Graph 7.4). The steep decline 
in deaths from SIDS (and hence, in overall infant mortality) begins very shortly after the South Australian 
paediatrician, Dr Susan Beal, published her recommendation stating There is a lower incidence of SIDS in 
communities that invariably use the supine position for infants than in those who do not. Abandoning prone 
sleeping for infants in Adelaide should reduce the incidence of SIDS.2 SIDS was a rare event in South Australia 
by the year 2005.

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pe
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bi

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Graph 7.2.2  Infant mortality in South Australia, 1991 2005

Source:  SA Health, Pregnancy Outcome Unit, Epidemiology Branch.



page 131South Australia: Our Health and Health Services

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0

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All causes

SIDS

Graph 7.2.3  Post-neonatal infant deaths in South Australia, 1971 2005

Source:  SA Health, Pregnancy Outcome Unit, Epidemiology Branch.



page 132 South Australia: Our Health and Health Services

chapter 7

7.3  Maternal deaths

Reducing maternal mortality is one of the eight priority Millennium Development Goals set by Member States 
of the United Nations. A reduction in these deaths is a powerful indicator of the skills of those in attendance at 
birth, the availability and accessibility of emergency obstetric care for all who develop complications, and of the 
availability and accessibility of family planning.

The World Health Organization (WHO) defines maternal death as the death of a woman while pregnant or within 
42 days of a termination of pregnancy, irrespective of the duration and the site of the pregnancy, 
from any cause related to or aggravated by the pregnancy or its management. The definition does not include 
accidental or incidental causes. Maternal deaths in South Australia are classified as  direct  obstetric deaths, 
resulting from obstetric complications of the pregnant state, or from interventions, omissions, or incorrect 
treatment of those complications; and  indirect  obstetric deaths, resulting from previous existing disease or 
disease that developed during pregnancy and which was not due to direct obstetric causes, but which was 
aggravated by physiologic effects of pregnancy.

It is readily apparent from Graph 7.3.1 that the number of deaths per 100 000 confinements has decreased 
markedly in South Australia over the past 45 years. The maternal mortality for direct and indirect deaths in the five 
years 2001 2005 was 9.1 per 100 000 confinements, which is very low by international standards. (The United 
Nations (UN) estimated in 2000 that, across the world and as a weighted average, around 400 women die per 
100 000 who give birth; 440 per 100 000 in developing countries, but only 20 per 100 000 in developed countries.)

A subcommittee of the South Australian Maternal, Perinatal and Infant Mortality Committee examines all deaths 
to determine if there are any recurring causes for concern.

Only 400 500 Aboriginal women give birth each year in South Australia. Across Australia, their mortality is 
around 45.9 deaths per 100 000 births (corresponding to 12 deaths for the period 2000 2002), 5.4 times 
the rate of non-Aboriginal Australian women.

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20

25

30

1961 1965 1966 1970 1971 1975 1976 1980 1981 1985 1986 1990 1991 1995 1996 2000 2001 2005

Years

M
at

er
na

l d
ea

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pe
r 

10
0 

00
0

Graph 7.3.1  Maternal deaths in South Australia, 1961 2005

Source:  SA Health, Pregnancy Outcome Unit, Epidemiology Branch.



page 133South Australia: Our Health and Health Services

chapter 7

7.4  Interventions in childbirth: caesarean section

It is readily apparent from the sections on maternal and infant mortality that childbirth is not without 
attendant risks, the most severe of which is death of the mother or her baby.

Advances in knowledge and the technology of maternity care mean that outcomes of childbirth among 
non-Aboriginal South Australians are now among the best in the world. Nevertheless a number of 
women s advocacy groups have argued for some years that childbirth has become  over-medicalised  
and  disempowering , and that we may be able to enjoy the same level of favourable outcomes, with fewer 
interventions than are applied currently. These interventions include induction of labour, and episiotomies, 
but the most controversial is caesarean section. Pre-existing medical conditions in the mother, and 
complications during pregnancy and labour, sometimes unequivocally demand a section although it is 
widely acknowledged that there are increased (albeit reasonably small) risks to both mother and baby 
associated with a caesarean section; the controversy has to be viewed as one where it is necessary to achieve 
the appropriate balance. There are some women who ask, for various reasons (including time-management, 
fear of labour pain, and perceived effects on sexuality) for their baby to be born by caesarean section. 
Obstetricians are divided over whether this wish should take precedence over the existence, or otherwise, 
of medical indications for a section.

Nearly 33 per cent of all confinements in South Australia in 2006 resulted in birth by caesarean section; 
from Graph 7.4.1, it will be readily apparent that this proportion is growing rapidly.

This growth is greater in private hospitals than in public hospitals. Women with private hospital insurance 
on average are older than uninsured women, and age is universally recognised as a  risk factor  for child birth, 
leading quite often to the need for caesarean section; numerous studies, however, have failed to show that 
maternal age alone is responsible for the differences between the figures for the two types of hospital.

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Ca
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ar
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 (p

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 c

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Public hospitals
Private hospitals

Graph 7.4.1  Caesarean sections in South Australia, 1991 2006

Source:  SA Health, Pregnancy Outcome Unit, Epidemiology Branch.



page 134 South Australia: Our Health and Health Services

chapter 7

7.5  Teenage pregnancy

It is generally recognised that a large proportion of teenage pregnancies are unplanned and unwelcome, 
although some teenage women plan their pregnancies, or are happy to find they are pregnant. Enormous stress 
can be put on both the young women and their families where the pregnancy is unexpected; they may not have 
sufficient resources, life-skills and emotional availability to give their new baby an appropriate start in life.

Groups of young women who are especially at risk of having an unwanted pregnancy include:

 women who are disadvantaged educationally and with few job opportunities, and who may not know about,  &gt;
or use effective contraception

 women who are victims of sexual abuse, and who are more likely to have early and unprotected sexual activity &gt;

women with disabilities, who often receive less information, and insuffi cient support and protection. &gt;

Termination of a pregnancy is lawful in South Australia if a doctor believes the continuation of the pregnancy 
presents a grave risk to the physical or mental health of the woman. This availability means that South Australia 
is one of the few states with good quality data relating to the numbers of terminations undertaken. Termination 
is available usually up to 12 weeks gestation, but can occur as late as 22 weeks using a different procedure.

A 16-year-old may make the decision to terminate her pregnancy (or undergo any medical procedure) without the 
knowledge of her parents. Young people under 16 may have a termination without parental consent, only if two 
doctors agree that this is an emergency situation, and that there is a major risk to the health of the young woman.

There are around 50 000 teenage women aged 15 19 in South Australia, and around 1 800 to 2 200 (between 
4 and 5 per cent) in any one year will become pregnant. Graph 7.5.1 shows the births and terminations that 
have occurred in teenage women over the period 1991 2005. Slightly more than half of all these teenage 
pregnancies have been terminated since 1994. The figure shows a downward trend in teenage pregnancies 
beginning around 1995.

Year

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

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15

20

25

30

35

40

Ev
en

ts
 p

er
 1

00
0 

te
en

ag
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w
om

en

Graph 7.5.1  Teenage pregnancies in South Australia 1991 2005

Births
Abortions

Pregnancies

Source:  SA Health, Pregnancy Outcome Unit, Epidemiology Branch.



page 135South Australia: Our Health and Health Services

chapter 7

7.6  Terminations of pregnancy

Abortion legislation came into force in 1970 under the Criminal Law Consolidation Act. Termination of 
pregnancy became legal in South Australia if performed in a prescribed hospital by a medical practitioner 
for a woman who had been resident here for at least two months. The practitioner and another medical 
practitioner must have examined the woman and formed the opinion that the continuation of the pregnancy 
would involve greater risk to her life, or greater risk of injury to her physical or mental health, than if the 
pregnancy was terminated; or that there was a substantial risk that if the pregnancy was not terminated 
and the child was born, the child would suffer from such physical or mental abnormalities as to be 
seriously handicapped.

A total of 4 712 terminations were performed in South Australia in 2005, but only 3 per cent of these were 
for fetal abnormalities (chromosomal or otherwise) or because the fetus had been exposed to damage from 
drugs or other agents.

The number of terminations performed since 2001 in South Australia has been decreasing (Graph 7.6.1). 
Reasons for this downward trend have not been investigated formally, but suggested explanations include 
better sex and contraception education, improved methods of contraception, (particularly the long-acting 
methods involving implants under the skin), and possibly some effect from the Australian Government s cash 
baby bonus.

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Te
rm

in
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 p
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00
  w

om
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Graph 7.6.1  Pregnancy terminations in women aged 15 44 from 1978 2005

Source:  SA Health, Pregnancy Outcome Unit, Epidemiology Branch.



page 136 South Australia: Our Health and Health Services

chapter 7

7.7  Hospital services for children and adolescents

The children and adolescents (0 17 year-olds) of South Australia have required around 53 000 separations 
to hospital each year for the past five years, with the exception of 2005 when these separations fell to 
around 50 000. This first figure corresponds to 0.16 separations per individual in this age group, but it 
should be borne in mind that some children and adolescents may have multiple separations within a year. 
Graph 7.7.1 shows the number of separations from hospital for all causes for each age from 0 17 years.

The graph shows that infants and very young children require more hospital services than older children; 
due in large measure to the fact that many of the conditions that can be treated at home safely in older 
children require much closer care and attention in very small children. Illnesses and conditions that 
affect breathing (for example, acute bronchiolitis, croup, and asthma) and hydration state (for example, 
gastroenteritis) are common reasons requiring hospitalisation in the very young.

The most common medical condition requiring hospitalisation of South Australia s children and adolescents 
is bronchitis and asthma. Graph 7.7.2 shows that nearly all uncomplicated bronchitis and asthma is treated 
in public as distinct from private hospitals and that there was a steady decrease in separations prior to 2002 
which has stabilised now at around 2 000 separations a year. This decrease may reflect the considerable 
efforts made in recent years to provide parents and children with better information on preventing asthma 
attacks, and on recognising and treating an impending attack.

Age-year

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

0

2 000

4 000

6 000

8 000

10 000

12 000

Se
pa

ra
ti

on
s 

 

Graph 7.7.1  Hospital separations by age year for 0-17-year-olds in South Australia, 2006

Note:  Some children have multiple separations within a single calendar year.
Source:  SA Health, Integrated South Australian Activity Collection (ISAAC), 2007.



page 137South Australia: Our Health and Health Services

chapter 7

It is difficult to diagnose asthma in infants, and separations for another common diagnosis   acute 
bronchiolitis   almost certainly include many infants who subsequently will be considered to be asthmatic.

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1 000

Quarter

Se
pa

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on
s

Graph 7.7.2  Quarterly separations for uncomplicated bronchitis and asthma

Private hospitals

Public hospitals

Source:   SA Health, Integrated South Australian Activity Collection (ISAAC).



page 138 South Australia: Our Health and Health Services

chapter 7

The graph above dramatically illustrates the seasonal nature of these separations with infectious agents in 
winter and early spring being held responsible. A very strong seasonal pattern also is evident in separations 
for  croup  (laryngotracheitis and epiglottitis with typically over 600 separations per year), although peaks 
occur earlier in late autumn and early winter.

The most commonly performed surgical procedures in paediatrics are the removal of tonsils and/or adenoid 
glands (tonsillectomy/adenoidectomy), and the insertion of tubes or grommets to facilitate drainage of fluid 
from the ear (myringotomy). Substantial proportions of these procedures are performed in private hospitals. 
Approximately equal numbers of tonsillectomies/adenoidectomies were performed in the private and public 
hospitals in the past; in recent years, however, the number of myringotomies performed in private hospitals 
has outstripped those undertaken in public hospitals. 

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0

100

200

300

400

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700

Quarter

Se
pa

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ti

on
s

Graph 7.7.3  Quarterly separations for uncomplicated acute bronchiolitis

Private hospitals

Public hospitals

Note:  A very small percentage of cases of whooping cough also may be included in these numbers.
Source:  SA Health, Integrated South Australian Activity Collection (ISAAC).



page 139South Australia: Our Health and Health Services

chapter 7

Graph 7.7.4 shows that between 3 200 to 3 600 myringotomies have been performed each year in 
South Australia since 2000. The number of instances of this surgery was higher before 2000.

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Quarter

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p

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at

io
n

s

Graph 7.7.4  Quarterly separations for myringotomy with tube insertion

Private hospitals

Public hospitals

Source:  SA Health, Integrated South Australian Activity Collection (ISAAC).



page 140 South Australia: Our Health and Health Services

chapter 7

A similar pattern of surgical intervention is evident in the removal of tonsils and adenoids (Graph 7.7.5). 
Between 2 200 and 2 700 children have undergone the procedure annually for the past six years, 
with approximately equal numbers performed in private and public hospitals. The procedure is undertaken 
for recurrent throat infections, or to assist children with breathing problems and sleep disorders.

0

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Graph 7.7.5  Quarterly separations for tonsillectomy/adenoidectomy

Private hospitals

Public hospitals

Source:   SA Health, Integrated South Australian Activity Collection (ISAAC).



page 141South Australia: Our Health and Health Services

chapter 7

7.8  Immunisations

It is recommended that, during the first few years of life, all children be immunised against organisms 
responsible for hepatitis B, diphtheria, tetanus, whooping cough, poliomyelitis, chickenpox, measles, mumps, 
rubella, meningococcal disease and (pneumococcal) pneumonia, as well as against infections by the 
Haemophilus infl uenzae type b bacterium, and rotavirus (gastroenteritis). A national immunisation schedule 
can be viewed at the Australian Government s immunisation web site.7 Many of these vaccinations occur 
in the first 24 months of life, with some repeats and boosters required in subsequent years.

The success of an immunisation program can be measured both in terms of the degree to which the 
population participates, and by the incidence of the communicable diseases at which the program is aimed. 
Participation statistics are published quarterly by the Australian Childhood Immunisation Register (ACIR); 
the following graph shows the percentage of children vaccinated at the highest level appropriate for three 
different age groups.

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t 

qu
ar

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r 

20
05

2n
d 

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ar

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20
05

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d 

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ar

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20
05

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20
05

1s
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20
06

2n
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20
06

3r
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20
06

4t
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20
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1s
t 

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07

2n
d 

qu
ar

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20
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Quarter of processing

 P
er

 c
en

t 
co

ve
ra

ge
 

Graph 7.8.1  Immunisation coverage in South Australian children

12 &lt;15 Months

24 &lt;27 Months

72 &lt;75 Months

Source:  Redrawn from Australian Childhood Immunisation Register s web site8.



page 142 South Australia: Our Health and Health Services

chapter 7

It can be seen that in excess of 90 per cent of all South Australian children have had appropriate 
immunisations by the time they turn two-years-old, or shortly thereafter. Around 86 per cent of children 
as of June 2007 have complied with the required schedule by six years of age, an increase from 82 per cent 
in December 2005.

Rubella, or German measles, can have a catastrophic effect on the unborn child. Annual figures for the 
number of notifications to the South Australian Department of Health (all ages) of new cases of rubella 
demonstrate the effectiveness of introducing more intensive rubella vaccination programs in South Australia. 
The recommended immunisation schedule from 1994 was to vaccinate all males and females at 12 months 
of age and again at 10 16 years. Immunisation of Year 8 students began in South Australia in 1995. 
All children (the primary transmission group) now are offered rubella vaccinations at one and four years 
of age, in combination with a measles and mumps vaccine; the annual number of notifications has been 
extremely low since 1997 (Graph 7.8.2). Rubella is a rare occurrence now in South Australia.

A more complex picture is emerging with respect to pertussis, or whooping cough. Notifications now show 
that childhood vaccinations against this disease do not provide lifelong protection, and increasing numbers 
of infections in people over the age of 20 have been observed in recent years. Children under the age of 5 
continue to show a declining incidence of whooping cough (Graph 7.8.2), but the problem of increasing 
incidence in adults highlights the need for infants to receive their vaccinations as soon as they reach the 
recommended age.

19
90

19
91

19
92

19
93

19
94

19
95

19
96

19
97

19
98

19
99

20
00

20
01

20
02

20
03

20
04

20
05

20
06

Year

1

10

100

1 000

10 000

Ca
se

s

Graph 7.8.2  Whooping cough (pertussis) and German measles (rubella) in South Australia, 1990 2006

pertussis 0 4 years

pertussis 20+ years

rubella (all ages)

Note: 2005 data unavailable for rubella.
Source:  SA Health, Communicable Disease Control Branch.



page 143South Australia: Our Health and Health Services

chapter 7

7.9  Mental health and wellbeing of young people in South Australia

Approximately 14 per cent of children and adolescents suffer from mental health problems. Only a minority 
of those with problems receive professional help. Administrative or medical databases as a result cannot 
provide accurate information about the true prevalence of mental health problems in the community.

Sawyer et al. published the results of a nationwide community survey9 aimed at determining:

how many children and adolescents in Australia have mental health problems? &gt;

what is the nature of these problems? &gt;

what is the degree of disability associated with these problems? &gt;

what are the services used by children and adolescents with mental health problems? &gt;

This survey remains the best and only resource for gauging the prevalence of mental health problems amongst 
Australia s young people. The number of participants in South Australia is insufficient to provide an accurate 
estimate of the prevalence of mental health problems among young people in this state, although 4 500 
children and adolescents across the nation participated in the survey; consequently, the findings reported here 
are not South Australian specifically. These findings nevertheless are similar in several aspects to those reported 
in the Western Australian Child Health Survey.10

The prevalence of total mental health problems, externalising problems (antisocial or under-controlled 
behaviour, such as delinquency or aggression), and internalising problems (inhibited or over-controlled 
behaviour, such as anxiety or depression) is shown in the following table.

Estimates of the number of children with mental health problems in South Australia are based on the total 
numbers of children living in the state at the time of the 2006 Census.

It can be seen in Graph 7.9.1 following that among children and adolescents who were identified as having 
a mental disorder, school counsellors, family doctors and paediatricians were the most frequently used source 
of help and advice; however, only 29 per cent of the children and adolescents in this cohort attended any 
service at all.

Table 7.9.1  Estimates of the prevalence of mental health problems in males and females aged 4 12
      and 13 17 years, June 2006

 Total problems Externalising problems Internalising problems

  per Population per Population per Population 
 cent estimate cent estimate cent estimate

All children 14.1 38 289 12.9 35 030 12.8 34 759

Males (by age years)

4 12 15.0 13 080 13.6 11 859 15.0 13 080

13 17 13.4 7 004 11.7 6 115 13.6 7 108

Females (by age years)

4 12 14.4 11 985 12.2 10 154 11.3 9 405

13 17 12.8 6 254 14.1 6 890 10.7 5 228

Source: The Child and Adolescent Component of the National Survey of Mental Health and Wellbeing.9 

 



page 144 South Australia: Our Health and Health Services

chapter 7

C
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0

2

4

6

8

10

12

14

16

Service

Pe
r 

ce
nt

 
Graph 7.9.1  Service use by children and adolescents with a mental disorder 

Source:  Sawyer et al., 2000.



page 145South Australia: Our Health and Health Services

chapter 7

Graph 7.9.2 below shows the reasons parents gave to explain why children and adolescents who met the 
criteria for needing help (having a mental disorder and scoring in the clinical range on the Child Behaviour 
Checklist11,12, and whose parents reported that they needed professional help) did not attend a professional 
service to get help. Approximately 50 per cent of the parents reported that help was too expensive or that 
they did not know where to get it.

60

0

10

20

30

40

50

H
el

p 
to

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Barrier

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nt

  

Graph 7.9.2  Barriers to obtaining professional help

Source:   Sawyer et al., 2000.



page 146 South Australia: Our Health and Health Services

chapter 7

7.10  Children and adolescents with physical disabilities

The authors of the South Australian Paediatric Rehabilitation Implementation Plan13 found that there is no 
simple way of estimating the numbers of children living with disabilities sufficiently severe as to require 
paediatric rehabilitation. 

Conditions likely to generate a demand for rehabilitation services include birth defects and chromosomal 
abnormalities, and acquired brain damage.

Brain damage is acquired from head injuries, severe infections involving the brain (meningitis, encephalitis), 
reduced oxygen to the brain for any reason (including near-drowning), some brain tumours, and complications 
of inborn errors of metabolism. The Australian Institute of Health and Welfare has estimated that there 
are 4.5 children per 1 000 in the 0 14 year age group with acquired brain damage.14 The total number of 
children and adolescents in South Australia, with acquired brain damage, based on the 2006 Census is 1 534, 
assuming the same rate applies across all 0-17 year-olds.

Around 38 children are diagnosed with cerebral palsy in South Australia each year15 and the number of 0-18 
year-olds with cerebral palsy in this state has been estimated at around 684. It should be noted, however, that 
close to two-thirds of these children will have only relatively mild cerebral palsy. 

Conditions requiring  Estimated number of 0 18 year olds

rehabilitation services in 2004 South Australians in 2004

Acquired Brain Injury 1 667

Deformations and chromosomal abnormalities 1 703

Cerebral palsy  684

Total 4 054

Source:  SA Health, South Australian Paediatric Rehabilitation Implementation Plan 2007
 

Table 7.10.1  Estimates of the numbers of children in South Australia requiring rehabilitation services



page 147South Australia: Our Health and Health Services

chapter 7

7.11  Services and initiatives

7.11.1 Case load midwifery
Midwifery Group Practice (MGP) is a continuity model of midwife care in which each midwife cares for 
40 women per year, across the continuum of pregnancy, labour, birth and up to six weeks post-natally. 
The principles underpinning this model of care are the relationship between the woman and the midwife, 
continuity of care, and the collaboration with other health care providers.

MGP began in January 2004 and over 2 500 women to-date have received care under this model. 
The clinical outcomes are very favourable for women receiving MGP care compared with other women 
attending the Women s and Children s Hospital (WCH). Women receiving MGP care have less caesarean 
sections, less instrumental births, less inductions of labour, less epidurals in labour and less episiotomies. 
More babies stay with their mothers and go directly to the Postnatal Ward and women receiving MGP care 
are discharged earlier from hospital.

A formal evaluation of the MGP model of care demonstrated that the satisfaction of midwives working in 
this way was high, and women were very satisfied with their care.

7.11.2 Family Home Visiting
The Family Home Visiting program provides a series of visits by a child health nurse over the first two years 
of a child s life. The nurses build relationships with the families and work closely with other service providers 
to broker appropriate support for families assessed as requiring additional help. The aim of the program is 
to enhance child development and parental attachment, thus improving health and wellbeing. Entry into the 
Family Home Visiting program is through assessment provided by the Universal Contact Program operating 
across South Australia. Universal Contact provides the family of every newborn with a visit in the first two 
weeks of life, to undertake a child health enrolment, health check, and an assessment of risk and need. 
Family Home Visiting currently is being offered   based on an assessment of capacity to benefit   to families 
with a baby where the primary caregiver is under 20 years of age and/or socially isolated and/or where the 
baby is of Aboriginal or Torres Strait Islander descent and/or where the relationship between a mother and 
her baby is considered to be poor.

7.11.3 The Parent Helpline
The Parent Helpline and Youth Healthline provide telephone-based services across South Australia, 
24-hours-a-day, every day of the year. Nursing and social work staff are supported by specifically trained 
volunteers and, in August 2005, the services celebrated 10 years of volunteer support. Calls to the Contact 
Centre Services in 2006 numbered 133 000.

The web site at &lt;www.cyh.com&gt; is one of the most successful health information sites in Australia and 
currently hosts more than 900 topics. The site has sub-sites for parenting and child health, kids  health, 
teen health and young adults. Staff provide information and support on a wide variety of issues relating to 
parenting, from birth of a child to them being 25 years-old. Topics include breastfeeding, sleep issues in 
the under-the-12-month-old child, toddler behaviour, schoolyard bullying, sibling rivalry, sexuality, drugs and 
alcohol, safety, suicide, depression, relationships and self-harm. The site had 2 170 000 visits in 2005 06.

7.11.4 Parenting Services
The Parks Children s House is a hub for community activity. The Children s House aims to improve health 
and learning outcomes for children by providing a range of integrated collaborative services that support 
community participation. Families using more than one service can have their needs met in a coordinated 
manner. On-site services include Child and Adolescent Mental Health Service, an outpatient clinic and the 
Parenting Network.

Kids  n  You, located at Elizabeth Grove Primary School, is an early intervention program for families and 
children aged up to five years-old who have experienced the effects of domestic violence, mental health issues 
and childhood abuse.



page 148 South Australia: Our Health and Health Services

chapter 7

7.11.5  Neonatal Hearing Screening
Permanent bilateral hearing impairment has a major impact on a child s speech and language and social 
development. Early detection of hearing impairment, coupled with an appropriate early intervention, is critical 
to speech, language and cognitive development.16 The development of new screening technologies involving 
the measurement of echoes from the hair cells within the ear (oto-acoustic emissions), and of electrical brain 
activity following stimulus with sounds, has meant that congenital hearing impairment now can be readily 
detected in the newborn infant, and appropriate hearing aids can be fitted before the child s development 
is significantly delayed. All parents in South Australia are now offered a hearing test for their new baby, 
following the successful trialing of a screening service in this state in 2002 and 2003.

7.11.6 Immunisation against rotavirus 
All babies born on or after 1 May 2007 now are offered an oral rotavirus vaccine; three doses are 
recommended. The first dose is to be given by the 12th week of life; the second at four months and the 
third at around 6 months but, in any event, before 32 weeks. Rotavirus infection is a major cause of small 
children being hospitalised with gastroenteritis.



page 149South Australia: Our Health and Health Services

chapter 7

7.12  Notes

1.  Maternal, Perinatal and Infant Mortality Committee, Maternal, perinatal and infant mortality 2005 including 
the South Australian protocol for the investigation of stillbirths: twentieth report. Department of Health, 
Adelaide, 2006.

2.  S M Beal,  Sudden Infant Death Syndrome: epidemiological comparisons between South Australia and 
communities with a different incidence , Australian paediatric journal, vol. 22, suppl1, 1986, pp. 13 16.

3.  Department of Health and Ageing, HealthWIZ: Australia s national social health statistical data library, 
Department of Health and Ageing, Canberra, 2005, viewed 19 November 2007, &lt;http://in.health.sa.gov.
au/healthwiz.&gt;

4.  J Lous, M J Burton, J U Felding, T Ovesen, M M Rovers &amp; I Williamson,  Grommets (ventilation tubes) 
for hearing loss associated with otitis media with effusion in children , Cochrane Database of Systematic 
Reviews, 2005, issue 1, art. no. CD001801. DOI: 10.1002/14651858.CD001801.pub2.

5.  S Blunden, K Lushington, B Lorenzen, J Martin &amp; D Kennedy,  Neuropsychological and psychosocial 
function in children with a history of snoring or behavioural sleep problems , Journal of Pediatrics, vol. 
146, issue 6, 2005, pp. 780 786.

6.  J L Paradise, C D Bluestone, D K Colborn, B S Bernard, R N Howard, E Rockette &amp; M Kurs-Lasky, 
 Tonsillectomy and adenotonsillectomy for recurrent throat infection in moderately affected children . 
Pediatrics, vol. 110, no. 1, 2002, pp. 7 15.

7.  Department of Health and Ageing, National immunisation programs Schedule (NIPS),Department of Health 
and Ageing, Canberra, 2007, viewed 2 October 2007, &lt;http://www.immunise.health.gov.au/internet/
immunise/publishing.nsf/Content/nips&gt;.

8.  Medicare Australia, Australian childhood immunisation register Medicare Australia, Canberra, 2007, 
viewed 2 October 2007, &lt;http://www.medicareaustralia.gov.au/public/services/acir/index.shtml&gt;.

9.  M G Sawyer, R J Kosky, B W Graetz, F Arney, S R Zubrick &amp; P Baghurst, Mental health of young people 
in Australia: child and adolescent component of the National Survey of Mental Health and Wellbeing, 
Mental Health and Special Programs Branch, Australian Department of Health and Aged Care, 2000.

10.  S R Zubrick, S R Silburn, A Garton, P R Burton, R Dalby, J Carlton, C Shepherd &amp; D Lawrence, 
Western Australian Child Health Survey: developing health and wellbeing in the Nineties, Australian Bureau 
of Statistics and the Institute of Child Health Research, Perth, 1995.

11.  T M Achenbach, Manual for the child behaviour checklist/4-18 and 1991 profi le, University of Vermont 
Department of Psychiatry, Burlington, VT, 1991.

12.   , Manual for the youth self report and 1991 profi le, University of Vermont Department of Psychiatry, 
Burlington VT, 1991.

13.  South Australian Paediatric Rehabilitation Implementation Plan (2007 in draft). Children Youth and 
Women s Health Service, Department of Health, Government of South Australia

14.  Australian Institute of Health and Welfare, Disability updates: children with disabilities, Bulletin 42, 
AIHW cat. no. AUS 19, AIHW, Canberra, 2006.

15.  South Australian Cerebral Palsy Register, 2006 annual report of the South Australian Cerebral Palsy 
Register: children born 1993 to 2001 with cerebral palsy notifi ed to the Register by 31st December 2006, 
South Australian Cerebral Palsy Register. North Adelaide, 2006.

16 .  C Yoshinaga-Itano, A L Sedley, D K Coulter &amp; A L Mehl, Language of early and later identified children 
with hearing loss. Pediatrics. 1998, 102(5):pp1161 71.



page 150 South Australia: Our Health and Health Services

chapter 8

8  Older people

In this chapter

Chronic diseases &gt;

Main years of life lost due to disability &gt;

Mortality &gt;

Hospitalisation &gt;

Mental health &gt;

Falls &gt;

Living arrangements &gt;

Services for older people &gt;

Services and initiatives &gt;

Summary

 The chronic condition with the highest prevalence for older men is arthritis, followed by cardiovascular  &gt;
disease and diabetes. The most prevalent chronic conditions for older females are arthritis, osteoporosis 
and cardiovascular disease.

 The number of occupied bed days for older people in hospital for chronic disease was highest for  &gt;
 care involving dialysis  (an indicator for chronic kidney disease), followed by chronic obstructive pulmonary 
disease and stroke.

 Dementia and Alzheimer s disease are the leading causes of the morbidity burden in older people of both  &gt;
genders and accounted for 17.7 per cent of the total years lost due to disability. Women registered a 
greater burden from these conditions, however, because of their longer life span.

 Death rates for older people declined quite signifi cantly over the period from 1995 to 2004. The greatest  &gt;
decline was in the 65 74 year age group, by 31 per cent for males (from 2 768 to 1917 per 100 000), 
and by 28 per cent for females (from 1 488 to 1 077 per 100 000).

 Patients aged 65 and over accounted for 38 per cent of all hospital separations in 2006 07 and for  &gt;
51 per cent of all patient days, yet older people account for only 15 per cent of the state s population.

 It is estimated that approximately 11 per cent of people aged 65+ years have a current doctor-diagnosed  &gt;
mental health condition.

 There were 9 095 separations in both private and public hospitals as a result of falls by older people  &gt;
during 2006 07. Females accounted for 68.2 per cent of these hospitalisations, and males 31.8 per cent. 
The average length of stay for fall-related injuries was 9.6 days.

The majority of older people in South Australia live with their marital partner, or live alone. &gt;

A total of 858 older people received a transition care package of support during 2006 07. &gt;

 The number of South Australian community aged care places increased 15.9 per cent from 2 996 at June  &gt;
2005 to 3 472 places at June 2006.

 The number of operational residential aged care places increased 2.3 per cent from 15 640 at June 2005  &gt;

to 15 994 places at June 2006.



page 151South Australia: Our Health and Health Services

chapter 8

Introduction

The South Australian population aged 65+ years has increased steadily over the past two decades and is 
projected to rise further over the next 15 years.

There were 240 722 people aged 65+ years in South Australia as at 30 June 2007. This figure represents 
15.2 per cent of the state s entire population compared to 13.1 per cent for Australia as a whole. 
Females made up 56.0 per cent of this age group, with the remaining 44.0 per cent being male.

The ageing of the South Australian population is caused by three main factors. First, South Australian families 
are having, on average, fewer children.10 Second, large numbers of ageing  baby boomers  are entering into 
their senior years. Third, increasing life expectancy is contributing to the ageing population. The increase in 
life expectancy has resulted in more people surviving to an older age, hence modifying the age structure of 
the state s population.9

The increase in life expectancy, as well as the decrease in mortality, is a result of improved access to medical 
services and medical techniques, and the practice of healthier diets and lifestyles.11

The results of the 2004 05 National Health Survey (NHS) by the Australian Bureau of Statistics (ABS), showed 
that two-thirds of older South Australians self-reported as having good, very good or excellent health.5 As a 
result, many older people remain involved in community activities such as voluntary and paid employment, 
and extended family support, as well as participating in community social, sporting and cultural activities.4

Older Australians are an important and rapidly growing group within South Australia. This chapter gives an 
overview of the health status of people aged 65+ years.



page 152 South Australia: Our Health and Health Services

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8.1  Chronic diseases

Chronic diseases cause a heavy burden on communities, including individuals and health service 
providers such as hospitals, because these conditions generally are long-term.12

The control of infectious diseases, along with changes to demographic factors and living and 
working conditions, and increases in the prevalence of risk factors, have seen chronic diseases grow in 
relative importance.12

The results from the 2006 07 SAMSS survey indicate the highest prevalence of chronic conditions   of the 
selected conditions in the survey   for older men was arthritis (40.4 per cent), followed by cardiovascular 
disease (32.2 per cent) and diabetes (18.9 per cent). The most prevalent chronic conditions for older females 
were arthritis (56.3 per cent), osteoporosis (22.9 per cent) and cardiovascular disease (22.4 per cent).

Males were more likely than females (based on the SAMSS) to report having COPD (8.9 per cent compared 
to 5.5 per cent) and cardiovascular disease (32.2 per cent compared to 22.4 per cent), while females were 
more likely than males to report having arthritis (56.3 per cent compared to 40.4 per cent) and osteoporosis 
(22.9 per cent compared to 4.1 per cent). People aged 80+ years were more likely to report having 
cardiovascular disease compared to people in younger age groups (31.9 per cent compared to 28.8 per cent 
for 70 79 year-olds and 18.1 percent for 65 69 year-olds) and osteoporosis (19.7 per cent compared to 
14.6 per cent and 9.7 per cent).

Diabetes

Asthma

Chronic obstructive 
pulmonary disease (COPD)

Cardiovascular
disease

Arthritis

Osteoporosis

0 5 10 15 20 25 30 35 40 45 50 55 60

Per cent

Female

Male

Graph 8.1.1  Prevalence of chronic conditions for older people, South Australia, 2006 07

Note:  Chronic conditions were determined by asking respondents if they had ever been told by a doctor that they 
 had diabetes, asthma, chronic obstructive pulmonary disease (COPD), cardiovascular disease, arthritis or osteoporosis.
 Asthma is defined according to the Australian Centre for Asthma Monitoring (ACAM) definition3 of whether 
 respondents had ever been told by a doctor that they had asthma, and had experienced symptoms (wheeze, shortness 
 of breath or chest tightness) of asthma in the last 12 months or had taken treatment for asthma in the last 12 months.
Source: SA Health, South Australian Monitoring and Surveillance System (SAMSS), 65+ years.



page 153South Australia: Our Health and Health Services

chapter 8

The number of occupied bed days (OBDs) during 2006 07 was highest for  care involving dialysis  
(36 072 days), followed by COPD (26 167 days) and stroke (24 251 days). The number of OBDs is high for 
dialysis because patients with chronic kidney disease often require frequent dialysis treatments in hospital. 
The average length of stay (at one day) in hospital for care involving dialysis, however, was the shortest of 
the 12 chronic diseases.

Hospital stays for oral diseases likewise were relatively short, averaging 1.5 days, as most of these are for 
dental procedures which usually do not require a long post-operative recovery period.8 Stroke, depression, 
colorectal cancer, lung cancer, COPD and osteoporosis   at the other end of the scale   each had an average 
length of stay of more than 7 days.

0

2

4

6

8

10

12

14

16

18

A
ve

ra
ge

 le
ng

th
 o

f 
st

ay
 (d

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s)

A
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ys
is

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 o
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e 
(C

O
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C
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C
or

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ar

y 
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ar
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 c
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is

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O
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0

4 000

8 000

12 000

16 000

20 000

24 000

28 000

32 000

36 000

O
cc

up
ie

d 
be

d 
da

ys

Chronic diseases

Average length of stay (ALOS) Bed days

Graph 8.1.2  Occupied bed days for chronic diseases, South Australia, 2006 07

Note: Includes both public and private hospitals in South Australia. Codes are based on ICD 10AM.
Source: SA Health, Integrated South Australian Activity Collection (ISAAC).



page 154 South Australia: Our Health and Health Services

chapter 8

8.2  Main years of life lost due to disability

Years lost due to disability (YLD) is a measure of the morbidity burden of a disease. YLDs represent the number 
of  healthy  years of life lost due to disability. Disability refers in this definition to any departure from an ideal 
health state. For a detailed description of YLD, refer to the glossary.

The graph above shows the YLD contributions for the major disease groups and injury among older people 
during 2001 2003. Nervous system and sense disorders are the leading cause of YLD, accounting for 
45.1 per cent of the non-fatal burden of disease. The main conditions within this category were Dementia 
and Alzheimer s disease, adult-onset hearing loss, and age-related vision disorders.2

Cardiovascular disease was responsible for 17.6 per cent of the disability burden, with the core conditions 
being ischaemic heart disease and stroke. Cancer accounted for 13.1 per cent, mainly comprising colorectal 
and prostate cancers.2

The disability burden overall was higher for older females (53.5 per cent) than for males (46.5 per cent). 
The non-fatal burden of nervous system and sense disorders, mental disorders and musculoskeletal disorders 
are all higher for females than for males. The male burden is higher, however, for cardiovascular disease, 
chronic respiratory diseases and cancers.2

Years lost due to disability (YLDs)

1 000 2 000 3 000 4 000 5 000 6 000 7 000 8 000 9 000 10 0000

Others

Diabetes mellitus

Mental disorders

Nervous system and
sense disorders

Cardiovascular disease

Chronic
respiratory disease

Musculoskeletal
diseases

Injuries

Cancer

Females

Males

Graph 8.2.1  Burden of Disease, three-yearly average estimates for older people, South Australia, 2001 2003

Source: SA Health, South Australian Burden of Disease Study.



page 155South Australia: Our Health and Health Services

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The analysis above is based on years lost due to disability for major disease groups and injury. Three gender 
differences were noticeable at the specific condition level:

 age-related vision disorders accounted for 3.2 per cent of total morbidity burden for older males,  &gt;
compared with 10 per cent for older females (more than three times greater)

 adult-onset hearing loss was almost twice as high for older males (10.2 per cent) than for older females &gt;
(5.7 per cent)

Parkinson s disease accounted for 4.1 per cent of total morbidity burden for older males, compared with  &gt;
 6.8 per cent for older females.

Table 8.2.1  Top causes of morbidity burden (YLD) by gender and condition, South Australia, 

      2001 2003 (three-year average)

 Males Females

Condition YLD Per cent Condition YLD Per cent

Dementia and Alzheimer's disease 2 242 14.4 Dementia and Alzheimer's disease 3 695 20.6

Adult-onset hearing loss 1 587 10.2 Age-related vision disorders 1 805 10.0

Stroke 1 280 8.2 Parkinson's disease 1 216 6.8

Ischaemic heart disease 1 015 6.5 Osteoarthritis 1 135 6.3

Other nervous system disorders 837 5.4 Stroke 1 050 5.8

Osteoarthritis 762 4.9 Adult-onset hearing loss 1 029 5.7

Prostate cancer 735 4.7 Ischaemic heart disease 993 5.5

Parkinson's disease 641 4.1 Other nervous system disorders 776 4.3

Chronic obstructive pulmonary disease 587 3.8 Breast cancer 572 3.2

Benign prostatic hypertrophy 511 3.3 Chronic obstructive pulmonary disease 424 2.4

Age-related vision disorder 500 3.2 Colorectal cancer 379 2.4

Source: SA Health, South Australian Burden of Disease web site.

 



page 156 South Australia: Our Health and Health Services

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8.3  Mortality

One of the strongest indicators of the improving health of older South Australians is falling death rates. 
Death rates for older people declined quite significantly over the period from 1995 to 2004. The greatest 
fall was in the 65 74 year age group, by 31 per cent for males (from 2 768 to 1 917 per 100 000), and by 
28 per cent for females (from 1 488 to 1 077 per 100 000). There was almost as great a reduction for the 
75 84 year age group. Among males aged 85+ years, death rates declined by 15 per cent, from 17 632 
to 15 019 per 100 000 males, similar to the 14 per cent decline for females, from 14 132 to 12 151 
per 100 000 females.

Most of the overall reduction in age-specific death rates from 1995 to 2004 was due to a decline in the death 
rates for circulatory system diseases.4 The age-specific death rates for males for circulatory system diseases 
have fallen by 45 per cent for 65 74 year-olds, 41 per cent for 75 84 year-olds and 32 per cent for those 
aged 85+ years. The reductions in the rates for females were very similar.4

Age-specific death rates for malignant neoplasms also declined; however, the rate of decline was much 
greater for males than for females. The death rates for males declined by 21 per cent, 16 per cent, 
and 12 per cent for the age ranges of 65 74, 75 84 and 85+ years respectively. There was a decline for 
females of 9 per cent for 65 74 year-olds, 1 per cent for 75 84 year-olds, and 9 per cent in women aged 
85+ years.

Table 8.3.1  Age-specific deaths per 100 000 males and females for persons aged 65+ years, 

     all causes and selected conditions, South Australia, 1995, 2000 and 2004

 Males Females

    per cent    per cent
    increase    increase

 1995 2000 2004 1995 2004  1995 2000 2004 1995 2004

All causes

65 74 2 768 2 436 1 917 -31 1 488 1310 1 077 -28

75 84 7 312 6 498 5 404 -26 4 554 3964 3 492 -23

85+ years 17 632 16 486 15 019 -15 14 132 13 563 12 151 -14

Circulatory system diseases 

65 74 1 129 909 617 -45 602 404 265 -56

75 84 3 454 2 675 2 022 -41 2 386 1 814 1 340 -44

85+ years 9 432 7 741 6 371 -32 8 733 7 340 6 153 -30

Malignant neoplasms 

65 74 1 024 999 813 -21 546 514 498 -9

75 84 1 961 1 939 1 646 -16 993 892 982 -1

85+ years 3 349 3 078 2 960 -12 1 224 1 583 1 338 9

Respiratory diseases

65 74 236 176 154 -35 106 120 90 -15

75 84 752 850 718 -5 280 395 375 34

85+ years 1 694 2 847 2 382 41 811 1 536 1 369 69

Nervous system diseases

65 74 37 29 43 16 39 33 40 1

75 84 173 98 125 -28 146 97 104 -29

85+ years 539 285 428 -21 466 259 408 -13

Musculoskeletal conditions

65 74 2 4 9 406 13 21 5 -61

75 84 27 28 30 11 36 29 24 -33

85+ years 58 54 92 60  138 106 108 -21

Note: Categories are derived using ICD 10AM.

Source: Australian Bureau of Statistics, Deaths Data.

 



page 157South Australia: Our Health and Health Services

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8.4  Hospitalisation

2002 03 2003 04 2004 05 2005 06 2006 07

Years

0

300

600

900

1 200

1 500

1 800

2 100

2 400

N
u

m
b

er
 o

f 
sp

ea
ra

ti
o

n
s 

( 
00

0)

Separations 0 64

Separations 65+

Occupied bed days (OBD) 0 64

Occupied bed days (OBD) 65+

Graph 8.4.1  Older people hospital separations and occupied bed days, South Australia

Note: Includes both public and private hospitals in South Australia.
Source: SA Health, Integrated South Australian Activity Collection (ISAAC).



page 158 South Australia: Our Health and Health Services

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Older South Australians account for a large number of hospital separations. They have a higher rate of 
admission to hospital than do younger people, and have a tendency to stay longer. Patients aged 65+ years 
accounted for 233 329 hospital separations (38 per cent of all separations) and 1 111 092 patient days 
(51 per cent of all patient days) in 2006 07. Older men and older women accounted for roughly equal 
numbers of separations (118 789 and 114 539 respectively), but women predominated in terms of patient 
days (504 447 for men and 606 642 for women).

Hospital separations for older people in South Australia have increased from 198 883 in 2002 03 to 233 329 
in 2006 07 (17 per cent). Most of the increase is attributed to same-day separations, which increased from 
93 534 to 118 686 (27 per cent). The growth in overnight stay separations was more modest, from 105 349 
to 114 643 (9 per cent).

Public hospitals accounted for 62 per cent of separations for older people, and 72 per cent of patient days 
during 2006 07. The average length of stay in public hospitals was 5.6 days, compared with 3.5 days for 
private hospitals. It is evident that the average length of stay in hospital increases with age. The average stay 
for males was 3.7 days for those ages 65 74 years, 5.2 days for the 75 84 age group and 8.6 days for those 
aged 85+ years. The average stay for females increased from 4.0 days for those aged 65 74 years, to 6.3 days 
for the 75 84 age group, and 10.8 days for those aged 85+ years.

The most common  same-day  extended service-related groups (ESRG) for older people in public hospitals 
during 2006 07 were renal dialysis, chemotherapy and colonoscopies. They were renal dialysis, lens and 
glaucoma procedures, and colonoscopies in private hospitals. Private hospitals reported more separations 
for treatment of cataracts, while public hospitals reported more separations for treatment of dementia, 
depression, cardiovascular disease and renal disease.

The most common  overnight  ESRGs for older people in public hospitals were for treatment of chronic 
respiratory diseases including bronchitis, emphysema and chronic obstructive airways disease. Non-
acute rehabilitation and diseases of the digestive system including oesophagitis, gastroenteritis and other 
miscellaneous diseases also were common causes of overnight ESRGs. Non-acute rehabilitation also was a 
common overnight ESRG for older people treated in private hospitals. Orthopaedic surgery involving hip and 
knee replacements was more common in private than public hospitals.



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8.5  Mental health

Good mental health is an important aspect to an individual s social connections and support networks, 
which can influence their overall health and wellbeing. The majority of older people experience good mental 
health that enables them to cope better with any deterioration in physical health.

The types of mental disorders as people age can vary. The prevalence of anxiety or substance abuse, 
for example, declines as people get older, whereas other disorders such as dementia can occur more 
frequently. The increase in the levels of dementia reported is due to longer lifespans, but it also is partly to 
do with higher levels of awareness, reporting and diagnosis. The prevalence of depression is less common 
in older people, but is a predictor of premature death and is more common for those who are ill, 
disabled or in institutions.13

Results from the 2006 07 SAMSS show that 10.8 per cent of respondents aged 65+ years reported a current 
doctor-diagnosed mental health condition. Females were significantly more likely to report having a current 
mental health condition than were males (12.7 per cent compared to 8.3 per cent). There is a decrease in 
prevalence with age of current diagnosed mental health conditions from 12.3 per cent for those aged 65 69 
years, to 10.5 per cent for 70 79 year olds, and 9.8 per cent for people aged 80+ years.

The proportion of South Australian older people with a self reported current diagnosed mental health 
condition has not varied notably over the past five years, with 10.7 per cent in 2002 03 and 10.8 per cent 
in 2006 07.

The majority of older South Australians with a diagnosed mental health condition live in their usual residence, 
supported by general practitioners, aged health care services and general community health services. 
Inpatient services are provided by general and specialist psychiatric hospitals in the public and private sectors, 
including psychogeriatric and forensic care.14

2002 03 2003 04 2004 05 2005 06 2006 07

Years

0

3

6

9

12

15

Pe
r 

ce
nt

Male

Female

Graph 8.5.1  Prevalence of current diagnosed mental health condition for older people, South Australia

Note:  Current diagnosed mental health condition is determined if the respondent was diagnosed with a mental health 
 condition such as anxiety, depression, a stress-related problem, or any other mental health problem in the last 
 12 months, or was currently receiving treatment for a mental health condition.
Source: SA Health, South Australian Monitoring and Surveillance System (SAMSS), 65+ years.



page 160 South Australia: Our Health and Health Services

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8.6  Falls

Falls are the most common cause of serious injury among older people within South Australia, and account 
for the largest proportion of all injury-related deaths and hospitalisations. The results of the 2006 07 
SAMSS indicate that 29.4 per cent of respondents aged 65+ years self-reported falling at least once in 
the 12 months prior.

Just over 12 per cent of respondents who reported at least one fall during 2006 07 also required medical 
treatment for injuries, according to SAMSS, while 12.5 per cent had limited activity for more than two days, 
and 18.6 per cent had both medical treatment and limited activity.

The number of private and public hospital separations as a result of falls by older people during 2006 07 
was 9 095. Females accounted for 68.2 per cent of these hospitalisations, and males 31.8 per cent. 
Hospital separation rates for falls by older people increased 6.3 per cent between 2005 06 and 2006 07.

The most frequent type of injury sustained in a fall and resulting in a hospital admission during 2006 07 
was to the head (22.2 per cent), followed by injury to the hip and thigh (21.6 per cent), and injury to the 
elbow and forearm (11.0 per cent).

The average length of stay in hospital for older people with fall-related injuries was 9.6 days during 2006 07. 
The total number of occupied hospital bed-days was 87 012, representing 7.8 per cent of all hospital bed-days 
for this age group.

There are several reasons why people may experience a fall, such as their physical ability, medical condition, 
and walking ability. Effects from medication and alcohol, and the non-familiarity of the physical environment 
around them (for example, surfaces, lighting) additionally can result in a person falling.16

(See Chapter 11 for more information about falls.)

0

1 000

2 000

3 000

4 000

5 000

6 000

7 000

N
um

be
r 

of
 f

al
ls

2002 03 2003 04 2004 05 2005 06 2006 07

Years

Male

Female

Graph 8.6.1  Fall-related hospital separations for older people, South Australia

Note: Includes both public and private hospitals in South Australia.
Source: SA Health, Integrated South Australian Activity Collection (ISAAC).



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8.7  Living arrangements

The living arrangements of older South Australians are influenced by a number of characteristics such as 
marital, health, financial status and cultural beliefs.6 An elderly person s requirement for accessible services 
or facilities can result, in some instances, in their moving out of their home, and away from their local 
community; this can end up being socially isolating with potential health implications.7

People often experience changes in their living arrangements as they age, including living as a couple, 
living with others (family or non-family), living alone or living in a residential aged care facility. The majority 
of older people continue to live in their own homes, making use of aged care assistance packages, or support 
from families and friends as needed.

The majority of older people live with their married partner, or live alone. Census night in 2006 identified 
201 360 older people living at home in South Australia; of these:

57.7 per cent (116 200 persons) lived with their married partner &gt;

4.0 per cent (7 943) lived with at least one sibling &gt;

 2.7 per cent (5 495) lived with at least one other family related member (for example, cousin/brother &gt;
/sister et al.) 

1.3 per cent (2 660) lived with their de facto partner (that is, not legally married) &gt;

3.5 per cent (6 999) lived with at least one non-family member(s) &gt;

30.8 per cent (62 063) lived alone. &gt; 1

Women generally live longer than men and they tend to outlive their partners. This reality leads to differences 
in living arrangements between older men and women. A majority of older men lived with their married 
partner (72.4 per cent), with a smaller number living alone (19.0 per cent). Only 45.8 per cent of older 
women, by contrast, lived with their partner and 40.4 per cent lived alone.1

Most people are able to continue living independently in their own homes; however, as they age, their need 
for assistance increases. Assistance is often obtained from families, friends or community and government 
organisations, but some people do need to move out of their home into some form of supported 
accommodation (that is, into nursing homes or aged care hostels). 

With a married
partner

With at least
one sibling

With at least one
other family-related

member

With a de facto
partner

With at least one
non-family member

Alone

Living arrangements

0

10

20

30

40

50

60

70

80

Pe
r 

ce
nt

 (p
op

ul
at

io
n)

Males

Females

Graph 8.7.1  Living arrangements of older people on 2006 Census Night, by gender, South Australia

Source: Australian Bureau of Statistics, 2068.0 Census of population and housing, relationship in household by age and sex.



page 162 South Australia: Our Health and Health Services

chapter 8

8.8  Services for older people

The majority of the state s older people lead independent lives well into old age requiring little or no formal 
support. The need for health services increases with age, however, and peaks in the last two years of life.

Older people are high users of health services and often have more complex needs because of increases 
in the incidence of chronic diseases and co-morbidities. There are a number of State and Australian 
Government services that specifically supports older people; these are designed to increase their chances 
of remaining at home longer and avoiding premature admission to residential care and/or admission or 
re-admission to hospital.

8.8.1 Residential-based aged care
Residential aged care assists older people who can no longer manage living at home/independently. 
Residential aged care provides two levels of care: high and low. The level of care required for each resident 
is determined according to his/her assessed needs.

The number of operational residential aged care places increased from 15 640 at June 2005 to 15 994 places 
at June 2006 (low and high care combined).

The Australian Government target population, for aged care planning purposes, is people aged 70+ years, 
and Aboriginal and Torres Strait Islander people aged 50+ years. The Australian Government aims to achieve 
88 residential aged care places (44 high care places and 44 low care places) per 1 000 of the target 
population by 2010.

The ratio of operational residential aged care places in South Australia as of June 2005 was 91.2 places 
per 1 000 of the target population; this ratio increased to 91.8 places per 1 000 at June 2006.

0

1 000

2 000

3 000

4 000

5 000

6 000

7 000

8 000

Residential
high-care places

N
um

be
r 

of
 p

la
ce

s

Residential
low-care places

Transition care
places

Community care
places

Graph 8.8.1  Total aged care places available, South Australia, as at June 2006

Source: Aged Care Statistics for South Australia.



page 163South Australia: Our Health and Health Services

chapter 8

8.8.2 Community-based aged care

Community-based aged care helps older people who are able to live at home but require some support to do 
so. Services that are provided through community services include bathing, showering, and personal hygiene; 
toileting; dressing and undressing; mobility; transfer; preparing and helping with eating meals; sensory 
communication, or fitting sensory communication aids; laundry; home help; gardening; and support with 
short-term illness.

The number of community aged care places increased from 2 996 at June 2005 to 3 472 places at June 2006. 
The provision ratio of community aged care places per 1 000 persons aged 70+ years increased from 17.5 
at June 2005 to 19.9 at June 2006.

8.8.3 Home and Community Care Program (HACC)

70 000

75 000

80 000

85 000

90 000

95 000

100 000

N
um

be
r 

of
 p

la
ce

s

2002 03 2003 04 2004 05 2005 06 2006 07

Years

Graph 8.8.2  Growth in HACC clients, South Australia

Source: Department for Families and Communities, South Australian Home and Community Care Program 
 Minimum Data Set.



page 164 South Australia: Our Health and Health Services

chapter 8

The Home and Community Care Program was established in 1985. The program is funded jointly by the 
Australian, State and Territory Governments to support frail older people, younger people with disabilities 
and their carers.

The total recurrent funding for the HACC Program in South Australia increased from $118.6 million in 2005 06 
to $128.1 million in 2006 07. The Commonwealth contribution was $78.9 million, and the state contribution 
was $49.1 million.

The main objectives of the HACC Program are to:

 provide a comprehensive, coordinated and integrated range of basic maintenance and support services  &gt;
for frail older people, younger people with disabilities and their carers

 support these people to be more independent at home and in the community, thereby enhancing their  &gt;
quality of life and/or preventing their premature or inappropriate admission to longer term residential care

 provide fl exible, timely services that respond to the needs of these people. &gt;

Services available to HACC clients have been categorised into seven service groups:

 Service group 1   domestic assistance, personal care, social support, home maintenance, respite care  &gt;
and other food services

 Service group 2   assessment, client care coordination, case management, counselling/support,  &gt;
information and ddvocacy

Service group 3   nursing and allied health care &gt;

Service group 4   centre based day care &gt;

Service group 5   home modifi cation, goods &amp; equipment and formal linen &gt;

Service group 6   meals &gt;

Service group 7   transport. &gt;

The number of South Australian HACC clients who received one of the above service/assistance types 
increased by 11 per cent from 85 412 in 2005 06 to 96 000 in 2006 07. It is envisaged that dependency 
on HACC services will continue to grow in future years.



page 165South Australia: Our Health and Health Services

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8.8.4 Transition care

The Transition Care Program provides short-term support for older people at the end of their hospital stay. 
The program is aimed at those people who require more time and support in a non-hospital environment 
to complete their recovery process, optimise their functional capacity and finalise their longer term 
care arrangements.

The program may be provided in a residential setting or in the older person s home, depending on 
each individual s care needs. A package of services is provided that includes low intensity therapy such as 
physiotherapy, occupational therapy and social work, nursing support and/or personal care.

There were 176 transitional care places as at June 2006. The mean age of people entering into transition 
care during 2006 07 was 82 years, with 50 per cent of people aged 81 90 years and 13 per cent aged 
90+ years. Women comprised 67 per cent of transition care recipients in South Australia, while men 
amounted to 33 per cent of the clientele. The Transition Care Program had an overall increase of 30 per cent 
in admissions between 2005 06 and 2006 07.

Almost 47 per cent of transition care recipients in South Australia during 2006 07 had been admitted 
to hospital with musculoskeletal problems (falls, fractures, and soft tissue injuries). The median length of stay 
in the transition care program was 50 days. Forty-nine per cent of older people returned to their home on 
completion of transition care rather than being admitted to a residential aged care facility (see graph above).

0 5 10 15 20 25 30 35 40 45 50 55

Re-admitted to hospital

Residential high-level care

Deaths

Residential low-level care

Home

Another transition care service

Other rehabilitation options

Other   still on program

Independent Living Unit

Per cent

Graph 8.8.3  Transition care program discharge destinations, South Australia, 2006 07

Source: SA Health, Transition care program data.



page 166 South Australia: Our Health and Health Services

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8.9  Services and initiatives

8.9.1 Out-of-hospital strategies
SA Health provided a number of out-of-hospital strategies during 2006 07 with the objective of developing 
primary health care programs to reduce demand on the acute system. Older people are high users of these 
health services as they often have more complex needs. These initiatives increase older people s chances of 
remaining at home longer and avoiding premature admission to residential care and/or admission to hospital. 
These programs include:

 Metro Home Link &gt;    provides care to patients who are at risk of hospital admission or re admission; short 
term packages of care are provided in a person s place of residence, including residential age care facilities

 Chronic Disease Management programs &gt;    health care planning programs for people with a chronic illness 
that aim to reduce complications and avoid future unplanned admissions to hospital

 Transition Care Program &gt;    provides older people with short-term assistance following a hospital stay; 
the program aims to give older people more time to recuperate in a non-hospital environment with care 
provided in a person s own home or in a residential facility dependent on the needs of the individual

  &gt; GP Plus Health Care Centres   assist in the early identifi cation of health risk factors affecting the immediate 
and long-term health of an individual; assisting in the management of patients with chronic and complex 
conditions; providing health promotion and prevention strategies in local communities; and providing 
a community resource for self-management groups and other health and wellbeing activities

 Lifestyle and Risk Factor programs &gt;    lifestyle advisers and coordinators work with high-risk populations 
and individuals to reduce the risk of their developing a preventable chronic disease in the future, such as 
diabetes, heart disease and respiratory disease.

8.9.2 Mental health
There are a variety of initiatives funded by the South Australian Government aiming to bolster the mental 
wellbeing of older people living in their communities. The Living Well pilot project aimed to identify, 
trial and evaluate primary health care approaches with residents of independent living units at allocated sites, 
who were at risk of experiencing depression, anxiety and/or stress.

A commitment also has been made through Improving with Age   Our Ageing Plan for South Australia to work 
with community services to support initiatives consistent with the national mental health initiative    beyond 
blue    in relation to the needs of older people with depression.

8.9.3 Support for carers
The development of the SA Carers Recognition Act 2005 demonstrated South Australia s commitment to 
supporting carers. There is a range of strategies funded by the South Australian Government that seek both 
to recognise and support the work of carers supporting older people to live independent and fulfilling lives in 
the community. Carers are a key target population for the Home and Community Care Program administered by 
the Department for Families and Communities. This assistance includes respite and other carer supports such 
as counselling, support information and advocacy.

8.9.4 Research
There were a range of research initiatives (trials) funded by the South Australian Government in 2006 07 
that sought to identify and establish healthy lifestyle practices for older people; these included:

The Healthy Ageing   Nutrition &gt;  project

Neighbourhoods &gt;    Older women s perceptions of health supporting qualities across metropolitan Adelaide

Non-metropolitan housing pathways for older people in South Australia &gt;

Housing assistance budgets for an ageing population &gt;

Factors that make housing more suitable for older people. &gt;

It is worth noting these overall strategies seek to complement the range of programs outlined across 
community, and residential care streams provided by the Australian Government.



page 167South Australia: Our Health and Health Services

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8.10  Notes

1.  Australian Bureau of Statistics, Census of population and housing, cat. no. 2068.0, viewed 16 August 2007,
&lt;http://www.censusdata.abs.gov.au/ABSNavigation/prenav/ViewData? action=404&amp;documentproductn
o=4&amp;documenttype=Details&amp;order=1&amp;tabname=Details&amp;areacode=4&amp;issue=2006&amp;producttype=Cens
us%20Tables&amp;javascript=true&amp;textversion=false&amp;navmapdisplayed=true&amp;breadcrumb=TLPD&amp;&amp;collectio
n=Census&amp;period=2006&amp;productlabel=Relationship%20in%20Household%20by%20Age%20by%20
Sex&amp;producttype=Census%20Tables&amp;method=Place%20of%20Usual%20Residence&amp;topic=Living%20
Arrangements&amp;&gt;

2.  Department of Health, South Australia Burden of Disease study, Department of Health, 2007, retrieved 
22 August 2007, &lt;http://www.health.sa.gov.au/burdenofdisease/DesktopDefault.aspx?tabid=25&gt;

3.   Australian Centre for Asthma Monitoring, Asthma in Australia 2003. AIHW Asthma Series 1. 
cat. no. ACM 1. AIHW, Canberra, 2003.

4.   Australian Institute of Health and Welfare, Health of older Australians, 2004, AIHW, Canberra, 2004, 
viewed 26 September 2007, &lt;http://www.aihw.gov.au/publications/index.cfm/title/10014&gt;

5.   Australian Bureau of Statistics, National Health Survey: Summary of results, 2004 05, cat. no. 4364.0, 
viewed 27 September 2007, &lt;http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4364.02004 05?
OpenDocument&gt;

6.   V A Velkoff, Living arrangements and well being of the older population, United Nations, viewed 
27 September 2007, &lt;http://www.un.org/esa/population/publications/bulletin42_43/velkoff.pdf&gt;

7.  Queensland Health, The Aged Care Strategy 2002 2007   A people centred approach to health care choices 
in Queensland, Queensland Health, Brisbane, 2002.

8.  Australian Institute of Health and Welfare, Use of hospital services, Australian Government, 
viewed 8 September 2007, &lt;http://www.aihw.gov.au/cdarf/data_pages/hospital/index.cfm&gt;

9.  Australian Indigenous, Population sub groups, Ageing, HealthInfoNet, viewed 18 September 2007, 
&lt;http://www.healthinfonet.ecu.edu.au/html/html_population/population_subgroups_ageing.htm&gt;

10.  Australian Government, Australia s Demographic Challenges, The Treasury, Canberra, viewed 
18 September 2007, &lt;http://demographics.treasury.gov.au/content/_download/australias_demographic_
challenges/html/adc-04.asp&gt;

11.  South Australian Government, Fact Sheets on Older Australians, Health &amp; Mortality, Department of 
Human Services, Adelaide, viewed 18 September 2007, &lt;http://www.cas.flinders.edu.au/sanra/
FactSheets/fact16.pdf&gt;

12.  Australian Government, Chronic Diseases and Associated Risk Factors in Australia 2006, Australian Institute 
of Health and Welfare, Canberra, viewed 18 September 2007, &lt;http://www.aihw.gov.au/publications/
index.cfm/title/10319&gt;

13.  Australian Government, Overview of Mental Health, Department of Health and Ageing, viewed 
18 September 2007, &lt;http://www.health.gov.au/internet/wcms/Publishing.nsf/Content/8E0E3BC67E396
2AFCA25712B0080235F/$File/nhpa1.pdf&gt;

14.  Parliament of New South Wales, Term of Reference, NSW Health, viewed 18 September 2007, 
&lt;http://www.parliament.nsw.gov.au/prod/parlment/Committee.nsf/0/7909bd5e019e335fca256b3b001
f05fc/$FILE/NSWHealth%20Chapter%207.PDF&gt;

15.  Australian Institute of Health &amp; Welfare, Fall-related hospitalisations among older people, AIHW Welfare, 
Canberra, 2007, retrieved 18 September 2007, &lt;http://www.nisu.flinders.edu.au/pubs/reports/2007/
injcat97.pdf&gt;

16.  Australian Institute of Health &amp; Welfare, Population Health, Australian Institute of Health and Welfare, 
retrieved 18 September 2007, &lt;http://www.aihw.gov.au/publications/aus/ah02/ah02 c04.pdf&gt;



page 168 South Australia: Our Health and Health Services

chapter 9

9  Aboriginal people

In this chapter

Aboriginal population and distribution &gt;

Life expectancy and causes of death &gt;

Burden of disease &gt;

Birthing outcomes &gt;

Chronic disease &gt;

Selected hospitalisations - environmental health &gt;

Risk factors &gt;

Mental health &gt;

Oral health &gt;

Health service access and equity &gt;

Services and initiatives &gt;

Summary

  Life expectancy for South Australian and Western Australian Aboriginal people (1996 2001) as a combined  &gt;
group was 58.5 years for males and 67.2 for females.

 The median age at death for Aboriginal males in 2005 was 42.4 years and for Aboriginal females,   &gt;
47.5 years.

 External causes of death such as transport accidents, intentional self harm and assault accounted for   &gt;
23.9 per cent of South Australian Aboriginal deaths in 2005.

 The leading causes of premature mortality for Aboriginal South Australians between 2001 2003 (in order   &gt;
of magnitude) were ischaemic heart disease, road traffic accidents, suicide and self inflicted injuries,  
and Type 2 diabetes.

 Birthing outcomes for Aboriginal South Australians in 2006 have reached six-year-low figures. The infant  &gt;
mortality rate was 9.0 per 1 000 births (5 deaths) and the proportion of low birth weight babies (less than  
2 500 grams) was 14.3 per cent.

 The crude hospitalisation rate for diabetes, renal disease and mental health conditions for Aboriginal   &gt;
South Australians in 2006 07 was 3.3 times higher, 8.0 times higher, and 3.5 times higher respectively than 
for other South Australians.

 Survey data in 2004 05 show that 56 per cent of Aboriginal South Australians were current daily smokers,  &gt;
and 64 per cent of Aboriginal South Australians were overweight or obese.

 South Australian Aboriginal children (4 16 years-old) have higher rates of dental decay, missing teeth, filled  &gt;
teeth and unhealthy gums than do other South Australian children.



page 169South Australia: Our Health and Health Services

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Introduction

Aboriginal cultural groupings within South Australia are defined by a diverse number of distinct language 
groups, numbering over 30, related to roughly defined regions of the state. The Aboriginal people of  
South Australia are a heterogeneous group with many unique and distinct cultural differences among them.

Aboriginal people live in large cities, small country towns and in remote areas of South Australia, from the 
coast to the arid lands of central Australia. The South Australian Aboriginal population also demonstrates 
diversity in its connection with traditional ways of life and culture.

The unacceptable standard of health and level of disadvantage for Aboriginal people in Australia have been 
described in numerous national reports and other publications, as instanced by the Generational Health 
Review, Better Choices Better Health, in 2003.1

Aboriginal people in South Australia experience poorer health and greater exposure to risk factors than do 
other South Australians.

Many South Australian Aboriginal people live in unsatisfactory environmental conditions, and in clear 
social and economic disadvantage. Socioeconomic factors such as education, employment and housing are 
intimately linked to health status.

Evidence of health improvements in recent times has been experienced by Aboriginal people. The gap 
between the health status of Aboriginal and other Australians, however, has widened because improvements 
have occurred at a faster rate for the non Aboriginal population.2

Aboriginal people traditionally embrace an holistic approach to their wellbeing   one that includes physical, 
psychological, social, emotional and cultural dimensions, the spiritual connection with their land, their affinity 
with the sea, and the interconnection of spiritual beliefs with family and clan, mind, body and spirit.  
Family relationships, obligations and ceremonies are central to Aboriginal life.

For the purposes of this report,  Aboriginal  is used to identify First Nation Australians, and where data cover 
both groups, is inclusive of Aboriginal and Torres Strait Islander people.



page 170 South Australia: Our Health and Health Services

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9.1  Aboriginal population and distribution

The estimated resident Aboriginal population of South Australia, based on the 2006 experimental Estimated 
Residential Population, is 26 044, being 1.7 per cent of the total South Australian population and 5.0 per cent 
of the total Aboriginal population in Australia.3

The Aboriginal population is younger than the rest of the community, with 36.1 per cent of the population 
being under 15 years of age and 56.0 per cent being under 25 years of age compared to the non-Aboriginal 
population with approximately 18.1 per cent being under 15 years of age and 31.5 per cent being under  
the age of 25 (Graph 9.1.1).

The highest numbers of Aboriginal people are aged 5 9 years. The number of Aboriginal people within each 
age group decreases, as the population gets older, whereas the non-Aboriginal population peaks in the 45 49 
age group, and then decreases.

The Aboriginal population in South Australia aged 65+ years is 3.5 per cent, compared to 15.3 per cent in the 
non-Aboriginal population. There also is a substantial drop in the number of Aboriginal people aged between 
20 24 and 25 29 years, reflecting a relatively high mortality rate among young adults.

The estimated resident Aboriginal population in South Australia between census periods has grown by  
2.0 per cent from 25 544 in 2001 to 26 044 in 2006. The non-Aboriginal population growth in South 
Australia over the same period was 3.8 per cent.

Aboriginal

Per cent

Non-Aboriginal

80 84

Per cent

-8 -6 -4 -2 0 0 2 4 6 8

0 4

5 9

10 14

15 19

20 24

25 29

30 34

35 39

40 44

45 49

50 54

55 59

60 64

65 69

70 74

75 79

85+ years

Source: Australian Bureau of Statistics (ABS), Australian Demographic Statistics 2007. 

Females

Males

Graph 9.1.1  South Australian estimated resident population distribution by age, 

       gender and Aboriginal status, 30 June 2006



page 171South Australia: Our Health and Health Services

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The 2006 population estimate for South Australia shows the proportion of males and females in both  
the state s Aboriginal and non-Aboriginal population to be 49 per cent and 51 per cent, respectively.

Census data from 2001 provide the most recent analysis on the South Australian population distribution  
by remoteness (Graph 9.1.2). Over half of the Aboriginal population resides outside the metropolitan areas  
of South Australia, compared with fewer than 30 per cent of other South Australians.

A stark difference is observed in the very remote areas of South Australia where 17.3 per cent of all  
South Australian Aboriginal people live, as distinct from only 0.7 per cent of all non-Aboriginal people.  
The very remote region of South Australia includes the Anangu Pitjantjatjara Yankunytjatjara (APY) Lands  
with an estimated resident population of 2 149.4 This number represents almost half of the very remote  
South Australian Aboriginal population.

0

10

20

30

40

50

60

70

80

Adelaide

Year

Pe
r 

ce
nt

Inner regional Outer regional Remote Very remote

Aboriginal

Non-Aboriginal

Source: Australian Bureau of Statistics (ABS), Census 2001.

Graph 9.1.2  South Australian estimated population distribution by remoteness, 2001



page 172 South Australia: Our Health and Health Services

chapter 9

9.2  Life expectancy and causes of death

Life expectancy for Aboriginal people in Australia is typically much less than that of the total population  
figure, indicating that mortality rates are higher and inferring that overall health status is lower than the rest 
of the population.

Graph 9.2.1 illustrates the latest available life expectancy information for Aboriginal South Australians.

The life expectancy gap within South Australia between Aboriginal males and other males is 18.5 years.  
The life expectancy gap is 15.3 years for females. The chances of an Aboriginal South Australian living to  
65 years of age   based on these figures   is approximately 25 per cent. This information is based on figures 
from the 2001 Census and may not reflect the life expectancy experienced currently.

Comparison with the life expectancy of Aboriginal people from other countries shows that the gap between 
Aboriginal people and non-Aboriginal people is much lower there than in Australia (New Zealand   male  
8 years, female 9 years; Canada   male: 7 years, female 5 years).2

More recent information on the mortality of Aboriginal South Australian can be gained from a review of the 
median age at death and numbers of deaths reported. Most recent trends show a lowering of the median 
age at death for both Aboriginal males and females, both reaching six-year-lows of 42.4 and 47.5 years 
respectively, for 2005 (Graph 9.2.2)5.This observation is accompanied by a sustained trend of increasing 
median age at death for non-Aboriginal South Australians.

 South Australia/
Western Australia

Aboriginal, 1996 2001

 South Australia total
1999 2001

Total Australia,
1996 2001

0

10

20

30

40

50

60

70

80

90

100

Y
ea

rs

Male

Female

Note:  Life expectancy calculations group the South Australia and Western Australia Aboriginal data together 
 to improve data quality.   
Source: Australian Bureau of Statistics (ABS), Deaths 2001 and 2005.

Note:  Life expectancy calculations group the South Australia and Western Australia Aboriginal data together 
 to improve data quality.   
Source: Australian Bureau of Statistics (ABS), Deaths 2001 and 2005.

Graph 9.2.1  Life expectancy comparisons South Australia/Western Australia, 1996 2001

       (see section 9.11 for comments) 



page 173South Australia: Our Health and Health Services

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The underlying causes of death for Aboriginal South Australians in 2005 are described in Table 9.2.1. 
The leading cause of death for both Aboriginal males and females is diseases of the circulatory system, 
representing 25.4 per cent of deaths compared to 36.3 per cent for other South Australians. Malignant 
neoplasms accounted for 12.0 per cent of South Australian Aboriginal deaths compared to 28.1 per cent 
of deaths in the remaining South Australian population. Malignant neoplasms as a proportion of Aboriginal 
female deaths accounted for 18.4 per cent of deaths.6

Year

2000 2001 2002 2003 2004 2005

30

40

50

60

70

80

90

A
g

e
Graph 9.2.2  Median age of death, South Australia, 2000 2005 

Aboriginal males

Aboriginal female

Non-Aboriginal males

Non-Aboriginal females

Source: Australian Bureau of Statistics (ABS), Deaths 2005.



page 174 South Australia: Our Health and Health Services

chapter 9

External causes of death represented 23.9 per cent of the 2005 deaths for Aboriginal South Australians, 
compared to only 5.6 per cent for other South Australians. Intentional self-harm contributed a major 
proportion of deaths due to external causes; 12 per cent of all South Australian Aboriginal deaths and 
representing 15.0 per cent of Aboriginal male deaths. Transport accidents represented 4.2 per cent of 
Aboriginal deaths, over three times the non-Aboriginal proportion.

Table 9.2.1  Underlying causes of death for Aboriginal South Australians, 2005

    Number of deaths
  

    Total Aboriginal Other South
      deaths Australian deaths
 Males Females Persons (per cent) (per cent)  

Medical causes 

Malignant neoplasms 8 9 17 12.0 28.1

Type 2 diabetes 4 6 10 7.0 2.6

Mental and behavioural disorders - - 3 2.1 3.3

Diseases of the circulatory system 25 11 36 25.4 36.3

Diseases of the respiratory system 9 5 14 9.9 9.2

Diseases of the digestive system - - 7 4.9 3.5

Perinatal conditions - - 1 0.7 0.6

All other medical conditions 13 7 20 14.1 10.8

External causes 

Transport accidents - - 6 4.2 1.3

Intentional self-harm 14 3 17 12.0 1.7

Assault - - 2 1.4 0.2

Other external causes - - 9 6.3 2.4

Total 93 49 142 100.0 100.0

Source: Australian Bureau of Statistics (ABS), Causes of death 2005.

 



page 175South Australia: Our Health and Health Services

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9.3  Burden of disease

Studies of burden of disease in specific populations categorise the impact of illness and death.  
The methodology requires analysis of the effects of disease, disability and death at the individual level  
and aggregation to present an overall picture. 

The leading causes of premature death for Aboriginal South Australians for the period 2001 2003  
are ranked in the table below. The table allows comparison of the age and sex adjusted rate of YLL with  
the non-Aboriginal population. The difference in the total YLL rate between Aboriginal (151.7) and  
non Aboriginal South Australians (65.8) reflects the life expectancy gap.

Table 9.3.1  Leading causes of premature mortality (YLL), three-year average, 2001 2003

 Aboriginal South Australians Other South Australians

  Crude rate Adjusted rate  Crude rate Adjusted rate 
Condition Rank per 1 000 *^ per 1 000# Rank per 1 000 per 1 000

Ischaemic heart disease 1 14.2 30.2 1 13.3 11.7

Road traffic accidents 2 9.0 10.5 8 2.0 2.1

Suicide and self-inflicted injuries 3 6.6 6.3 5 2.7 2.7

Type 2 diabetes 4 4.9 11.4 10 1.4 1.2

Cirrhosis of the liver 5 3.6 6.8 17 1.1 1.0

Stroke 6 3.0 7.1 2 5.0 4.4

Homicide and violence 7 2.5 2.8 47 0.3 0.3

Septicaemia 8 2.4 2.6 36 0.5 0.4

Pneumonia 9 2.3 4.3 9 2.0 1.7

Chronic obstructive pulmonary disease 10 2.2 6.0 7 2.5 2.2

Other chronic respiratory diseases 11 1.8 3.9 13 1.3 1.1

Lung cancer 12 1.8 5.0 3 4.4 3.9

Type 1 diabetes 13 1.7 3.5 54 0.3 0.2

Epilepsy 14 1.5 1.8 45 0.3 0.3

Inflammatory heart disease 15 1.5 2.2 25 0.7 0.7

Low birth weight 16 1.3 0.7 44 0.3 0.3

Heroin dependence and harmful use 17 1.3 1.4 37 0.4 0.4

Other endocrine and metabolic 18 1.2 2.1 23 0.8 0.8

Nephritis and nephrosis 19 1.0 1.6 22 0.9 0.8

Rheumatic heart disease 20 1.0 1.0 72 0.1 0.1

All others - 22.8 40.6 -  32.5 29.5

Total  - 87.4 151.7  - 72.6 65.8

Note: *High Series Projections of Aboriginal population by age by year for South Australia from ABS Cat 3238.0, 0 4, 
 then 10-year age groups to 55+ years.
 ^ 1999 &amp; 2000 population figures not available within ABS Cat 3238.0. Rate calculations use 2001 estimates for 
 1999 2001 period, then 2001 and 2002 for 2000 2002 and 2001 2003 periods.
 #Age and sex adjusted to Australia 2001 population.
Source: SA Health.

 



page 176 South Australia: Our Health and Health Services

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Comparison of the rates of premature mortality indicate that ischaemic heart disease is the leading  
cause of death in both population groups, with the Aboriginal rate (30.2 YLL/1 000) being more than  
two-and-a-half times higher than that for the non-Aboriginal population (11.7 YLL/1 000). Years life lost  
to road traffic accidents for South Australian Aboriginal people occur at five times the rate of other  
South Australians. Further analysis of the pattern of rankings in each population group clearly indicates a 
different profile of causes of premature death.

The total rate of YLL (Years of life lost - YLL) for Aboriginal South Australians (over the three periods of 
analysis, 1999 2001, 2000 2002 and 2001 2003) has fallen from 168.7 YLL per 1 000 to 151.7 YLL  
per 1 000. It is not clear whether the improvement in the YLL rate is a sustainable trend. The ranking of 
suicide and self-inflicted injuries, cirrhosis of the liver, and homicide and violence have increased over the three 
time periods, while the category of heroin dependence and harmful use has shown a decrease in ranking.

Further analysis of the burden of disease data demonstrates a relationship between place of residence  
and YLL for Aboriginal South Australians (Graph 9.3.1). Much higher rates of YLL per 1 000 (1.4 times higher) 
are experienced by country-based Aboriginal people than by those living in metropolitan areas. This location 
phenomenon is not evident for non Aboriginal South Australians demonstrating almost identical rates.  
Some decrease is evident in the difference between the Aboriginal and non Aboriginal rate of YLL over  
the time period shown below, but it is not clear if this is sustainable.

50

100

150

200

A
dj

us
te

d 
Y

LL
 r

at
e 

pe
r 

1 
00

0

1999 2001 2000 2002 2001 2003

Period

Graph 9.3.1  Premature mortality (Years of life lost-YLL) by Aboriginality and area, 

       South Australia, three-year annual averages 

Aboriginal   country

Non-Aboriginal   country

Aboriginal   metropolitan

Non-Aboriginal   metropolitan

Source: SA Health.



page 177South Australia: Our Health and Health Services

chapter 9

9.4  Birthing outcomes

Aboriginal women accounted for 2.7 per cent (487) of the confinements in South Australia in 2005.7  
This figure has varied slightly over the previous three years, ranging between 2.5 per cent to 3.0 per cent.

Aboriginal teenage women account for a higher proportion of confinements than do non-Aboriginal teenage 
women, typically around 20 per cent (21.5 per cent in 2005), compared to around 5 per cent. High rates  
of teenage pregnancy are associated with poorer birthing outcomes.8

Benefits of antenatal visits during pregnancy are achieved through education and health monitoring.  
Low attendance records at antenatal visits for South Australian Aboriginal women is a consistent finding with 
41 per cent having had fewer than seven antenatal visits during pregnancy in 2005 compared with 7 per cent 
of non-Aboriginal women.7 These figures have been very consistent over the previous three years.

Preliminary results from the 2006 birthing data on perinatal mortality, infant mortality and low birth weight 
show improved pregnancy outcomes across all indicators9; the 2006 data have yielded the best results for the 
period 2001 2006, with lowest figures for all three indicators (Graphs 9.4.1, 9.4.2 and 9.4.3). The long-term 
patterns have shown significant variability and sustained outcomes are required from future reporting periods, 
although these results are encouraging.

The most recent perinatal mortality rate for South Australia is for 2006, and shows 14.3 deaths per 1 000  
(8 deaths), half the previous year s rate (Graph 9.4.1).

0

5

10

15

20

25

30

35

40

Ra
te

 p
er

 1
 0

00
 b

ir
th

s

Year

2001 2002 2003 2004 2005 2006

Graph 9.4.1  Perinatal mortality, South Australia, 2001 2006 

Aboriginal population

Total South Australian population

Source: SA Health, Pregnancy Outcome Unit, Epidemiology Branch. 



page 178 South Australia: Our Health and Health Services

chapter 9

The infant mortality rate for 2006 for South Australian Aboriginal births was 9.0 deaths per 1 000 (5 deaths), 
down from 14.6 in 2005 (7 deaths), closing the gap on the overall population result (Graph 9.4.2).

The percentage of low birth weight Aboriginal babies dropped from 19.3 per cent to 14.3 per cent following  
a fairly constant trend between 2001 2005 and closing the gap on the total South Australian population 
result (Graph 9.4.3).

0

5

10

15

20

25

30

Ra
te

 p
er

 1
 0

00
 li

ve
 b

ir
th

s

Year

2001 2002 2003 2004 2005 2006

Graph 9.4.2  Infant mortality, South Australia, 2001 2006 

Aboriginal population

Total South Australian population

Source: SA Health, Pregnancy Outcome Unit, Epidemiology Branch. 

0

5

10

15

20

25

Pe
r 

ce
nt

Year

2001 2002 2003 2004 2005 2006

Graph 9.4.3  Low birthweight babies (&lt;2500 grams), South Australia, 2001 2006 

Aboriginal population

Total South Australian population

Source: SA Health, Pregnancy Outcome Unit, Epidemiology Branch. 



page 179South Australia: Our Health and Health Services

chapter 9

Smoking during pregnancy is a recognised risk factor for poor birthing outcomes and is associated  
strongly with low birth weight babies.10 No significant improvements in smoking rates during pregnancy for 
Aboriginal women were noted in South Australia over the time period 2001 2006 (Graph 9.4.4), while a 
definite improvement is noted for the total South Australian population for the same time period. Just over  
55 per cent (55.7) of South Australian Aboriginal women were smoking in 2006 at the first antenatal visit  
and 48.4 per cent were smoking during the second half of their pregnancy.

15

25

35

45

55

65

75

Pe
r 

ce
nt

Year

2001 2002 2003 2004 2005 2006

Graph 9.4.4  Smoking during pregnancy, South Australia, 2001 2006 

1st antenatal visit, Aboriginal 2nd half of pregnancy, Aboriginal
1st antenatal visit,
total South Australian population

2nd half of pregnancy,
total South Australian population

Source: SA Health, Pregnancy Outcome Unit, Epidemiology Branch. 



page 180 South Australia: Our Health and Health Services

chapter 9

The latest national comparisons show that of the five jurisdictions reported (New South Wales, Queensland, 
South Australia, Western Australia, and the Northern Territory), for the period 2003 2005, South Australia 
had the lowest reported infant mortality rate of 7.7 infant deaths per 1 000 (Table 9.4.1).5

The latest national figures for birth weight indicate that South Australian Aboriginal women have the second 
highest proportion of babies weighing less than 2 500 grams at 17.6 per cent (Table 9.4.2).

It is expected that in future reported timeframes the national data will mirror the improvements seen in 
the South Australian data sets, as the national data are not as current as those belonging to the Pregnancy 
Outcomes Unit, SA Health.

Table 9.4.1  National infant mortality 2003 2005 (three-year average), infant deaths per 1 000

 South New Queensland Western Northern 
 Australia South  Australia Territory
  Wales

Aboriginal persons 7.7 8.4 10.9 12.8 15.6

Total persons 4.0 4.7 5.0 4.2 9.5

Source: Australian Bureau of Statistics (ABS), Deaths 2005.
 

Table 9.4.2  National births by low birth weight, percentage, 2004

 South New Queensland Western Victoria Tasmania Australian Northern 
 Australia South  Australia   Capital Territory
  Wales     Territory

Aboriginal persons 17.6 12.3 11.5 14.4 16.2 na 19.2 14.0

Total persons 6.6 5.9 6.7 6.6 6.3 7.1 7.9 9.3

Source: Australia s mothers and babies 2004.
 



page 181South Australia: Our Health and Health Services

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9.5  Chronic disease

Chronic diseases generally develop over long periods of time as the result of numerous possible risk factors 
including smoking, physical inactivity, obesity, poor diet, excessive alcohol use, diabetes (which, while a 
chronic disease itself also is a risk factor for the progression of chronic disease), and environmental and 
socio economic factors 11. Chronic diseases are major causes of morbidity and mortality for Aboriginal people 
in South Australia and Australia.

National information from the Australian Institute of Health and Welfare (AIHW) demonstrate higher rates  
of hospitalisations for chronic conditions for Aboriginal people than for other Australians.12 Table 9.5.1 
describes the age standardised hospitalisation rates for various chronic disease for Aboriginal males and 
females, expressed as a ratio of the rates for their non Aboriginal counterparts. The hospitalisation rates were 
higher for Aboriginal male and females for all chronic diseases, except cancer. 

The table above shows that the greatest difference between Aboriginal and non-Aboriginal hospitalisation 
rates was for end stage renal disease: 10.9 times higher for Aboriginal males and 18.8 times higher for 
Aboriginal females than for their non-Aboriginal counterparts. The Aboriginal rate of diabetes is 4.2 times 
higher for males and 6.7 times higher for females. The Aboriginal rate of chronic obstructive pulmonary 
disease is 4.9 times higher for males and 5.7 times higher for females.

Hospitalisations for cardiovascular disease have shown a decreasing trend for Aboriginal South Australians,  
to a level of 15.2 per 1 000 in 2006 07.

Table 9.5.1  Age standardised hospitalisation rate ratio, Aboriginal to non-Aboriginal, South Australian,

      Western Australian, Queensland and Northern Territory public hospitals, by gender, 2004 05

Condition Male Female

Cancer   0.6 0.6

Lung cancer 1.6 1.8

Cervical cancer na 3.6

Mental and behavioural disorders  2.1 1.4

Circulatory diseases  1.6 1.9

Diabetes  4.2 6.7

End stage renal diseases  10.9 18.8

Chronic obstructive pulmonary diseases  4.9 5.7

Source: Australian Institute of Health and Welfare (AIHW), National Hospital Morbidity Database, 
 OID 2007 tables 3A.2.11, 3A.2.15.12

 



page 182 South Australia: Our Health and Health Services

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Hospitalisations for chronic obstructive pulmonary disease have remained relatively static for Aboriginal  
South Australians over the last four financial years, but they clearly are over double the crude rate for  
non-Aboriginal people (Graph 9.5.2).

0

2

4

6

8

10

12

14

16

18

20

2003 04 2004 05 2005 06 2006 07

Year

Ra
te

 p
er

 1
 0

00

Aboriginal

Non-Aboriginal

Graph 9.5.1  South Australian hospitalisation rates for cardiovascular disease, 2003 04 to 2006 07   

Note:  Non-age-standardised hospitalisation rates. 
Source: SA Health, Integrated South Australian Activity Collection (ISAAC). 

0

1

2

3

4

5

6

7

2003 04 2004 05 2005 06 2006 07

Year

R
at

e 
p

er
 1

 0
00

Aboriginal

Non-Aboriginal

Graph 9.5.2  South Australian hospitalisation rates for chronic obstructive pulmonary disease,

       2003 04 to 2006 07   

Note:  Non-age-standardised hospitalisation rates. 
Source: SA Health, Integrated South Australian Activity Collection (ISAAC). 



page 183South Australia: Our Health and Health Services

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South Australian Aboriginal hospitalisations for diabetes and renal disease both have shown increasing trends 
over the four time periods (Graphs 9.5.3 and 9.5.4). The crude hospitalisation rate for diabetes in 2006 07  
is 3.3 times higher for Aboriginal people (8.7 per 1 000) compared to non-Aboriginal South Australians  
(2.6 per 1 000). The crude hospitalisation rate for renal disease in 2006 07 is eight times higher for Aboriginal 
people (234.7 per 1 000) compared with non-Aboriginal South Australians (29.5 per 1 000).

0

2

4

6

8

10

2003 04 2004 05 2005 06 2006 07

Year

R
at

e 
p

er
 1

 0
00

Aboriginal

Non-Aboriginal

Graph 9.5.3  South Australian hospitalisation rates for diabetes, 2003 04 to 2006 07 

Note:  Non-age-standardised hospitalisation rates. 
Source: SA Health, Integrated South Australian Activity Collection (ISAAC). 

0

50

100

150

200

250

2003 04 2004 05 2005 06 2006 07

Year

R
at

e 
p

er
 1

 0
00

Aboriginal Non-Aboriginal

Graph 9.5.4  South Australian hospitalisation rates for renal disease, 2003 04 to 2006 07 

Note:  Non-age-standardised hospitalisation rates. 
Source: SA Health, Integrated South Australian Activity Collection (ISAAC). 



page 184 South Australia: Our Health and Health Services

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9.6  Selected hospitalisations   environmental health

Certain diseases are reflective of the status of environmental health for Aboriginal communities.  
These environmentally sensitive diseases are influenced by such factors as the quality of sanitation, water, 
housing and food safety. Hospitalisations reflect the more serious cases but they do not show the overall 
incidence of disease. Hospitalisations are influenced by the ability to get access to hospital services and also 
can reflect the capacity of primary health services or outpatient departments to treat certain conditions.

It can be seen from Table 9.6.1 that all hospitalisation rates for diseases associated with poor environmental 
health are higher for Aboriginal South Australians than they are for others. These hospitalisation rates 
demonstrate that Aboriginal people generally are at least twice as likely to be admitted to hospital for 
environmentally associated diseases than are non-Aboriginal South Australians.

Table 9.6.1  Hospitalisation crude rates per 1 000, selected conditions, 2005 06 and 2006 07

 2005 06 2006 07

 Aboriginal Other Ratio Aboriginal Other Ratio

Asthma 5.0 2.3 2.2 4.3 2.1 2.0

Bacterial disease 1.3 0.6 2.2 1.0 0.6 1.7

Influenzae and pneumonia 6.2 2.7 2.3 5.2 2.4 2.2

Intestinal infection disease 3.6 1.7 2.1 3.8 1.9 2.0

Otitis media 2.7 1.0 2.7 2.2 1.0 2.2

Note: Non-age-standardised hospitalisation rates.
Source: SA Health, Integrated South Australian Activity Collection (ISAAC). 

0

2

4

6

8

R
at

e 
p

er
 1

 0
00

Adelaide Inner regional Outer regional Remote Very remote

Location

Aboriginal Non-Aboriginal

Graph 9.6.1  South Australian hospitalisation rates for intestinal infectious disease, by remoteness, 

       three-year average, 2004 05 to 2006 07

Note: Non-age-standardised hospitalisation rates.
Source: SA Health, Integrated South Australian Activity Collection (ISAAC). 



page 185South Australia: Our Health and Health Services

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Graphs 9.6.1 and 9.6.2 show the proportion of hospitalisations for intestinal infectious diseases, and influenza 
and pneumonia, using a three-year average. Admission to hospital for these conditions is more likely in  
outer regional and remote areas of South Australia. This finding strongly suggests that standards of 
environmental health for rural and remote Aboriginal communities are lower than those found in the major 
cities of South Australia. It also is noted that hospitalisations for influenza and pneumonia also are indicative 
of the extent and effectiveness of vaccination programs.

0

2

4

6

8

10

R
at

e 
p

er
 1

 0
00

Major cities Inner regional Outer regional Remote Very remote

Location

Aboriginal Non-Aboriginal

Graph 9.6.2  South Australian hospitalisation rates for influenza and pneumonia, 

      by remoteness, 2004 05 to 2006 07

Note:  Non-age-standardised hospitalisation rates. 
Source: SA Health, Integrated South Australian Activity Collection (ISAAC). 



page 186 South Australia: Our Health and Health Services

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9.7  Risk factors

A strong association exists between the effects of health risk factors, and the onset and prognosis of a variety 
of chronic diseases. Many chronic diseases share common risk factors and the combination of multiple risk 
factors is likely to hasten development of disease. Health risk factors are associated with many aspects of 
socioeconomic status. It is well established that Aboriginal people experience disadvantage across numerous 
social and economic parameters.12

The health risk factors discussed here are behavioural in nature; however, other risk factors are recognised, 
such as environmental and socioeconomic influences. It is important to understand the effect of health risk 
factors, since the diseases that result are largely preventable.

9.7.1  Smoking 
Smoking is associated with numerous chronic diseases including cardiovascular, chronic lung disease  
and cancer. Smoking during pregnancy has an adverse effect on foetal development. Other people also 
experience health effects from passive smoking, which can contribute to the onset of asthma and other 
chronic lung diseases.

Fifty-six per cent of Aboriginal people in South Australia in 2004 05 were current smokers, compared to 
52 per cent of the total Australian Aboriginal population and 23 per cent of the non-Aboriginal Australian 
population (Table 9.7.1).13, 14

Smoking was less prevalent in remote areas of South Australia. A more detailed breakdown of the data by 
gender, (data not shown in Table 9.7.1), indicates a greater percentage of South Australian Aboriginal males 
(59.5 per cent) smoked than did Aboriginal women (52.8 per cent). This difference is more substantial in 
remote South Australia where 61.6 per cent of Aboriginal males smoked compared to 46.8 per cent  
of women.13

Table 9.7.1  Smoking status, Aboriginal South Australia by location, Australia by Aboriginal status, 2004 05

  South Australia   Aboriginal   Australia

 Remote Non-remote Total Aboriginal  Non-Aboriginal 
 per cent   per cent per cent per cent  per cent

Smoker status     

Current smoker 53 57 56 52  23

Ex-smoker 16 17 17 20  30

Never smoked 31 26 27 28  47

Note: Smoking status  not known  was excluded.
Source: Australian Bureau of Statisitcs (ABS), National Aboriginal and Torres Strait Islander Health Survey, 
 2004 05 (NATSIHS, 2004 05) and ABS National Health Survey 2004 05 (NHS, 2004 05).
 



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9.7.2 Overweight and obesity

Overweight and obesity are risk factors for various chronic diseases, including renal disease, Type 2  
diabetes and cardiovascular disease. Overweight and obesity also can be associated with poor self image  
and psychological problems.

The South Australian Aboriginal population reported the highest proportion of overweight or obese people 
(64 per cent) of all Aboriginal people from other Australian jurisdictions (Table 9.7.2).13

The percentages of overweight or obese people are higher for Aboriginal South Australians across all age 
groups than for non-Aboriginal South Australians (Graph 9.7.1). Most striking is the difference between the 
Aboriginal and non-Aboriginal 15 24 years age group, recording levels of overweight or obese of 40 per cent 
and 25 per cent respectively.

Table 9.7.2  Aboriginal overweight and obesity, by state and territory, 2004 05

 State/Territory Australia

 South Victoria New Queensland Western Tasmania Northern Australian Total
 Australia  South  Australia  Territory Capital
   Wales     Territory

Overweight/
obese
per cent 64 48 59 58 59 54 50 58   57

Note: 15 years and over. Excluding body mass unknown. Measured using Body Mass Index.
Source: Australian Bureau of Statisitcs (ABS), NATSIHS, 2004 05
 

0

10

20

30

40

50

60

70

80

90

15 24 years 25 44 years 45+ years

Year

Pe
r 

ce
n

t

Aboriginal Non-Aboriginal

Graph 9.7.1  Overweight or obese, by Aboriginality, in South Australia, 2004 05 

Source: Australian Bureau of Statisitcs (ABS), NATSIHS, 2004 05. 



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9.7.3  Alcohol consumption
Excessive alcohol consumption is associated with a number of adverse health and social consequences.  
It is a risk factor for liver disease, pancreatitis, Type 2 diabetes and some types of cancer.

Alcohol consumption is associated with traffic accidents, injury and has psychological consequences. The social 
ramifications of excessive alcohol consumption can include family violence and breakdown of relationships.10

Aboriginal people of South Australia and across Australia are less likely to consume alcohol than are  
non-Aboriginal people. Close to 44 per cent of Aboriginal South Australians did not consume alcohol in the 
week prior to the National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) 2004 05, compared to 
27 per cent of non-Aboriginal Australians (Table 9.7.3). Those Aboriginal South Australians who did drink 
were more likely to consume alcohol at risky or high-risk levels. Seventeen per cent of the South Australian 
Aboriginal population surveyed reported risky to high-risk drinking in the week prior to interview. Aboriginal 
South Australians living in non-remote locations were more likely to consume alcohol at risky or high-risk 
levels (18.6 per cent) than were remotely located Aboriginal people (11.9 per cent).

Table 9.7.3  Alcohol risk, as percentage, Aboriginal South Australia by location, 

      Australia by Aboriginal status, 2004 05

  South Australia   Aboriginal Australia

 Remote Non-remote Total Aboriginal Aboriginal Non-Aboriginal
   South Australia

Alcohol risk

Low-risk 17.0 32.2 28.7 29.7 49.2

Risky/high-risk 11.9 18.6 17.0 15.3 13.5

Did not drink 51.9 41.5 43.9 42 27.3

Never consumed alcohol 18.2 7.1 9.7 11.4 8.8

Note: Risk level based on the Australian Alcohol guidelines, 2001. Based on consumption in week prior to survey.
Source: Australian Bureau of Statisitcs (ABS), NATSIHS, 2004 05 and ABS NHS, 2004 05.
 



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9.8  Mental health

Mental health for Aboriginal people is a product of social and emotional wellbeing that is related to individual, 
family and community relationships. Socioeconomic disadvantage contributes to reduced states of physical 
and emotional wellbeing. High rates of suicide, intentional self-harm, violence and incarceration for Aboriginal 
people are related directly to the emotional wellbeing of individuals, which in turn contributes to further 
emotional trauma.15

Consequences of excessive consumption of alcohol and substance use contribute to social breakdown and 
contact with the criminal justice system, as well as having a direct effect on mental health.

A modification of the Kessler Psychological Distress Scale 10 (K10) of non-specific psychological distress was 
used, for the purposes of the National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) 2004 05. 
The K10 yields a measure of psychological distress based on questions about negative emotional states 
experienced in the four-weeks prior to interview. Five questions (K5) were selected for the NATSIHS 2004 05 
regarding feeling nervous, without hope, restless or jumpy, everything was an effort, and, so sad that nothing 
could cheer them up.

Results from the NATSIHS 2004 05 showed that 30.2 per cent of South Australian Aboriginal people 
experienced high to very high distress levels, which was higher than the Australian Aboriginal average and 2.3 
times higher than the proportion (13.1 per cent) in the non-Aboriginal Australian sample (Table 9.8.1).12

Interstate comparison of hospitalisations for the principal diagnosis of a mental health-related condition 
(includes behavioural disorders due to alcohol or substance use) for the four jurisdictions (South Australia, 
Queensland, Western Australia and Northern Territory) 2002 2004 shows that South Australian Aboriginal 
people had the highest rate of 41.0 hospitalisations per 1 000 and 3.2 times the South Australian  
non-Aboriginal rate (Table 9.8.2).16

Analysis of South Australian hospitalisations for mental health-related conditions (includes behavioural 
disorders due to alcohol or substance use), over a four-year period, shows a constant rate of hospitalisation. 
The crude hospitalisation rate was 33.6 hospitalisations per 1 000 for South Australian Aboriginal people in 
2006 07   3.5 times higher than the non-Aboriginal rate (Graph 9.8.1).

Table 9.8.1  Psychological distress (K5), South Australia Aboriginal, Australia Aboriginal and non-Aboriginal

  South Australia Australian Australian

  Aboriginal Aboriginal non-Aboriginal
  per cent per cent per cent

Low/moderate distress level  67.1 71.3 86.8

High/very high distress level  30.2 27.2 13.1

Note: Includes refusals and persons with no score.
Source: Australian Bureau of Statisitcs (ABS), NATSIHS 2004 05, NHS Table 9A.4.1 9A.4.2 Overcoming Aboriginal Disadvantage: 
 Key Indicators 2007.
 

Table 9.8.2  Hospitalisations for the principal diagnosis of a mental health-related condition

 South Australia Queensland Western Australia Northern Territory

Aboriginal  41.0 20.0 32.7 9.0

Other  12.8 14.7 13.2 5.0

Note: Age standardised rate per 1 000.
Source: Aboriginal and Torres Strait Islander Health Performance Framework 2006: detailed analysis.
 



page 190 South Australia: Our Health and Health Services

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Analysis of mental health hospitalisations by remoteness shows an increasing rate with increasing remoteness 
for South Australian Aboriginal people, excluding the result for very remote South Australia (Graph 9.8.2). 
Hospitalisation of Aboriginal people in very remote regions is likely to be influenced by referral to the  
Northern Territory for people on the Anangu Pitjantjatjara Yankunytjatjara (APY) Lands as well as by lack  
of access resulting in avoidance of hospital care.

0

5

10

15

20

25

30

35

40

2003 04 2004 05 2005 06 2006 07

Year

R
at

e 
p

er
 1

 0
00

Aboriginal Other

Graph 9.8.1  South Australian hospitalisation rates for mental health conditions, 2003 04 to 2006 07 

Note: Non-age-standardised hospitalisation rates.  
Source: SA Health, Integrated South Australian Activity Collection (ISAAC). 
 

0

10

20

30

40

50

60

Major Cities Inner regional Outer regional Remote Very remote

R
at

e 
p

er
1 

00
0

Aboriginal Other

Graph 9.8.2  South Australian hospitalisation rates for mental health conditions by remoteness, 

       three-year average, 2004 05 to 2006 07   

Note: Non-age-standardised hospitalisation rates.  
Source: SA Health, Integrated South Australian Activity Collection (ISAAC). 
 



page 191South Australia: Our Health and Health Services

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9.9  Oral health

Aboriginal people are more likely to have lost all their teeth, have gum disease, receive less caries treatment 
and more likely to have untreated dental disease.2

The National Survey of Adult Oral Health 2004 2006 reported disproportionately elevated rates of tooth loss, 
untreated decay and tooth wear among Aboriginal Australians. Oral examination results were consistent with 
the findings of Aboriginal people who self-reported poor oral health, more toothache and difficulty eating, 
due to dental problems.17

The dmft (sum of decayed, missing and filled primary teeth) and DMFT (sum of Decayed, Missing and Filled 
permanent (adult) teeth) indices commonly are used to measure oral health outcomes.

9.9.1 Children
Many Aboriginal children experience expensive destruction of their deciduous teeth especially in remote 
communities where treatment options are limited. Oral disease influences systemic health and the quality  
of life from childhood through to adulthood.21 It has been noted that the relatively poor oral health of 
Aboriginal children appears to begin early in life.18 Poor dental health is evident from the age of four-years-old 
for Aboriginal South Australians. Aboriginal children show poorer outcomes than other children across all oral 
health indicators.16

Comparisons possible with other jurisdictions in Australia indicate Aboriginal South Australian children  
have poorer oral health (DMFT scores) than Aboriginal children from New South Wales and similar results  
to Aboriginal children from the Northern Territory.16

Details on the mean number of decayed, missing or filled teeth in South Australia children are presented  
in Table 9.9.1, indicating higher rates of decay, missing and filled teeth.

Table 9.9.1  Mean number of decayed, missing or filled teeth, South Australian children, 2003

 Aboriginal Other Ratio

4 6 years-olds, primary teeth

decayed 2.23 0.91 2.4

missing  0.33 0.08 4

filled 1.1 0.58 1.9

dfmt 3.66 1.58 2.3

8 10 years-olds, permanent teeth

Decayed 0.48 0.19 2.5

Filled 0.31 0.25 1.2

DFMT 0.83 0.45 1.8

12 14 years-olds, permanent teeth

Decayed 0.94 0.41 2.3

Filled 0.86 0.65 1.3

DFMT 1.85 1.08 1.7

Source: Australian Institure of Health and Welfare (AIHW), Dental Statistics and Research Unit.
 



page 192 South Australia: Our Health and Health Services

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Data from the SA School Dental Service show that Aboriginal children have a lower percentage of healthy 
gums and a higher percentage of bleeding gums than do other children in the age groupings 6 7 and 14 15 
years of age.19

Aboriginal children living in the regional area of Port Augusta were compared with non-Aboriginal children 
living in the same region over a five-year period, between 2001 2006. Aboriginal children had 2.7 times  
the mean number of decayed primary and permanent teeth compared to their non-Aboriginal counterparts. 
The dmft for Aboriginal children was 1.6 times the mean of non-Aboriginal children. Aboriginal children aged 
under 10 had 1.9 times the mean dmft of other Australian children living in the area.20

The rates for hospital dental procedures for Aboriginal children were shown to increase with geographic 
remoteness, with procedures for extraction and restorative treatment in children aged below five,1.5 times 
greater than other Australian children.21

9.9.2 Adults
The latest national data on DMFT scores for Aboriginal adults comes from adults seeking public dental care 
in Australia, 2001 02.16 There is a consistent pattern, although little difference exists between Aboriginal and 
other Australians in the DMFT measure, for adult age groupings. Aboriginal people over the age of 25 years 
had more missing teeth than other Australians and, in all adult age groups, the mean number of decayed 
teeth was higher for Aboriginal people. The mean number of filled teeth was higher for non-Aboriginal people 
in all adult age groups, indicating a higher rate of treated dental disease.

Aboriginal adults in South Australia, who received dental services from public clinics, demonstrated less 
dental disease than did other public dental patients.19 Aboriginal South Australians in the age group 25 44 
years, who are receiving public dental services, have a lower DMFT score (8.7 teeth) compared to other public 
patients (12.9 teeth).

Aboriginal clients attending dental services provided by the Aboriginal Community Controlled Health 
Organisation, Nunkawarrin Yunti and South Australian Dental Service Community Clinics from February 2005 
to 2007, by contrast, reported far greater experience of dental decay and missing teeth compared to other 
cardholders in each category (graph 9.9.1). Other cardholders eligible for these services include refugees, 
other non-Australians and non-Aboriginal Australians.



page 193South Australia: Our Health and Health Services

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0

2

4

6

8

10

12

14

16

18

20

16
 2

4

25
 3

4

35
 4

4

45
 5

4

55
 6

4

16
 2

4

25
 3

4

35
 4

4

45
 5

4

55
 6

4

16
 2

4

25
 3

4

35
 4

4

45
 5

4

55
 6

4

16
 2

4

25
 3

4

35
 4

4

45
 5

4

55
 6

4

16
 2

4

25
 3

4

35
 4

4

45
 5

4

55
 6

4

M
ea

n
 D

M
FT

NY
Aboriginal

NY
refugee

CDS
Aboriginal

CDS
Non-Australian
(from overseas)

CDS
Non-Aboriginal

Years

Filled teethMissing teethDecayed teeth

Graph 9.9.1  Mean adult dentate DMFT, 16 64 year-olds, Nunkawarrin Yunti and South Australian 

      Dental Service CDS, 2005 2007  

Note:  NY = Nunkawarrin Yunti, CDS = Community Dental Service. DMFT: decayed, missing, filled teeth. 
Source: Nunkawarrin Yunti Aboriginal Community Controlled Health Organisation. 



page 194 South Australia: Our Health and Health Services

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9.10  Health service access and equity

It is important in assessing the health status of minority population groups to understand the relationship 
between fair and reasonable access to appropriate health services and overall health outcomes.

Access and equity issues for Aboriginal people are difficult to analyse and require a level of qualitative 
assessment through the use of a number of indirect measures. Physical location, levels of health expenditure 
and provision of culturally appropriate environments will all affect the uptake and use of health services.  
The willingness of Aboriginal people to use health services may be influenced by community control of the 
health service, gender and age characteristics of staff, and availability of Aboriginal staff.

9.10.1 Geography
South Australian discrete Aboriginal communities   of all Australian states and territories   are the most 
geographically isolated from health services. Around 45 per cent of South Australian Aboriginal communities 
are located 250 km or more from an Aboriginal primary health centre or hospital.22 Only 13 per cent of 
Aboriginal communities across Australia are located 250 km or more from an Aboriginal primary health  
care centre.

Twenty-six per cent of Aboriginal people (for the period 2004 05 in South Australia) went to an Aboriginal 
Medical Service if they had a problem with their health; 68 per cent reported going to a doctor.16. Table 9.10.1 
shows the ratio of doctor to Aboriginal Medical Service use for all of Australia, dependent on remoteness.  
The reliance of Aboriginal people on Aboriginal medical services is evident with increasing remoteness.

Table 9.10.1  Regular health care by remoteness, Aboriginal person, 2004 05, Australia

 Doctor Aboriginal medical service

Adelaide 80 15

Inner regional 80 11

Outer regional 67 26

Remote 34 45

Very remote 6 76

Total Australia 60 30

Source: 2004 05 NATSIHIS, ABS and AIHW 2 



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Analysis of the NATSIHS 2004 05 indicates that remoteness is a factor for Aboriginal people not going to  
a general practitioner over the previous 12 months, across all of Australia. Logistical reasons were cited  
for 44.9 per cent of Aboriginal people in a remote location as the reason for not using the services of a 
general practitioner in the last 12 months compared to only 21.5 per cent of people in non-remote settings  
(Table 9.10.2).

Table 9.10.2  Reasons for not going to the GP in the last 12 months, 18+ years, Aboriginal Australia

 Remote (per cent) Non-remote (per cent)

Cost 3.4 14.2

Personal reasons(a) 36.3 40.1

Logistical reasons(b) 44.9 21.5

Other reasons 22.5 27.9

Decided not to seek care 5.2 11.4

Note (a):  Personal reasons included too busy, discrimination, service not culturally appropriate, language problems, 
 dislikes services, afraid, embarrassed, or felt service would be inadequate.
Note (b):  Includes transport /distance, service not available, waiting time too long, or service not available at the time required.
Source: Australian Bureau of Statistics (ABS), 2004 05 NATSIHS (unpublished).12

 



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9.10.2 Discharge against medical advice
Aboriginal South Australians demonstrate different behavioural characteristics than other South Australians 
in response to contact with health services. Aboriginal people as health consumers are more likely to 
demonstrate compliance with treatment, continue to use health services and actively participate in their 
treatment if they are satisfied.

Discharge against medical advice provides indirect evidence of the extent to which hospital services are 
appropriate or not for the needs of Aboriginal people. Table 9.10.3 describes the proportion of hospital 
separations for which patients were discharged against medical advice. Aboriginal South Australians  
discharge themselves against medical advice for all diagnoses at a rate six times higher than that of other 
South Australians.

Table 9.10.3  Proportion of separations for which patients were discharged against medical advice, 

       by principal diagnosis category and Aboriginal status, 2006 07

 Aboriginal Other
 per cent per cent

Diseases of the circulatory system 4.0 0.4

Diseases of the digestive system 6.7 0.6

Diseases of the ear 1.0 0.1

Diseases of the eye 1.8 0.1

Diseases of the genitourinary system 2.8 0.3

Diseases of the musculoskeletal system 5.3 0.3

Diseases of the nervous system 9.9 0.6

Diseases of the respiratory system 6.2 0.7

Diseases of the skin 6.9 0.6

Endocrine, nutritional and metabolic diseases 3.8 0.7

Factors influencing health status 0.2 0.0

Infectious and parasitic diseases 3.6 0.5

Injury, poisoning, external causes 7.9 1.2

Mental and behavioural disorders 10.1 3.0

Neoplasms 0.4 0.1

Pregnancy, childbirth 2.9 0.2

Symptoms, signs n.e.c 8.1 1.2

Other diagnoses (a) 5.5 0.4

All separations 3.2 0.5

All separations (excluding mental and behavioural disorders) 2.8 0.4

Note 1:  ISAAC subsetting rules have been applied.
Note 2: Other includes separations for non-Aboriginal Australians and those for whom Aboriginal status was not stated.
 (a) Includes factors influencing health, infectious and parasitic diseases, neoplasms, diseases of the blood, 
 diseases of the genitourinary system, diseases of the eye, diseases of the ear, certain conditions originating 
 in the perinatal period and congenital malformations.
Source: SA Health, Integrated South Australian Activity Collection (ISAAC).

 



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9.10.3 Hospitalisation for potentially preventable conditions
Potentially preventable hospitalisation rates indicate the effectiveness of non-hospital care; an analysis of  
the rates by location gives an indirect measure of the effect of remoteness on access to appropriate primary 
health care.

Conditions that are included in this group include vaccine preventable diseases (for example, influenza), 
potentially preventable acute diseases (for example, acute infections) and chronic disease (for example, diabetes).

Potentially preventable hospitalisation rates for non-Aboriginal South Australians vary little between patients 
from metropolitan and country locations (Graph 9.10.1). The rates of hospitalisation for Aboriginal people 
are higher than for other South Australians within both metropolitan and country categories. Most strikingly, 
Aboriginal people from country South Australia experience over twice the rate of hospitalisations for 
preventable conditions than do metropolitan Aboriginal people.

2003 04 2004 05 2005 06

0

2 000

4 000

6 000

8 000

10 000

12 000

14 000

A
dj

us
te

d 
ra

te
 p

er
 1

00
 0

00
 p

er
so

ns

Graph 9.10.1  Selected potentially preventable hospitalisation by Indigenous identification,

         South Australia, 2003 04 to 2005 06

Aboriginal country Non-Aboriginal country

Aboriginal metropolitan Non-Aboriginal metropolitan

Source: SA Health.



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9.11  Data issues associated with Aboriginal people

Overview
Data associated with Aboriginal populations often suffers from issues of quality due to causes such as  
under-identification of Aboriginal status, under reporting and small numbers of events, preventing assessment 
of developing trends. It is recognised that the detail presented does not present a comprehensive description 
of the health of Aboriginal South Australians but, rather, an attempt to focus on the key health issues.  
Most of the information reported reflects the overall state of the health of Aboriginal people in South 
Australia and does not attempt to analyse specific health issues at a community level.

Population growth
Prediction between census periods of the population for a future year is necessary to describe the rate 
of occurrence of a particular health statistic for that year. The ABS published estimates of the Aboriginal 
population for the period of 2001 2009, based on assumptions of growth over previous time periods, level 
of under-identification of Aboriginal status and enumeration in the Census collections. A high and low series 
of population projections was published by the ABS for Aboriginal people in South Australia. The high series 
estimates show a growth over the 2001 2006 of 15.7 per cent compared to the low series estimates with 
10.0 per cent growth. The low series projections are used for the purposes of reported health data for the 
South Australian Aboriginal population as they best reflect the actual population growth, defined by the  
2001 and 2006 Census.

Population distribution
Analysis of remote and very remote hospitalisation data for South Australia can be problematic. A significant 
proportion of the hospital-based health services for residents of the APY Lands are provided in the Northern 
Territory owing to the proximity of the APY Lands to Alice Springs. Rates of hospitalisations from SA Health  
data collections record only those episodes that occur in South Australian hospitals. This association influences 
the overall rates of hospitalisation of Aboriginal South Australians, and especially those from the very remote 
area classification. The population proportions are used to determine South Australian population numbers  
for subsequent analyses on remote areas.

Life expectancy
The most current reported life expectancy data for South Australian Aboriginal people is reported for the  
1996 2001 period. Comparisons are made to the closest chronological data sources for estimates of life 
expectancy for the total populations of South Australia and Australia. Life expectancy calculations group  
the South Australia and Western Australia Aboriginal data together to improve data quality.



page 199South Australia: Our Health and Health Services

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Birthing outcomes

Comparison of SA Health, Pregnancy Outcomes Unit (POU) data with the national data sets of the ABS 
and AIHW is problematic due to lack of conformity of methodology. POU data is based on birthing activity 
occurring in South Australia, includes interstate residents and also is recorded at the time of birth. ABS and 
AIHW determine birthing outcomes based on the mother s usual place of residence and on the date of 
registration of birth. These differences can effect the birthing outcomes data for South Australia, as complex 
cases from the Northern Territory often are retrieved to major hospitals in Adelaide, and low complexity cases 
from the APY Lands usually are confined in Alice Springs.

Non-age standardised hospitalisation data derived from SA Health sources
The South Australia hospitalisation data presented in this chapter are not age-standardised, in contrast to the 
information reported from national sources. The effect of this is to limit the ability to compare hospitalisation 
rates between the Aboriginal and non-Aboriginal population. The impact of diseases that affect older age 
groups, such as cardiovascular disease, will be understated for the Aboriginal population as a result of the 
differences in the age profiles of Aboriginal and non-Aboriginal populations. Conversely, conditions that 
affect younger age groups will be overstated for Aboriginal people. This limitation must be considered when 
reviewing the following South Australia-specific data for cardiovascular disease, diabetes, renal disease, and 
chronic obstructive pulmonary disease. All data using  crude  non-age standardised rates have been identified.



page 200 South Australia: Our Health and Health Services

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9.12  Services and initiatives

9.12.1 Burden of disease
The current methodology used to determine the burden of disease for Aboriginal South Australians calculates 
the level of premature mortality; that is, Years of life lost (YLL). This measure is limited in that it does not 
account for morbidity, or the burden of disease associated with disability. SA Health currently is working 
towards developing a means of measuring Health adjusted life expectancy (HALE) for Aboriginal people  
and this will be used in ascertaining progress for Target 2.5 of South Australia s Strategic Plan: T2.5 Aboriginal 
healthy life expectancy: lower the morbidity and mortality rates of Aboriginal South Australians.

9.12.2 Birthing outcomes
The Our Culture, Our Babies, Our Future: Improving Aboriginal and Torres Strait Islander Birthing Outcomes Context 
and Framework for Action has been completed and a statewide implementation strategy is being developed  
by the Children, Youth and Women s Health Service.

The  Connecting Mums  program (previously the  Parent and Infant Mental Health in the Community Project: 
Feeling Attached ) is now an Aboriginal and Torres Strait Islander-specific program. The program has increased 
the awareness of the needs of Aboriginal mothers and babies, and improved the communication between 
mainstream and Aboriginal health services to manage issues for Aboriginal mothers and infants through 
childcare and early childhood services. Programs have been conducted in Alice Springs and Darwin, and others 
are planned in 2008 for Katherine and Alice Springs. A training workshop has been conducted in the Coorong.

9.12.3 Chronic disease
The Menzies School of Health s Audit and Best Practice in Chronic Disease research program (ABDC) is being 
considered for use in South Australia. This Participatory Action model includes audit system assessment,  
data analysis and reporting in individual health units to improve service delivery and individual health 
outcomes around chronic disease management.

9.12.4 Risk factors
9.12.4.1 Smoking

A  Smoke-Free Pregnancy Project, Stage 4, Aboriginal Women and Their Families  is being considered as a 
means of increasing smoke-free pregnancy among Aboriginal women.

A $130 000 per annum five-year project will reduce Aboriginal tobacco use and exposure to passive smoking 
in communities identified by the Healthy Ways Project.

9.12.4.2 Obesity

A Healthy Weight Project Officer position has been established to coordinate plans across SA Health  
to implement the Eat Well Be Active Healthy Weight Strategy, and to develop an evaluation framework.

SA Health and five other jurisdictions, including the Australian Government, are jointly funding the national 
Remote Aboriginal Stores and Takeaways project (RIST) to support the provision and promotion of healthy 
food in remote community stores. The Department of Transport, Energy and Infrastructure is working with  
SA Health to support the development of freight plans in remote South Australian Aboriginal communities.

 Community Foodies  continued to grow in 2006 07 at existing sites in Whyalla and Enfield. Future projects 
are planned for the western metropolitan region in the remainder of 2007.

9.12.4.3 Alcohol

A substance misuse service for the Anangu Pitjantjatjara Yunkunytjatjara (APY) Lands, being developed 
by Drug and Alcohol Services SA, will include a residential facility for eight people at Amata and a mobile 
outreach service. The building of the main residential facility is expected to be completed in time to begin 
operations in 2008.



page 201South Australia: Our Health and Health Services

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9.12.4.4 Mental Health

A Memorandum of Understanding cross-border agreement between SA Health and the Northern Territory 
Department of Health and Community Services was finalised during the year. This agreement was developed to 
enhance the capacity of the Central Australian Remote Mental Health Team to support the Anangu Pitjantjatjara 
Yunkunytjatjara (APY) Lands and APY Land people residing in the Northern Territory. Services offered include 
providing a psychiatrist, mental health nurse and social worker based at the Alice Springs hospital.

The Pika Wiya Shared Care Project (Port Augusta) provides increased psychological and psychiatric services  
in the north and far western region.

Child Adolescent Mental Health Services (CAMHS) has appointed three Aboriginal staff as Aboriginal Child 
and Adolescent Mental Health Consultants. Two of these positions work with Aboriginal children and young 
people in the Magill and Cavan Youth Training Centres. The third position is based within the CAMHS 
Community service based in Port Adelaide.

SA Health is working collaboratively with the Social Inclusion Unit on its regional youth suicide initiative and 
programs which encompass Aboriginal needs in all of country South Australia.

Northern CAMHS Country negotiated in 2006 a contract with Northern and Far Western Regional Health 
Service (Country Health SA) to provide clinical child and adolescent mental health services to the APY Lands.  
A small, multi disciplinary team from Child and Adolescent Mental Health was involved in a pilot visiting 
service to a range of communities across the APY Lands. There has been a strong focus on responding to 
concerns raised within the communities in regard to sexualised behaviour and child sexual abuse.  
It is anticipated that future visits will be made every two months, with extension of this service through new 
funding from Healthy Young Minds.

9.12.4.5 Equity and Access

Developing a culturally responsive health system is a key objective of the SA Health Strategic Plan.  
The process of involving key stakeholders from across the health system in developing an Aboriginal Health 
Policy for SA Health has been part of a long process of raising awareness of Aboriginal issues and addressing 
practice issues.

SA Health participated in the development of the Australian Health Minsters  Advisory Council (AHMAC) 
Cultural Respect Framework (CRF); this is to be used as a guiding principle in policy construction and  
service delivery.

The CRF is designed to assist in implementing initiatives to strengthen relationships between the health  
care system and Aboriginal and Torres Strait Islander people, and to improve the response from mainstream 
health services.

The Cultural Respect Framework is being implemented currently across the SA Health system as a critical 
component of regional Aboriginal health improvement plans.

SA Health also has developed an Aboriginal Health Impact Statement that includes guidelines and check  
lists designed to help the portfolio to address Aboriginal interests in all its policies, programs, services  
and evaluations.

The Aboriginal Health Division is working with health regions on implementing the Aboriginal Health Impact 
Statement process which will be monitored on an annual basis through the Regional Aboriginal Health 
Improvement Plans.

A number of other activities address access and equity in specific areas of the health portfolio.

 Perko Ngurratti  Cancer Forum was held in September 2007   co-hosted by the Aboriginal Health Council of 
South Australia and the Cancer Council South Australia   and, as a result, the organisations are collaborating 
to address the recommendations from the forum. The forum provided an opportunity for Aboriginal 
community members and health professionals to discuss their cancer experiences and to raise awareness  
of issues faced by Aboriginal people with cancer.



page 202 South Australia: Our Health and Health Services

chapter 9

The Aboriginal Community Enhancement Program aims to strengthen the capacity of Aboriginal communities 
to improve health and wellbeing outcomes for their community. The program supported nine projects by 
incorporated Aboriginal organisations in 2006 07, addressing their health and wellbeing priorities around 
the social determinants of health. These projects included upgrading community buildings; the Healthy Food, 
Healthy Living program; and the Bush Tucker and Market Garden Project.

A new step-down facility in Ceduna was established to assist with coordinating the care of Aboriginal clients 
from Yalata, Oak Valley, Koonibba and transient groups from the Anangu Pitjantjatjara Yunkunytjatjara (APY) 
Lands in relation to their hospital admission, discharge, hospital transfer, transport and follow-up.

The Regional Aboriginal Integrated Social and Emotional (RAISE) Wellbeing Program, will look at the 
development and sustainability of Aboriginal and mainstream primary health care programs in Port Augusta  
as part of the Mapping Aboriginal Health Partnerships for Policy-Evidence Transfer (MAHPET).

The Mental Health Shared Care with GPs program involves providing specialist mental health workers to work 
with GPs and Aboriginal specialists in metropolitan Adelaide and selected country regions. Four Aboriginal 
specific metropolitan and rural positions began in 2007.



page 203South Australia: Our Health and Health Services

chapter 9

9.13  Notes

1.  Department of Health SA, Better Choices, better health: final report of the South Australian Generational 
Health Review, Department of Health, Adelaide, 2003.

2  Australian Health Ministers  Advisory Council, Aboriginal and Torres Strait Islander Health Performance 
Framework Report 2006. AHMAC, Canberra, 2006.

3 Australian Bureau of Statistics, Australian demographic statistics, cat. no. 3101.0, ABS, Canberra 2007.

4  Australian Bureau of Statistics, Population distribution of Aboriginal and Torres Strait Islander Australians, 
2001 cat. no. 4705.0, ABS, Canberra, 2002.

5 Australian Bureau of Statistics, Deaths Australia 2005, cat. no. 3302.0, ABS, Canberra, 2006.

6 Australian Bureau of Statistics, Causes of death Australia 2005, cat. no.3303.0, ABS, Canberra, 2007.

7  A Chan, J Scott, A Nguyen &amp; L Sage, Pregnancy Outcome in South Australia 2005, Pregnancy Outcome 
Unit, South Australian Department of Health, Adelaide, 2006.

8  D Mackerras, Evaluation of the strong women, strong babies, strong culture program: Results for the period 
1990 1996 in the three pilot communities, Menzies Occasional Papers, Issue No 2/98, Menzies School  
of Health Research, Darwin 1998.

9  Department of Health SA, Preliminary results of the Pregnancy outcome in South Australia, Department of 
Health, Adelaide, 2006.

10  Australian Institute of Health &amp; Welfare, Australia s Health 2004. Australian Institute of Health and 
Welfare, Canberra, 2004.

11  Australian Institute of Health &amp; Welfare, Chronic diseases and associated risk factor in Australia, 2006.  
AIHW, Canberra, 2006.

12  SCRGSP (Steering Committee for the Review of Government Service Provision) Overcoming Indigenous 
disadvantage: key indicators 2007, Productivity Commission, Canberra, 2007.

13  Australian Bureau of Statistics, National Aboriginal and Torres Strait Islander Health Survey, Australia,  
2004 05, cat. no. 4715.0, ABS, Canberra, 2006.

14  Australian Bureau of Statistics, National Health Survey: summary of results, 2004 05, cat. no. 4364.0,  
ABS, Canberra 2006.

15  Australian Institute of Health &amp; Welfare, The Health and Welfare of Australia s Aboriginal and Torres Strait 
Islander Peoples 2005, AIHW, Canberra, 2005.

16  Australian Institute of Health &amp; Welfare, Aboriginal and Torres Strait Islander Health Performance Framework, 
2006 report: detailed analysis. AIHW, Canberra, 2007.

17  G D Slade, A J Spencer &amp; K F Roberts-Thomson, Australia s Dental Generations: The National Survey of Adult 
Oral Health 2004 2006. Australian Institute of Health and Welfare, Canberra, 2007.

18  J Harford, J Spencer &amp; K Roberts-Thomson, Oral Health, in The health of Indigenous Australians,  
N. Thomson, Editor. Oxford University Press, Melbourne, 2003.

19  A Ellershaw, A J Spencer &amp; G D Slade, Oral health in South Australia 2004, Australian Institute of Health 
and Welfare, Canberra, 2005.

20  L Jamieson, E Parker and J Armfield,  Indigenous child oral health at a regional and state level ,  
Journal of Paediatrics and Child Health, vol. 43, no. 3, 2007, pp. 117 121.

21  Jamieson, L, J Armfield, and K Roberts-Thomson, Oral Health of Aboriginal and Torres Strait Islander 
Children. 2007, AIHW.

22  Australian Bureau of Statistics, Housing and infrastructure in Aboriginal and Torres Strait Islander 
Communities, Australia, 2006, cat. no. 4710.0, ABS, Canberra, 2007.



page 204 South Australia: Our Health and Health Services

chapter 10

10  Health care services and resources

In this chapter

Hospital care &gt;

General practitioners &gt;

Potentially preventable hospitalisations &gt;

Home and nursing services &gt;

Hospital avoidance program &gt;

Finance &gt;

Services and initiatives &gt;

Summary

 Hospital use has increased progressively over the years. There were 619 419 separations reported in   &gt;
South Australian public and private hospitals during 2006 07, an increase of 21 316 (3.6 per cent) 
compared to 2005 06.

 The number of separations in private hospitals between 2002 03 and 2006 07 increased by 13.3 per cent  &gt;
(24 805), while separations in public hospitals increased by 11.8 per cent (40 251).

 The average length of stay in South Australian hospitals (excluding same-day separations) has decreased  &gt;
from 6.6 days in 2002 03 to 6.4 days in 2006 07.

 Presentations in metropolitan public hospital emergency departments (ED) increased 5.8 per cent over the  &gt;
previous financial year. There were 348 075 presentations of which 170 605 attendances were classified as 
resuscitation/emergency/urgent (49.0 per cent) and 177 470 were classified as less urgent (51.0 per cent).

 The total percentage of emergency patients seen within the specified waiting time targets, based on  &gt;
urgency of required treatment, among metropolitan public hospitals has increased from 50.0 per cent  
in 2003 04 to 63.7 per cent in 2006 07.

 Just over 80 (82.4) per cent of elective surgery patients during 2006 07 were seen within the clinically  &gt;
appropriate time.

 The total South Australian general practitioner (GP) headcount during 2005 06 was 2 042. The number of  &gt;
full-time workload equivalent (FWE) GPs practising in the state was 1 404, an increase of 2.9 per cent from 
the previous year.6

 There were 8.306 million general practitioner attendances (including practice nurses) within South Australia  &gt;
during 2006 07.

 The number of potentially preventable hospitalisations increased 6.7 per cent between 2004 05 (52 092)  &gt;
and 2005 06 (55 562).

 The Royal District Nursing Service of SA Inc (RDNS) had 20 648 clients within metropolitan Adelaide   &gt;
during 2006 07. RDNS nurses made 527 285 nursing and support visits (an increase of 4 per cent from 
2005 06) and conducted 225 085 other client contacts (an increase of 3 per cent from 2005 06).

 Metro Home Link provided 14 706 care packages to 12 857 patients during 2006 07; nearly 8 000 (7 872)  &gt;
of the total number were hospital avoidance packages, with the remaining 6 834 being hospital supported 
discharge packages.

 The State Government provided financing of $3.043 billion to Health Regions and other health entities  &gt;
during 2006 07.



page 205South Australia: Our Health and Health Services

chapter 10

Introduction

SA Health is responsible for the effective administration and operation of South Australia s public health 
services. The Health Portfolio collectively is referred to as SA Health and consists of the Department of Health, 
the metropolitan health regions, Country Health SA and the SA Ambulance Service. Three regions manage 
the provision of health services in the metropolitan area: Central Northern Adelaide Health Service; Southern 
Adelaide Health Service; and the Children, Youth and Women s Health Service.

The first two regions named are responsible for providing services in defined geographical areas while the 
third region provides statewide services to children, youth and women. A new single country health region, 
Country Health SA, was established on 1 July 2006 to replace the previous seven country regions, with the 
objective of providing a more integrated system of care across country South Australia. Maps of the three 
geographical regions are shown below.

Port Lincoln

Port Augusta

Murray Bridge

Berri

Mount Gambier

Aldinga

Noarlunga Centre

Mt 
Barker

Glenelg

Bedford Park

Adelaide

Pt Adelaide

Modbury

Salisbury

Elizabeth

Gawler

Central
Northern 
Adelaide

Southern 
Adelaide

Country Health, SA

Figure 10.1  South Australian Health Service Regions 



page 206 South Australia: Our Health and Health Services

chapter 10

The four regions collectively provide to the people of the state hospital-based care, including medical,  
surgical and other acute services, in addition to mental health, rehabilitation, dental care, breast screening, 
drug and alcohol services, community health and public health-based services. Agencies that provide specific 
services include:

public hospitals &gt;

Child and Family Health (CFH) &gt;

community health centres &gt;

community mental health centres &gt;

SA Dental Service (SADS) &gt;

SA Ambulance Service &gt;

Drug and Alcohol Services of SA (DASSA) &gt;

Breast Screen SA &gt;

Prison Health Services &gt;

GP Plus Health Care Centres &gt;

Institute of Medical and Veterinary Science (IMVS). &gt;

The Australian Government also plays an important role in the provision of health care. It administers 
two national subsidy schemes: the Medicare Benefits Scheme and the Pharmaceutical Benefits Scheme, 
which subsidise payments for services provided by doctors and optometrists, and for a high proportion of 
prescription medications purchased from pharmacies. The Australian Government also funds a wide range  
of services for older people (for example, residential aged care places and community aged care packages)  
and eligible veterans.

A large amount of non-hospital health care is provided by non-government providers, including private 
medical and dental practitioners, other health practitioners (such as physiotherapists, psychologists,  
and podiatrists) and pharmaceutical retailers.

There were 133 hospitals throughout South Australia in 2006 07, comprising 79 public and 54 private 
hospitals (which includes 23 free-standing day facilities). There were an average 7 188 available hospital beds 
in 2006 07, 4 895 in public hospitals and 2 293 in private hospitals.

A comprehensive listing of health, family and community services offered across government,  
community and private sectors in South Australia, can be found at the Human Services Finder web site,  
&lt;www.hsfinder.sa.gov.au&gt;. Additional information on selected services and initiatives also can be found  
at the end of each chapter throughout this report.

This chapter provides information on the use of, access to, and spending on health care services in  
South Australia.



page 207South Australia: Our Health and Health Services

chapter 10

10.1  Hospital care

10.1.1 Inpatient separations

Hospital use has increased progressively over the years. There were 619 419 separations reported in  
South Australian public and private hospitals during 2006 07, an increase of 21 316 (3.6 per cent) compared 
with 2005 06; this was due predominantly to a 4.2 per cent increase in metropolitan public hospital 
separations during this period.

Private hospital demand for inpatient care has outpaced demand for the same care in public hospitals. 
Separations from private hospitals between 2002 03 and 2006 07 increased by 13.3 per cent (24 805),  
while separations in public hospitals increased by 11.8 per cent (40 251); this in part has been due to the 
growth in the number of private day surgery facilities.

Inpatient activity in metropolitan public hospitals has increased steadily due to advances in medical technology, 
population growth, the effect of ageing, the increase in demand for emergency department services, and an 
increase in the number of country residents receiving treatment in metropolitan public hospitals.

100

200

300

400

500

600

700

2002 03 2003 04 2004 05 2005 06 2006 07

N
um

be
r 

of
 s

ep
ar

at
io

ns
 ('

00
0)

Years

Private hospitals

Public hospitals

Graph 10.1.1  Public and private hospital separations, South Australia

Hospital type 2002 03 2003 04 2004 05 2005 06 2006 07

Public hospital 350.4  361.5  362.4  377.6  390.6 
Private hospital 204.0  207.4  212.4  220.5  228.8 
Total 554.4  568.9  574.8  598.1  619.4 

Source: SA Health, Integrated South Australian Activity Collection (ISAAC).



page 208 South Australia: Our Health and Health Services

chapter 10

Females accounted for 52.3 per cent (323 713) and males for 47.7 per cent (295 693) of total hospital 
separations in 2006 07. Separations for females aged between 15 39 years exceeded male separations in the 
same group (largely due to admissions for birth), with males having higher numbers in the 55 79 age group.

The most common  overnight  Extended service-related groups (ESRG) in the public sector during 2006 07 
was vaginal delivery, accounting for 4.7 per cent (9 383) of total separations. Other leading ESRGs included 
major psychiatric disorder with 3.2 per cent (6 318), and diseases of the digestive system including oesophagitis, 
gastroenteritis and other miscellaneous diseases with 2.7 per cent (5 422). The corresponding top three  overnight  
ESRGs in the private sector were other orthopaedics   surgical with 6.8 per cent (6 375) of total separations,  
non-acute rehabilitation with 3.9 per cent (3 650) and hip and knee replacement with 3.8 per cent (3 553).

N
u

m
b

er
 o

f 
se

p
ar

at
io

n
s 

('
00

0)

Age groups (years)

0

5

10

15

20

25

30

0 
4

5 
9

10
 1

4

15
 1

9

20
 2

4

25
 2

9

30
 3

4

35
 3

9

40
 4

4

45
 4

9

50
 5

4

55
 5

9

60
 6

4

65
 6

9

70
 7

4

75
 7

9

80
 8

4

85
+

Males

Females

Graph 10.1.2  Public and private hospital separations by age and gender, South Australia, 2006 07

Note: Includes both public and private hospitals in South Australia.
Source: SA Health, Integrated South Australian Activity Collection (ISAAC).

 



page 209South Australia: Our Health and Health Services

chapter 10

The most common  same-day  ESRGs in both the public and private sector during 2006 07 were renal dialysis, 
chemotherapy, and colonoscopy, accounting for 38 per cent of total separations.

There were 299 048 elective and 192 373 emergency inpatient separations in South Australian hospitals 
during 2006 07. Elective separations were evenly distributed between public and private hospitals  
(46 and 54 per cent respectively). The majority of emergency inpatient separations in contrast were handled  
in public hospitals (84 per cent) compared to private (16 per cent).

Table 10.1.1  South Australian private and public hospital  overnight  separations by ESRG, 2006 07

 Public hospitals Private hospitals Total
ESRG Number Per cent Number Per cent Number Per cent

Vaginal delivery 9 383 4.7 2 805 3.0 12 188 4.2

Other orthopaedics   surgical 5 021 2.5 6 375 6.8 11 396 3.9

Major psychiatric disorder 6 318 3.2 1 142 1.2 7 460 2.6

Non-acute rehabilitation 3 611 1.8 3 650 3.9 7 261 2.5

Chest pain 5 256 2.6 1 596 1.7 6 852 2.4

Oesophagitis, gastroenteritis and miscellaneous digestive system disorders 5 422 2.7 1 286 1.4 6 708 2.3

Caesarean delivery 4 001 2.0 2 249 2.4 6 250 2.1

Hip and knee replacement 2 087 1.1 3 553 3.8 5 640 1.9

Respiratory infections/inflammation 4 049 2.0 1 066 1.1 5 115 1.8

Other respiratory medicine 3 980 2.0 997 1.1 4 977 1.7

Chronic obstructive airways disease 3 829 1.9 793 0.9 4 622 1.6

Other procedural ENT (ear, nose, throat) 1 491 0.8 3 030 3.3 4 521 1.6

Other psychiatry 3 925 2.0 568 0.6 4 493 1.5

Other general medicine 3 407 1.7 890 1.0 4 297 1.5

Other urological procedures 2 089 1.1 2 133 2.3 4 222 1.4

Source: SA Health, Integrated South Australian Activity Collection (ISAAC).

 

4

5

6

7

8

2002 03 2003 04 2004 05 2005 06 2006 07

N
um

be
r 

of
 d

ay
s

Years

Public hospitals

Private hospitals

Graph 10.1.3  Public and Private Hospital average length of stay (excluding same-day separations), 

         South Australia

Note: Average length of stay is based on overnight separations only.
Source: SA Health, Integrated South Australian Activity Collection (ISAAC).



page 210 South Australia: Our Health and Health Services

chapter 10

The proportion of patients treated on a same-day basis is increasing due to improvements in clinical 
technologies, drugs, and patient procedures as well as better support for patients when they leave hospital. 
The proportion of same-day separations in all South Australian hospitals increased from 50.8 per cent in 
2002 03 to 53.0 per cent in 2006 07. Private hospitals performed 59.4 per cent of their total separations on 
a same-day basis in 2006 07, compared to 49.2 per cent by public acute hospitals.

Lengths of stay in hospital are decreasing for overnight patients for similar reasons. Most patients require  
a relatively short stay in hospital unless rehabilitation, maintenance or palliative care is required. The average 
length of stay (excluding same day separations) has decreased in all South Australian hospitals from 6.6  
days in 2002 03 to 6.4 days in 2006 07; in public acute hospitals, it decreased from 7.3 to 7.1 days, while  
private hospitals decreased from 5.3 to 4.9 days. This trend is growing throughout developed countries,  
and is believed to increase patient satisfaction as well as hospital throughput.2

10.1.2 Emergency department presentations

South Australian emergency departments (ED) provide care to people who typically are experiencing a medical 
emergency. People presenting to an emergency department are assessed by a nurse and assigned a level of 
urgency, known as a triage category. Services provided by an emergency department can vary from managing 
relatively minor injuries and conditions to treating patients who are critically ill.

The level of activity in public hospital emergency departments is affected by such factors as access to and cost 
of general practitioners (where charges exceed Medicare rebates), the availability of emergency department 
services within the private sector, demand due to seasonality, and population growth and ageing.2

Metropolitan public hospital EDs experienced high growth during 2006 07, up 5.8 per cent compared with 
the previous financial year   a continuation of recent trends. There were 348 075 presentations of which  
170 605 attendances were classified as resuscitation/emergency/urgent (49.0 per cent) and 177 470 were 
classified as being less urgent (51.0 per cent).

Country hospital ED presentations also increased during 2006 07, with 2.2 per cent (3 701) more activity than 
the previous year.

Pr
es

en
ta

ti
on

s

Years

0

150 000

100 000

50 000

200 000

250 000

300 000

350 000

400 000

2003 04 2004 05 2005 06 2006 07

Metropolitan hospitalsCountry hospitals

Graph 10.1.4  Public hospital emergency department presentations by hospital location, South Australia

Note: Includes South Australian public hospitals only.
Source: SA Health, Monthly Management Summary System.

 



page 211South Australia: Our Health and Health Services

chapter 10

The gap in ED presentations between metropolitan and country hospitals continues to widen each year. 
Metropolitan public hospitals accounted for 65.7 per cent of total ED presentations in 2003 04, and country 
public hospitals the remaining 34.3 per cent, while in 2006 07, 67.1 per cent of presentations were at 
metropolitan public hospitals and 32.9 per cent at country public hospitals.

Male ED presentations to metropolitan public hospitals outnumbered female presentations in the childhood 
years, but the opposite is true for the age groups between 20 and 39 years of age. Male presentations exceed 
female presentations between 40 and 74 years, but this status is reversed for the older age groups.

Nearly 30 (29.2) per cent of the total ED presentations to metropolitan public hospital EDs (excluding those 
who did not wait) in 2006 07 resulted in an admission to hospital. Most of the presentations that required 
hospital admission occurred among those aged 65 years or more (36.5 per cent). Only 15.9 per cent of child 
presentations (aged less than 15 years) in comparison required hospital admission.

10.1.3 Waiting times
10.1.3.1 Emergency departments

Emergency department waiting times measure the time a patient has waited to be seen by a treating doctor 
or nurse. The proportion of patients seen within specified targets, based on the urgency of required treatment, 
is an indicator of access to public emergency department services. The effect of longer waiting times ranges 
from discomfort to poor health outcomes.

The maximum waiting times as specified by the Australasian College of Emergency Medicine are:

Triage category 1: Immediate   resuscitation required &gt;

Triage category 2: 10 minutes   emergency &gt;

Triage category 3: 30 minutes   urgent &gt;

Triage category 4: 60 minutes   semi-urgent &gt;

Triage category 5: 120 minutes   non-urgent. &gt;

0 
4

5 
9

10
 1

4

15
 1

9

20
 2

4

25
 2

9

30
 3

4

35
 3

9

40
 4

4

45
 4

9

50
 5

4

55
 5

9

60
 6

4

65
 6

9

70
 7

4

75
 7

9

80
 8

4

85
+

Pr
es

en
ta

ti
on

s

3 000

5 000

7 000

9 000

11 000

13 000

15 000

17 000

19 000

21 000

23 000

Age groups (years)

Male

Female

Graph 10.1.5  Metropolitan public hospital emergency department presentation, 2006 07

Note: Includes metropolitan public hospitals only.
Source: SA Health, Emergency Department Data Collection (EDDC).



page 212 South Australia: Our Health and Health Services

chapter 10

The proportion of patients seen within the thresholds in metropolitan public hospitals improved during  
2006 07, despite the high growth in presentations; this is due to changes in processes and procedures within 
emergency departments and other areas within hospitals that have led to improved patient flows.

The total percentage of patients seen within the threshold among metropolitan public hospitals has increased 
overall from 50.0 per cent in 2003 04 to 63.7 per cent in 2006 07. Triage categories 2, 3 and 4 experienced 
marked improvements in the percentage of patients seen in time over this period. 

Pe
r 

ce
n

t 
se

en
 w

it
h

in
 t

h
re

sh
o

ld

Categories

30

40

50

60

70

80

90

100

Triage 1 Triage 2 Triage 3 Triage 4 Triage 5

2006 07

2003 04 2005 06

2004 05

Graph 10.1.6  Metropolitan public hospital emergency department patients seen within threshold

Note: Includes metropolitan public hospitals only.
Source: SA Health, Emergency Department Data Collection (EDDC).



page 213South Australia: Our Health and Health Services

chapter 10

10.1.3.2 Elective surgery

Elective surgery is surgery, not medical treatment, that a doctor considers necessary but which can be  
delayed for at least 24 hours. Patients requiring elective surgery are put on a waiting list, after assessment  
by a surgeon. The list is prioritised so that surgery is scheduled based on the degree of urgency for the 
procedure required.

Slightly under 40 000 (37 477) people received elective surgery procedures during 2006 07 in South Australia s 
metropolitan public hospitals (excluding Noarlunga Public Hospital), an increase of 3.7 per cent when 
compared to 2005 06. A significant amount of elective surgery also was provided in country hospitals.

Just over 80 (82.4) per cent of elective surgery patients during 2006 07 were seen within the clinically 
appropriate time. The breakdown by urgency category for South Australia s metropolitan public hospitals was:

 77.5 per cent of category 1 patients (urgent surgery required within 30 days) were treated on time   &gt;
(the national average in 2005 06 being 81 per cent)

 77.9 per cent of category 2 patients (semi-urgent surgery required within 90 days) were treated on time   &gt;
(the national average in 2005 06 being 74 per cent)

 90.2 per cent of category 3 patients (non-urgent surgery required within 12 months) were treated on time  &gt;
(the national average in 2005 06 being 88 per cent).

Categories

0

10

20

30

40

50

60

70

80

90

100

Category 1 Category 2 Category 3

Pe
r 

ce
n

t 
o

f 
p

at
ie

n
ts

 s
ee

n

2005 06

2006 072002 03 2004 05

2003 04

Graph 10.1.7  Metropolitan public hospital elective surgery patients seen within the clinically appropriate time

Note: Includes metropolitan public hospitals only.
Source: SA Health, Booking List Information System (BLIS).



page 214 South Australia: Our Health and Health Services

chapter 10

The number of metropolitan public patients waiting longer than 12 months for elective surgery at June  
2007 decreased by 6.3 per cent compared to June 2006, and 45.8 per cent compared with June 2003.

A number of factors affect the length of time a patient can wait for elective surgery. The number of 
emergency admissions often increases in winter, for example, causing a reduction in the capacity for the 
hospital to undertake elective surgery. Other factors influencing waiting times include the individual  
patient s assigned urgency category, the number of patients already on the waiting list, the type of treatment 
required and the availability of specialists.

The most common types of elective surgery performed during 2006 07 in metropolitan public hospitals  
were general (22.5 per cent), gynaecological (15.3 per cent), orthopaedic (11.7 per cent), ophthalmic  
(11.3 per cent), and otorhinolaryngeal (ear, nose and throat or ENT) (11.0 per cent).

600

800

1 000

1 200

1 400

1 600

1 800

2 000

June 2003 June 2004 June 2005 June 2006 June 2007

N
u

m
b

er
 o

f 
p

at
ie

n
ts

Years

Graph 10.1.8  Metropolitan public hospital patients waiting greater than 12 months for elective surgery, 

         June 2003 to June 2007

Note: Includes metropolitan public hospitals in South Australia only.
Source: SA Health, Booking List Information System (BLIS).

 



page 215South Australia: Our Health and Health Services

chapter 10

10.2  General practitioners

10.2.1 Number of GPs
General practitioners (GPs) usually are the first point of contact for people requiring healthcare. GPs provide 
primary healthcare in a variety of settings such as hospitals, and small and large practices, or are self-employed. 
GPs in the country may work in relatively isolated conditions. The total South Australian GP headcount during 
2005 06 was 2 042. The number of full-time workload equivalent (FWE) GPs practising in the state was 1 404, 
an increase of 2.9 per cent from the previous year6; this equates to nearly one FWE GP per 1 000 population.

Younger GPs are inclined to work fewer hours than older GPs. Additional GPs are required to provide similar 
services, therefore, as older GPs retire. The number of women entering the medical workforce has increased, 
although the majority works part-time.6

There were 8.306 million general practitioner attendances (including practice nurses) within South Australia 
during 2006 07; this was an increase of 0.9 per cent compared to the previous year, and an increase of  
7.8 per cent since 2002 03.7

The number of general practice items (including practice nurse items) claimed through Medicare per 1 000  
weighted population was 4 753 during 2006 07, slightly less than the national value of 4 920, and marginally 
less than the previous year (4 784).8

Females used GP services more than males, accounting for 57.9 per cent of services during 2006 07. 
There were 3.0 services per head of population for females and 2.2 per head for males. Females also 
were responsible for more services per patient in each age group, from 15 24 years onwards, with males 
accounting for more services only in the 0 14 year age group. People aged 45 74 years were the heaviest 
users of GP services during 2006 07, accounting for just over 40 per cent of total services. Females aged 
15 34 years used GP services nearly 67 per cent more often than males in the same age group.7

Age groups (years)

0 
4

15
 2

4

5 
14

25
 3

4

35
 4

4

45
 5

4

55
 6

4

65
 7

4

75
 8

4

85
+

0

50

100

150

200

250

300

350

400

450

A
tt

en
d

an
ce

s 
p

er
 1

 0
00

 p
eo

p
le

Males

Females

Graph 10.2.1  GP attendances by age and gender, South Australia, 2006 07

Source: Medicare Australia.



page 216 South Australia: Our Health and Health Services

chapter 10

10.2.2 Reasons for encounter
The Bettering the Evaluation and Care of Health (BEACH) survey of general practice activity collects information 
on the problems managed by GPs for patients in South Australia.

Reasons for encounter (RFE) reflect the patient s expressed demand for care as perceived and recorded  
by the GP.1 The most frequent reason for encounter by South Australians in 2005 2007 was for prescriptions 
(13.6 per 100 encounters), followed by test results (6.6 per 100) and for cough (5.3 per 100).

The most common problems that were managed by GPs during 2005 2007 were hypertension (8.7 per 100 
encounters), upper respiratory infection (5.1 per 100) and preventative immunisation (4.4 per 100).

Upper respiratory 
infection, acute

Throat symptom/complaint

Test results

Preventive immunisation/
vaccination/medications   all

Prescription   all

General check-up

Cough

Cardiac check-up

Back complaint

Rate per 100 encounters

0 2 4 6 8 10 12 14

Rash

Graph 10.2.2  Most frequent reasons for encounter, South Australia, 2005 2007

Source: Table 2.2, Top 60 reasons for encounters, BEACH Survey report, Australian GP Statistics and Classification Centre, 
 University of Sydney.

Problem Rate per 100 encounters

Hypertension 8.7

Acute upper respiratory tract infection 5.1

Preventive immunisations/vaccines/medications-all 4.4

Depression 4.3

Diabetes (all) 3.7

Lipid disorders 3.6

General check-up 3.4

Back complaint 2.8

Osteoarthritis 2.6

Oesophagus disease 2.4

Source:  Table 3.2, Top 60 problems managed, BEACH Survey report, Australian GP Statistics and Classification Centre, 
 University of Sydney.
 

Table 10.2.1  Top 10 problems managed by GPs, South Australia, 2005 2007



page 217South Australia: Our Health and Health Services

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The most common referrals to specialists by GPs over the period 2005 2007 (excluding continuation  
referrals) were to surgeons (including orthopaedic, plastic, vascular and neurosurgery) with 2.1 per 100 
encounters, ophthalmologists (0.8 per 100), and gastroenterologists (0.5 per 100).1

The most common GP referrals to allied health professionals over the period 2005 2007 were to 
physiotherapists (1.4 per 100 encounters), podiatrists/chiropodists (0.3 per 100), and psychologists  
(0.3 per 100).1

10.2.3 GP prescribing patterns
The BEACH survey of general practice activity also collects information on drugs prescribed by GPs. 
Medications were prescribed in 2005 2007 at a rate of 78 per 100 encounters; of the 10 most frequent 
prescribed medications, four were from the antibiotic group, and two from the painkillers group.

The most common prescribed medication was Amoxycillin, accounting for 3.5 per cent of all prescriptions, 
followed by Paracetamol (3.1 per cent), Paracetamol/Codeine (2.8 per cent), Cephalexin (2.5 per cent),  
and Amoxycillin with potassium clavulanate (2.2 per cent).

Table 10.2.2  Medications most frequently prescribed by GPs, South Australia, 2005 2007

Generic name Action Proportion   Prescriptions per
  of prescriptions 100 encounters
   (per cent) 

Amoxycillin Antibiotic 3.5 2.7

Paracetamol Painkiller 3.1 2.4

Paracetamol/Codeine Painkiller 2.8 2.2

Cephalexin Antibiotic 2.5 2.0

Amoxycillin/potassium clavulanate Antibiotic 2.2 1.7

Salbutamol Open airways 2.0 1.6

Atorvastatin Lowers blood cholesterol 2.0 1.5

Diazepam Reduces anxiety 1.9 1.5

Roxithromycin Antibiotic 1.8 1.4

Temazepam Sleeping tablet 1.7 1.3

Note: These data refer to prescriptions written by GPs. Actual prescriptions filled per 100 encounters may be higher than 
 the numbers in this table because many prescriptions have  repeats .
Source: Table 4.3 Top 30 medications prescribed GP-Patient encounters in SA April 2005-March 2007, BEACH Survey report, 
 Australian GP Statistics and Classification Centre, University of Sydney.

 



page 218 South Australia: Our Health and Health Services

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10.3  Potentially preventable hospitalisations

There are a number of conditions for which hospital separations are seen to be potentially preventable  
if timely and adequate non-hospital care is provided. The list of potentially preventable hospital  
separations includes:

 vaccine-preventable conditions including influenza, pneumonia, and other conditions such as hepatitis B,  &gt;
diphtheria, tetanus, measles, mumps, rubella and polio

 potentially preventable acute conditions including appendicitis, convulsions and epilepsy, dehydration/ &gt;
gastroenteritis; gangrene; perforated ulcer; cellulitis, pyelonephritis; pelvic inflammatory disease; ear, nose 
and throat infections; and dental conditions

 potentially preventable chronic conditions including diabetes complications, asthma, angina, hypertension,  &gt;
iron deficiency anaemia, nutritional deficiencies, congestive heart failure and chronic obstructive  
pulmonary disease.

The list above is not comprehensive. There are other conditions that may be preventable, such as coronary 
heart disease, substance abuse, lung cancer, and injury. The list above includes conditions for which there 
is evidence that prevention and management methods, lifestyle changes and specific non-hospital care can 
reduce hospitalisation rates.

Angina

Appendicitis

Asthma

Chronic obstructive
pulmonary disease

Cellulitis

Congestive cardiac failure

Convulsions and epilepsy

Dehydration/gastroenteritis

Dental

Diabetes complications

Ear, nose and throat

Gangrene

Hypertension

Influenza/pneumonia

Iron deficiency anaemia

Nutritional deficiencies

Other vaccine preventable

Pelvic inflammatory disease

Perforated   bleeding ulcer

Pyelonephritis

Rheumatic heart disease

Number of separations

2 000 4 000 6 000 8 000 10 000 12 000 14 000 16 000 18 0000

Graph 10.3.1  Potentially preventable hospitalisations by condition, South Australia, 2005 06

Source: SA Health, Integrated South Australian Activity Collection (ISAAC).



page 219South Australia: Our Health and Health Services

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Separations for potentially preventable hospitalisations are used most often as an indication of appropriate 
and adequate non-hospital care. An increase in separations, however, also may be due to increased prevalence 
of the condition in the community, leading to increased hospital use, and improvements in the identification 
of conditions in data collections.

Nearly 9.3 per cent of total hospital separations (both public and private) in South Australia during 2005 06 
were potentially preventable.

The number of potentially preventable hospitalisations increased 6.7 per cent between 2004 05 (52 092) and 
2005 06 (55 562). The number of potentially preventable hospitalisations as a proportion of total separations 
was 9.3 per cent during 2005 06, an increase of 0.2 percentage points on the previous year.

Chronic conditions were the most common type of potentially preventable hospitalisation during 2005 06, 
comprising 57.1 per cent overall. Acute conditions accounted for 40.9 per cent, while vaccine-preventable 
conditions were 2.0 per cent.

The largest single cause of preventable hospital separations was diabetes complications (25.2 per cent);  
next was chronic obstructive pulmonary disease (10.0 per cent), followed by dental conditions (8.0 per cent), 
and dehydration and gastroenteritis (8.0 per cent). Influenza and pneumonia accounted for 1.6 per cent  
of potentially preventable hospitalisations, both of which can be prevented by vaccination.

Males had higher hospitalisation rates for potentially preventable admissions than did females during  
2005 06 in the older age groups. The rates of potentially preventable hospitalisations for all people aged 
60+ years was nearly five times higher than for the rest of the South Australian population. The rate of all the 
potentially preventable hospitalisations in South Australia was 23.1 per cent higher for males than females.

The patterns of preventable hospital separations by socioeconomic status in South Australia were similar to 
Australian patterns.5 The separation rate during 2005 06 for the most disadvantaged quintile was 63.1  
per cent higher than for the least disadvantaged quintile; this is attributed mainly to chronic conditions,  
which were 120.6 per cent higher than for the least disadvantaged quintile.

0.00

0.04

0.08

0.12

0.16

R
at

e

Age groups (years)

0 
4

5 
9

10
 1

4

15
 1

9

20
 2

4

25
 2

9

30
 3

4

35
 3

9

40
 4

4

45
 4

9

50
 5

4

55
 5

9

60
 6

4

65
 6

9

70
 7

4

75
 7

9

80
 8

4

85
+

Males

Females

Graph 10.3.2  Potentially preventable hospitalisation rates, by age and gender, public hospitals, 

         South Australia, 2005 06

Source: SA Health, Integrated South Australian Activity Collection (ISAAC).



page 220 South Australia: Our Health and Health Services

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10.4  Home and nursing services

10.4.1 Domiciliary Care SA
Domiciliary Care SA was established on 1 July 2007 with the transfer of funding responsibility from the 
Department of Health to the Department for Families and Communities; the service existed before this as 
Metropolitan Domiciliary Care (MDC), from 2002 to 30 June 2007. MDC was the state-based provider of 
government-funded domiciliary care services in metropolitan Adelaide.

Domiciliary Care SA provides the same service as the former MDC: assisting people with reduced ability to  
care for themselves while living in their own homes.

The organisation s major services include personal care, domestic assistance, case management, respite care, 
social support and allied health services. A range of professional groups provide paramedical assistance, 
occupational therapy, physiotherapy, social work, speech pathology, podiatry and dietetics.

Domiciliary Care SA also manages three business units:

 Domiciliary Equipment Service (DES), which provides equipment, independent living aids and home  &gt;
modifications; on average, there are 35 000 equipment items rented per month

 Manual Handling Australia, which provides training and consultancy services upon request, both to  &gt;
Domiciliary Care SA and to external agencies

 Therapy Solutions, which provides allied health services and expertise to Domiciliary Care SA and to   &gt;
other agencies.

Domiciliary Care SA also manages the Adelaide Aged Care Assessment Team (AACAT), which conducts 
assessments under the Commonwealth Aged Care Assessment Program, as well as offering advice to older 
people who experience difficulty living at home. AACAT completed 12 044 new client assessments during 
2006 07.

Domiciliary Care SA primarily assists people aged 65+ years, with over 90 per cent of clients in this age group. 
Younger people with a disability also may qualify for support in some circumstances. 

The largest proportion of clients is aged between 76 85 years (42 per cent), with the next largest group of 
clients aged 85+ years (25 per cent). Services were provided to 12 036 clients across eight client service areas 
in Adelaide during 2006 07. The most common service was for arthritis (3 820), followed by hypertension 
(high blood pressure) (2 922) and cardiovascular disease (2 517).



page 221South Australia: Our Health and Health Services

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A significant proportion of Domiciliary Care SA clients come from culturally and linguistically diverse 
backgrounds (CALD) and speak English as a second language. Thirty per cent of clients currently report that 
they were born in a non-English-speaking country and 15 per cent report that English is not the primary 
language they speak at home.

There has been a significant decrease over the past year in the total number of clients waiting for services. 
The total waiting list has fallen by 20 per cent, with a 64 per cent decrease in the number of Priority 1 clients 
waiting for care (those assessed as having the most urgent and complex care needs). These reductions have 
been achieved through innovations to entry assessment, strategic waiting list management, and improvements 
to services and intake processes.

Domiciliary Care SA Palliative Care services are managed by two regional teams based in the North and  
South of Adelaide, in partnership with regional palliative care services and the Royal District Nursing Services 
of SA Inc (RDNS). The palliative care teams provide respite, social support, domestic assistance, equipment, 
home modifications and linen service as part of a joint program with other service providers.

The Palliative Care Program was used by 1 930 clients during 2006 07. Around 500 clients receive  
services from this program at any given time. The former MDC had achieved a rapid response rate for all 
palliative care referrals as of 30 June 2007, with 90 per cent of new clients seen within one business day  
of their initial referral.

10.4.2 Country Health SA Domiciliary Care
In country South Australia, domiciliary care services are provided predominantly by public sector incorporated 
health units, as well as by non-government service providers in some locations. Services are provided to 
hundreds of communities from 95 sites based in 77 towns.

Services encompass a range of coordinated social, personal care, nursing, home support and allied health 
services provided in support of independent, community-based living.

Domiciliary care supports the management of chronic disease, and reduces the risk of injury or deteriorating 
health, thus reducing the frequency and length of hospital admissions by focusing on health promotion,  
early intervention and maintaining independence. Domiciliary care also minimises the requirement for 
residential aged care by providing a sustainable alternative in the client s own home.

0 500 1 000 1 500 2 000 2 500 3 000 3 500 4 000

Cardiovascular disease

Arthritis

Cerebrovascular disease

Dementia

Diabetes

Hypertension 
high blood pressure

Obesity

Respiratory system

Number of services

D
ia

g
n

o
se

s
Graph 10.4.1  Metropolitan services by clinical diagnosis, 2006 07

Source: Department for Families and Communities, Client Management Engine.



page 222 South Australia: Our Health and Health Services

chapter 10

Nearly 809 000 services were provided by Country Health SA during the 2006 calendar year. The predominant 
services provided were personal care (15.8 per cent of services), domestic assistance (14.7 per cent) and 
nursing care (10.0 per cent). Nearly 836 000 hours of service time were provided over this 12-month period. 
The largest proportion of service hours were dedicated to the provision of centre-based care (38.5 per cent  
of total service hours) and domestic assistance (17.2 per cent).

10.4.3 Royal District Nursing Service of SA Inc
The Royal District Nursing Service of SA Inc (RDNS) is a non-government organisation that provides 24 hour, 
7-day home and community nursing services across the Adelaide metropolitan area. Services to clients  
include general and specialised nursing, with the dual objectives of improving their health status while also 
enabling them to enjoy the benefits of remaining at home.

Table 10.4.1  Country Health SA Domiciliary Care Services, 2006

Domiciliary care services Number of services Service hours

Aged care assessment team 20 830 15 047
Counselling/support, information and advocacy 9 053 4 458
Case management 2 568 10 500
Case planning/review, and coordination 61 623 34 764
Assessment 16 107 12 626
Personal care 127 996 81 591
Domestic assistance 119 137 143 844
Respite care 15 351 39 906
Social support 49 355 46 102
Home modification 1 877 2 648
Allied health 73 489 50 160
Centre-based day care 78 558 321 392
Formal linen service 2 741 118
Home maintenance 5 877 7 299
Meals (home) 69 339 13 888
Meals (centre) 60 774 2 553
Other food sources (home) 7 604 1 669
Nursing care 81 039 43 360
Home-based support services for adults following an acute admission 5 209 3 673

Total  808 527 835 598

Source: Department for Families and Communities, Country Consolidated Client Management Engine.
 



page 223South Australia: Our Health and Health Services

chapter 10

Specialist clinical services include wound and diabetes management, palliative care, continence promotion 
and health care for people with disabilities, HIV-AIDS, dementia and mental health. RDNS staff also undertake 
procedures that once were performed only in hospitals or medical clinics; these include blood transfusions  
and ultrasound investigations. This service gives people with serious illnesses more choice to remain in their 
own home.

The RDNS had 20 648 clients within metropolitan Adelaide during 2006 07. RDNS nurses made 527 285 
nursing and support visits (an increase of 4 per cent from 2005 06) and conducted 225 085 other client 
contacts (an increase of 3 per cent from 2005 06).

The RDNS also carried out 6 528 hospital referrals during 2006 07, an increase of 3.9 per cent over the 
previous year.

0

5 000

10 000

15 000

20 000

25 000

2002 03 2003 04 2004 05 2005 06 2006 07

N
um

be
r 

of
 c

lie
nt

s

Years

 
Graph 10.4.2  RDNS clients, South Australia, from 2002 03 to 2006 07 financial years

Source: Royal District Nursing Services (RDNS).



page 224 South Australia: Our Health and Health Services

chapter 10

10.5  Hospital avoidance program

Metro Home Link provides hospital avoidance and discharge packages to patients who reside in metropolitan 
Adelaide and/or who have been admitted to a metropolitan hospital. The program is aimed at helping people 
to avoid a presentation or admission to hospital, or to facilitate an early discharge. Referrals to the service can 
be made by hospital staff, general practitioners or residential care facilities.

Examples of packages of care provided through Metro Home Link include personal care, assistance with the 
activities of daily living, technical nursing and allied health care. Services are short-term in nature. The majority 
of packages do not exceed seven days.

Metro Home Link provided a total of 14 706 care packages to 12 857 patients during 2006 07. A total of  
14 124 care packages was provided to 11 400 patients in the period 2005 06.

Nearly 8 000 (7 872) of the total packages provided in 2006 07 were for hospital avoidance and 6 834 were 
hospital-supported discharge packages; 7 655 avoidance packages and 6 469 hospital-supported discharge 
packages were provided in the previous financial year.



page 225South Australia: Our Health and Health Services

chapter 10

10.6  Finance

10.6.1 State Government spending
The South Australian government has spent cumulatively, in real terms $13.4 billion on Health Regions  
and other health entities from 2002 2003 to 2006 2007; this includes $3.043 billion during 2006 2007. 
These amounts exclude the Central Office of SA Health and SA Ambulance service expenditure.

10.6.2 State spending on mental health services
South Australian Government recurrent expenditure on mental health has increased considerably since  
2002 03. The South Australian Government has committed an additional $83 million from 2002 03  
to 2006 07 on a range of mental health initiatives. A further $155.4 million has been committed over  
the next four years on a range of initiatives, including additional community-based support for non-
government organisations.

10.6.3 Per capita spending on health
Per capita spending on health is based on total government and non-government expenditure. Information 
has been provided for the previous years for comparative purposes. Expenditure is specified below in terms 
of current and constant prices. A constant price refers to expenditure that has been adjusted to remove the 
effects of inflation; hence, expenditure over different years can be compared. The term  current price  refers  
to expenditure for a particular year (unadjusted for inflation).4

The average recurrent health expenditure per person, based on constant prices, for South Australia was $3 912 
in 2005 06 compared with $3 864 in 2004 05 and $3 731 in 2003 04; this represents an increase of 4.9 per 
cent over that two-year period. Per capita spending for South Australia in 2005 06 was 4.1 per cent above the 
national average.4

Average recurrent health expenditure per person, based on current prices, for South Australia (all sources of 
funds) was $4 070 in 2005 06 compared with $3 864 in 2004 05 and $3 582 in 2003 04. South Australian 
per capita expenditure in 2005 06 was 13.6 per cent higher than in 2003 04, and 2.6 per cent above  
the national average.4

2 000

2 200

2 400

2 600

2 800

3 000

3 200

2002 03 2003 04 2004 05 2005 06 2006 07

$ 
m

ill
io

n

Years

Graph 10.6.1  State Government spending, health regions and services, financial years from 2002 02 to 2006 07

Source: SA Health, Corporate Finance calculation as per October 2007.



page 226 South Australia: Our Health and Health Services

chapter 10

10.6.4 Health spending as a proportion of Gross Domestic Product
Australia s health expenditure totalled $87 billion during the 2005 06 financial year, representing 9.0 per cent 
of Gross Domestic Product (GDP).4

The Organisation for Economic Co-Operation and Development (OECD) median health-to-GDP ratio was 7.5  
per cent in 1995, compared with 8.1 per cent in 2000 and 9.0 per cent in 2005; Australia s average was 
slightly lower in 1995 (7.4 per cent), higher in 2000 (8.3 per cent) and lower again in 2005 (8.8 per cent).4

The biggest spender on health care in the OECD countries during 2005 was the United States of America, 
spending 15.3 per cent of GDP. The average expenditure per person was more than double the amount for 
Australia ($8 833 per person compared with $4 121 for Australia).

Australia in 2005 had a health-to-GDP ratio similar to that of Italy and New Zealand, while it was higher than 
the United Kingdom and much lower than the United States of America, as shown in the table below.

10.6.5 Private health insurance
Just under 44 (43.9) per cent of South Australians had private health insurance (PHI) hospital cover as at  
June 2007; this compares to 44.5 per cent of South Australians at June 2003. The percentage of people  
with PHI has stayed reasonably steady during this period, at around 44 per cent.

Table 10.6.1  Health expenditure as a proportion of GDP and per person, top 20 OECD countries, 1995 2005

 1995 2000 2005

 Health-to-  Health-to-  Health-to-
 GDP ration Per person GDP ration Per person GDP ration Per person
Country (per cent) (A$) (per cent) (A$) (per cent) (A$) 

United States of America 13.3 4 826 13.2 5 985 15.3 8 833
Switzerland 9.7 3 394 10.4 4 167 11.6 5 764
France 9.9 2 726 9.6 3 258 11.1 4 656
Germany 10.1 2 937 10.3 3 451 10.7 4 536
Belgium 8.2 2 416 8.6 3 014 10.3 4 677
Austria 9.8 2 970 10.0 3 701 10.2 4 856
Portugal 7.8 1 447 8.8 2 129 10.2 2 806
Greece 7.5 1 650 9.3 2 555 10.1 4 114
Canada 9.0 2 715 8.8 3 287 9.8 4 590
Iceland 8.2 2 446 9.3 3 533 9.5 4 751
Denmark 8.1 2 433 8.3 3 119 9.1 4 289
Norway 7.9 2 497 8.4 4 037 9.1 6 022
Sweden 8.1 2 288 8.4 2 976 9.1 4 027
New Zealand 7.2 1 642 7.7 2 103 9.0 3 233
Italy 7.3 2 062 8.1 2 722 8.9 3 494
Australia b 7.4 2 111 8.3 2 956 8.8 4 121
United Kingdom 7.0 1 827 7.3 2 435 8.3 3 759
Spain 7.4 1 575 7.2 1 991 8.2 3 112
Turkey 3.4 247 6.6 591 7.6    809
Finland 7.5 1 886 6.6 2 249 7.5 3 217

Notes: (a) Expenditures converted to Australian dollar values using GDP purchasing power parities.
 (b) Expenditure based on the OECD System of Health Accounts (SHA) framework.
Source: Health Expenditure Australia, 2005 06.

 



page 227South Australia: Our Health and Health Services

chapter 10

The percentage of South Australians with PHI aged 0 39 years has been sitting at just under 38 percent  
since June 2003.

The percentage of people with PHI has slowly decreased for the 40-64 age cohort from 55.5 per cent in 
June 2003 to 53.0 per cent in June 2007; in contrast, the percentage of people 65+ years of age has steadily 
increased from 41.9 per cent in June 2003, to 45.7 per cent in June 2007.

0

10

20

30

40

50

60

June 2003 June 2004 June 2005 June 2006 June 2007

Pe
rc

en
ta

g
e

Years

0 39

40 64

65+ years

Total

Graph 10.6.2  People with private health insurance as a percentage of their age cohort, South Australia

Source: Private Health Insurance Administration Council (PHIAC).



page 228 South Australia: Our Health and Health Services

chapter 10

10.7  Services and initiatives

South Australia s Health Care Plan has been developed by the South Australian Government to meet future 
challenges of health service delivery through health system reform and represents the most significant  
single investment in health care in South Australia s history. The SA Health Care Plan will reform the state s 
health system so that it meets the health challenges of an ageing population, increasing incidence of  
chronic diseases, international workforce shortages and ageing infrastructure. These changes will ensure  
that South Australians have access to the best available health care in hospitals and health care centres,  
and through GPs and other health professionals.

The new health system outlined in the SA Health Care Plan aims to achieve the best balance between 
enhancing hospital services, reforming mental health care and strengthening primary health care services. 
Health system reform, and the decisions about health services roles and functions, is guided by a range  
of principles that enable ongoing provision of caring, complete, safe, effective and efficient services  
within the new SA Health environment. Key reform principles incorporated include taking a population 
approach in planning the level and location of services, achieving an appropriate balance of in-hospital  
and out-of-hospital health services, consolidating clinical expertise, optimising access to care where needed, 
and ensuring affordability and long-term financial sustainability.

The SA Health Care Plan will mean better coordinated hospital services and a responsive health workforce for 
the future. The  spine  of tertiary hospitals will provide a full range of complex medical, surgical and diagnostic 
services and specialist mental health care, guided by the health reform principles, and consolidating highly 
specialised clinical expertise and complex services in a smaller number of locations. The SA Health Care Plan 
describes the new Marjorie Jackson-Nelson Hospital, which is due for completion in 2016, and is planned both 
to replace the ageing infrastructure at the Royal Adelaide Hospital, and to accommodate some of The Queen 
Elizabeth Hospital s (TQEH) more complex services.

The SA Health Care Plan describes how specialist hospital care will be provided now through this central  spine  
of more complex hospital services comprising the Lyell McEwin Hospital in the north, the Royal Adelaide 
Hospital and the Women s and Children s Hospital (WCH) in the centre, and Flinders Medical Centre in the 
South, and the new Marjorie Jackson-Nelson Hospital into the future. The other metropolitan hospitals, as part 
of the Plan, will be reoriented to provide more general hospital services by increasing routine elective surgery, 
and providing new chronic disease, rehabilitation, drug and alcohol, and palliative care services that are 
delivered in partnership with general practice.

Country SA services will be informed by the SA Country Health Care Plan currently being developed in 
partnership with health units and health professions. Enhancing hospital care in country SA will involve 
expanding existing services at four hospitals located in Berri, Mount Gambier, Port Lincoln and Whyalla;  
so that they can provide a more comprehensive range of services, reducing the need for country residents  
to travel to metropolitan Adelaide.

Strengthening primary health care will involve new models of early intervention provided through newly 
established GP Plus health care centres. GP Plus centres will build on the existing infrastructure of community 
health centres and will be established on the basis of approximately one centre per 100 000 population, 
which means there will be about 10 centres in the Adelaide metropolitan area. Centres are being planned for 
Elizabeth and Marion with centres at Aldinga and Woodville already operating. GP Plus health care centres 
also are planned for Country SA, with one centre planned for Port Pirie; and the redevelopment of the  
Ceduna Health Service to incorporate a GP Plus Health Care Service. These innovative models of primary care 
  designed to help prevent or delay onset of ill health   will be focused on chronic diseases, mental health 
care, rehabilitation, drug and alcohol, and palliative care services. This construct recognises the available  
future workforce across the continuum of care, ensuring timely access to services where and when needed,  
while maintaining quality and safety standards.



page 229South Australia: Our Health and Health Services

chapter 10

10.8  Notes

1.  The University of Sydney, BEACH   GP Patient Encounters in South Australia, April 2005 March 2007, 2007. 

2.  Department of Health, Department of Health, Annual Report, 2005 06, Department of Health, Adelaide, 
2007, viewed 14 September 2007, &lt;http://in.health.sa.gov.au/filestore/061212055.pdf&gt;

3.  Department of Health, ISAAC Reference Manual 2007, Department of Health, Adelaide, 2007,  
viewed 23 November 2007, &lt;http://in.health.sa.gov.au/isaac/&gt;

4.  Australian Institute of Health and Welfare, Health expenditure Australia 2005 06, cat. no. HWE 37, 
AIHW, Canberra, 2007, viewed 14 December 2007, &lt;http://www.aihw.gov.au/publications/index.cfm/
title/10529&gt;

5.  Australian Institute of Health and Welfare, Australian hospital statistics 2005 06, cat. no. HSE 50, AIHW, 
Canberra, 2007, viewed 2 August 2007, &lt;http://www.aihw.gov.au/publications/hse/ahs05-06/ahs05-06.
pdf&gt;

6.  Department of Health and Ageing, Divisions of General Practice Workforce data   1995 96 to 2005-06, 
Department of Health and Ageing, Canberra, viewed 16 August 2007, &lt;http://www.health.gov.au/
internet/wcms/publishing.nsf/Content/health-pcd-programs-workforcestats&gt;

7.  Medicare Australia, GP Attendances (inc practice nurses), 2006 07, Medicare Australia, viewed  
30 November 2007, &lt;http://www.medicareaustralia.gov.au/statistics/dyn_mbs/forms/mbsgtab4.shtml&gt;

8.  Department of Health and Ageing, Medicare Statistics   June Quarter 2007, Table C1A, Department  
of Health and Ageing, viewed 30 November 2007, &lt; http://www.health.gov.au/internet/wcms/
publishing.nsf/Content/medstat-jun07-tables-c&gt;



page 230 South Australia: Our Health and Health Services

chapter 11

1 1   Safety and Quality

In this chapter

Blood safety &gt;

Medication safety &gt;

Health care associated infections &gt;

Pressure ulcer prevention and management &gt;

Patient evaluation of health services &gt;

Sentinel events incident management &gt;

Falls, falls-related injuries and falls incidents &gt;

Initiatives &gt;

Summary

 The introduction of the BloodSafe  pilot program and its interventions reduced the rate of red cell  &gt;
transfusions outside the national guidelines from 18 per cent (2002) to 4 per cent and then a further 
2 per cent after the pilot had been converted into an ongoing program across eight metropolitan 
hospitals in 2005.

 Estimates suggest that each year in Australia in excess of 140 000 hospital admissions are associated with  &gt;
medicine related problems, accounting for 10 20 per cent of the incidents that are reported in hospitals. 
Importantly, a large proportion of these incidents up to 50 per cent are preventable. Medication errors 
in the public hospital system throughout Australia are estimated to cost $380 million per annum.

 Implementation of the National Inpatient Medication Chart in all South Australian public hospitals was  &gt;
completed in March 2007, allowing accurate data collection and the use of a standard medication chart 
across all health sites.

 SA Health is participating in a pharmaceutical reform process that aims to increase equity, access and  &gt;
safety of medication use. One of the fi rst steps, the implementation of national medication management 
guidelines, began in 2007 with the employment of additional pharmacist positions across the metropolitan 
hospitals. Changes associated with the guidelines build in safeguards to medication management practices 
in public hospitals.

 The incidence of health care related infection and appropriate antibiotic use in South Australia s public and  &gt;
private metropolitan hospitals has been monitored since 2001. An improvement has been seen during this 
time in the overall rate of bloodstream infection from 6.5 per 10 000 bed-days in 2002 to 5.9 per 10 000 
bed-days in 2006. The rate of infection due to MRSA (antibiotic-resistant golden staph) has been halved 
over the same period of time, from 3.5 to 1.8 per 10,000 bed-days.

 A Pressure Ulcer Prevention Project was conducted in 2005 involving 13 health services across the state.  &gt;
The key recommendation from that project was to conduct a statewide survey on the prevalence of pressure 
ulcers. The recommended survey, funded by SA Health, has been conducted and demonstrated a strong 
commitment and collaboration across private, community, public and aged care health services in improving 
the quality of health care. The survey results provide a foundation for targeting specifi c actions for reducing 
the prevalence of pressure ulcers



page 231South Australia: Our Health and Health Services

chapter 11

 The Patient Evaluation of Health Services (PEHS) Program indicated consumers had an overall satisfaction  &gt;
rate of 87.2 per cent in 2005.

 SA Health is committed to learning from adverse events that occur in the health system. The fi rst national  &gt;
sentinel event report was released in 2007 by the Australian Institute of Health and Welfare (AIHW) 
based on all states (including South Australia) and territories contributing their sentinel event information 
to a national report. Analysis of adverse events and reporting of improvements made as a result of 
recommendations is published annually in the South Australian Patient Safety Report.

 A recent report by AIHW estimated that falls and related injuries have an annual cost across Australia  &gt;
in excess of $566m.4 Falls injuries are chiefl y a problem associated with older people, and occur at high 
rates in acute, residential and community settings. Risks for falling and for injury vary across settings. 
The draft falls prevention strategy will address data needs and implementation of initiatives to reduce the 
impact of falls.



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Introduction

The delivery of safe, quality health care is fundamental in the strategic directions of SA Health. A clear 
plan and well defined clinical governance for the safe provision of health care is essential. The Patient Safety 
Framework 2002 2006 provided the structure for the coordinated implementation of a statewide safety system. 
This Framework supported effective implementation of:

integrated patient information systems &gt;

centralised electronic incident reporting &gt;

standardised approach to investigating and analysing adverse events &gt;

supported culture change &gt;

redesign of systems through continuous quality improvement. &gt;

The South Australian Safety and Quality Framework &amp; Strategy 2007 2011 was launched in 2007, following broad 
consultation across the state, and investigation of the latest national and international safety and quality 
research and initiatives. This new strategy is centred around consumer and community needs and involves all 
sectors of health care working collaboratively, including primary, public, private, community and aged care. 
The Framework and Strategy guides the improvement of safety and quality of health care in South Australia 
with initiatives across the continuum of care.

The Framework and Strategy comprises five key interconnected and interdependent action areas:

1. Clinical governance &gt;
      Rigorous clinical governance will support safety and quality improvement and enable all stakeholders to 

contribute effectively to safe and high quality care and services.

2. Consumer and community participation  &gt;
     Consumers and the community partner with health services to drive safety and quality improvement.

3. Workforce  &gt;
      The health workforce is equipped and supported to meet health consumer and organisation safety and 

quality needs.

4. Knowledge, information management and technology  &gt;
      Knowledge, information management and technology are used effectively to improve safety and quality 

of care and services.

5. Prioritising and targeting areas of risk and opportunities for improvement &gt;
      The clinical priorities are falls prevention, infection prevention, the safe use of medications, safe use of 

blood products and pressure area prevention.

Improvements in safety and quality 

SA Health safety and quality programs are an integral part of a continuous cycle of improvement. Examples of 
project areas include: 

BloodSafe  &gt;

medication safety &gt;

infection control &gt;

pressure ulcer prevention and management &gt;

patient evaluation of health services &gt;

incident management &gt;

Clinical Practice Improvement &gt;

falls prevention. &gt;



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11.1  Blood safety 

A statewide collaborative called BloodSafe  was formed in 2002 between SA Health, the Australian 
Red Cross Blood Service, and South Australian hospitals and their transfusion providers. BloodSafe  was 
established to coordinate a safety and quality framework for all steps of the blood transfusion process to 
improve patient outcomes and ensure sufficiency of blood supply. The program ran as a pilot for two years 
before becoming an ongoing health funded program with a multidisciplinary team of transfusion nurse 
consultants, medical scientists and haematologists.

The National Health and Medical Research Council and the Australasian Society of Blood Transfusion released 
clinical practice guidelines on the use of blood components in 2001. Audits of red cell transfusions in other 
states indicated that a third of red cell transfusions were inappropriate. BloodSafe  audits at the start of 
the pilot in 2002 found that 18 per cent of red cell transfusions in stable patients were outside the guidelines. 
This rate was reduced to 4 per cent with the initial introduction of BloodSafe  program interventions. 
This rate had reduced further to 2 per cent in 2005, after the pilot was converted into an ongoing program 
across eight metropolitan hospitals.

There has been growing recognition in developed countries in recent years that the current serious hazards 
of transfusion are not so much the viral disease risks but are related more to the administration of blood 
or the wrong blood being given to a patient, which can have fatal consequences. BloodSafe  has worked 
hard to educate staff and consumers, and to redesign systems in hospitals to help prevent these events. 
BloodSafe  has focused in particular on the following areas to improve patient outcomes:

decision to transfuse and dosage of transfusion &gt;

transfusion specimen collection &gt;

bedside administration of blood &gt;

issuance/collection of correct product &gt;

timeliness of transfusion &gt;

special requirements/pre-medication &gt;

anaemia assessment and alternatives &gt;

better engagement of patients and their families/carers in the transfusion process. &gt;

BloodSafe  activities have included the involvement of transfusion scientists to help transfusion laboratories 
better manage their blood stocks and minimise wastage of blood supplies across both the public and private 
sectors, as well as focus on initiatives to improve transfusion practice within hospitals.

The stakeholders involved in the BloodSafe initiative have worked towards a common goal. This has resulted 
in improved sharing of ideas and preventative measures amongst hospitals, with stronger relationships forged 
amongst the organisations involved in the project. Visit the BloodSafe  web site at &lt;http://www.health.
sa.gov.au/BloodSafe&gt; for more information.



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11.2  Medication safety 

Medicines are a key component of disease management and prevention, and make a significant contribution 
to the health and wellbeing of our communities. Use of medicines is not without risks, however, as with 
any form of treatment. Medicine related errors are among the most common medical errors, and the most 
common threat to patient safety. Estimates suggest that each year1 in Australia:

in excess of 140 000 hospital admissions are associated with medicine related problems  &gt;

 medicine related incidents account for 10 20 per cent of the incidents that are reported in hospitals;  &gt;
importantly, a large proportion, up to 50 per cent, of these incidents are preventable

medication errors in the public hospital system are estimated to cost $380 million per annum. &gt;

Medication safety, therefore, is a significant strategic goal for SA Health. A number of initiatives have been 
established to improve medication safety for our patients.

11.2.1 Implementation of National Inpatient Medication Chart (NIMC)
Ensuring that a patient in hospital receives the best medication therapy in an accurate and safe manner 
is a complex process involving many health professionals. One critical element of this process is the 
communication of the medication order or prescription.

Australian Health Ministers agreed in 2004 to implementing a National Inpatient Medication Chart in all 
public hospitals by 2006.

The development of the NIMC was informed by research into the most common errors arising from medication 
charts including human factors research. The NIMC incorporates design features that reduce the potential 
for errors in prescribing, dispensing and administering of medications; including specific sections managing 
high risk processes such as documenting adverse drug reactions and high risk medications such as Warfarin, 
a blood thinning drug. A standard set of abbreviations and administration codes also were incorporated.

Five South Australian hospitals participated in the national pilot and evaluation of the NIMC. The pilot 
hospitals elected to continue using the NIMC on the basis of the demonstrated improvements in medication 
management and reduced errors, and subsequently assisted in developing the plan for statewide 
implementation. SA Health provided resources for project officers to coordinate a series of train-the-trainer 
workshops and to develop tools to assist hospitals in their local implementation. A regular newsletter and 
a comprehensive web site also were used to communicate with hospital teams, provide updates and 
highlight the safety features of the chart.

A feature of the implementation process and the ongoing evaluation of the impact of the NIMC, is the 
collection of pre- and post-implementation audit data using a standard audit tool. These data are 
valuable for highlighting areas for further education, and for benchmarking and achieving quality standards 
for accreditation.

The easier transitioning of staff across sites is an additional benefit of the standardisation of the medication 
chart and of key processes of the medication use cycle; wherever a doctor, nurse or pharmacist works, 
the chart will be the same.

The implementation of the NIMC also was an excellent opportunity to raise awareness of the broader issues 
of medication safety, and of the strategies and processes known to minimise potential for harm.

Implementation of the NIMC in all South Australian public hospitals was completed in March 2007. 
Further work is now underway to develop a number of specialty charts and an electronic version.



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11.2.2 Pharmaceutical Reforms
SA Health continues progress toward implementing the Australian Government s offer of 
Pharmaceutical Reforms.

The objectives of the reforms are to improve:

 equity of access to medications for patients regardless of their place of care   public or private hospital  &gt;
or community care

 safety and quality of medication management, including smooth transitions between hospital and  &gt;
community based care.

The reforms achieve these objectives via two main strategies:

access to medications under the Pharmaceutical Benefi ts Scheme (PBS) for public hospital patients &gt;

 implementation of the Australian Pharmaceutical Advisory Council s (APAC) Guiding Principles to achieve  &gt;
continuity of medication management.2

Implementation of the reforms   and in particular the APAC guidelines   provides an important opportunity 
to make a significant and sustained impact on the safety, quality and continuity of medication management 
for patients of South Australian public hospitals. The 10 guiding principles address all areas of medication 
management in the patient journey, from admission to discharge back to their primary caregiver. 
A component of the reforms, by way of example, is medication reconciliation, including ensuring:

collection of an accurate medication history of every patient  &gt;

confi rmation of details of the medication history  &gt;

 reconciliation of the information (that is, documenting details accurately and ensuring correct information  &gt;
is transferred to the next point in the medication use process).

Other areas covered include, for each patient, preparation of a medication care plan, adverse drug 
reaction management, medication counseling on discharge and timely transfer of medication information. 
These functions typically will be provided by a clinical pharmacist or other trained health professional.

SA Health began a  stepwise  implementation of the APAC guidelines in 2007 with the employment of 
additional pharmacist positions across the metropolitan hospitals. There has been very positive feedback 
on the impact of this strategy to-date. It is anticipated that the PBS component of the reforms will be 
implemented in the 2007 08 financial year and will result in significant improvements in patient outcomes 
by optimising pharmaceutical care.

11.2.3 High risk medications
SA Health also has a key focus on medications associated with a high risk of error. This focus includes 
continued support for research and development of safer systems and decision support tools to reduce the 
associated risks; example are:

 developing standard guidelines for use of anticoagulants (blood thinning medications such as Warfarin  &gt;
and Heparin) with implementation supported by academic detailing; that is, the personal provision of 
information about the effects of medications to the prescriber by a pharmacist

developing an IT-based support tool for medications that are removed from the body via the kidneys &gt;

 alerting the health care system to the high risk for patient harm from errors with medications such as  &gt;
potassium chloride and vincristine injection by promoting educational material and risk reduction strategies 

 conducting research into factors related to insulin and management of hypoglycaemia (low blood sugar)  &gt;
in the acute setting.



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11.3  Health care associated infections

SA Health has been monitoring the incidence of health care associated infection and appropriate antibiotic use 
in its public and private metropolitan hospitals since 2001. An improvement in the overall rate of bloodstream 
infection has been seen in this time, from 6.5 per 10 000 bed-days in 2002 to 5.9 per 10 000 bed-days in 
2006. The rate of infection due to methicillin resistant staphylococcus aureus (MRSA), commonly known as 
antibiotic resistant  golden staph , has been halved over the same period of time, from 3.5 to 1.8 per 10 000 
bed-days. Total antibiotic use has remained fairly constant over the period, although there are some concerns 
about increased use of certain antibiotic classes.

The improvements in infection rates have been achieved through an increased focus on infection control in 
South Australian hospitals that has been largely facilitated through an infection control  link nurse  program, 
funded by SA Health. The Infection Control Service of SA Health oversees this program and delivers centralised 
training in infection control for the nurses who act as a  link  between the hospital s infection control teams 
and the nurses on the wards. 

There has been an increased focus on the role of hand hygiene in the transmission of infection in hospitals, 
and resources have been provided to deal with this problem. SA Health is initiating a project to deliver a 
package of information and education tools to health care facilities, other government departments, businesses 
and schools, designed to raise awareness of the importance of hand and respiratory hygiene in preventing 
the spread of respiratory and gastrointestinal illness within the community as well as in the hospitals.



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11.4  Pressure ulcer prevention and management 

The development of pressure ulcers (commonly known as bed sores) is considered to be largely preventable. 
Pressure ulcer rates continue to be of concern, however, and have an effect on the individual concerned, 
health services and the wider community. Pressure areas can result in pain, decreased mobility and loss of 
independence. It is expected that the prevalence of pressure ulcers will continue to rise as the population ages.

A Pressure Ulcer Prevention Project was conducted in 2005 involving 13 health services across the state. 
The participants in this project delivered a comprehensive set of evidence based guidelines, resources and 
tools that were used to improve the identification, assessment and management of pressure ulcers in their 
health service. This material is available online at &lt;www.safetyandquality.sa.gov.au&gt; and has received 
international interest. 

The key recommendation from that project was to conduct a statewide survey on the prevalence of pressure 
ulcers. The recommended survey, funded by SA Health, has since been conducted, showing a demonstrably 
strong commitment to and collaboration across private, community, public and aged care health services 
to improve the quality of health care, and providing a foundation to target specific actions to reduce the 
prevalence of pressure ulcers. This program is now being extended to continue improvements in managing 
pressure ulcers in South Australia.

Survey data have been complied in the South Australian Pressure Ulcer Point Prevalence Survey Report 2007.3



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11.5  Patient evaluation of health services

The Patient Evaluation of Health Services (PEHS) Program is an initiative of the former South Australian Safety 
and Quality Council. The PEHS Program objective is to monitor consumer satisfaction with health services. 
Surveys are conducted to gain patient s perceptions, experiences and satisfaction with their health service, 
their care and their treatment.

The overnight PEHS survey is a statewide survey designed to monitor, analyse, benchmark and respond to 
patient needs, to enhance service delivery and improve patient outcomes. The 2005 overnight survey presented 
satisfaction scores for a sample of 4 440 adult patients who received at least one night of care in a South 
Australian public hospital in April, May or June 2005. Data were collected from May to October 2005 using 
computer assisted telephone interviewing (CATI) techniques. The Overall Patient Satisfaction Score was 87.2 
statewide, in 2005, higher than the Overall Satisfaction score of 86.3 for the 2003 survey. Participants in the 
age group  65+ years  had a significantly higher level of overall satisfaction than did other age groups.

2001 2002 2003 2005

Year

75

80

85

90

95

100

Sa
ti

sf
ac

ti
on

 le
ve

l (
m

ea
n)

Graph 11.5.1  Overall patient satisfaction from overnight survey 

Source: SA Health, Patient Evaluation of Health Services (PEHS) Overnight Surveys.



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Age groups (years)

16 24 25 34 35 44 45 54 55 64 65+ years

75

80

85

90

95

100

S
at

is
fa

ct
io

n 
le

ve
l (

m
ea

n)
Graph 11.5.2  Patient satisfaction from overnight surveys, by age groups, 2005. 

Source: SA Health, Patient Evaluation of Health Services (PEHS) Overnight Survey 2005.



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11.6  Sentinel events incident management

Patient safety reporting systems enhance patient safety by facilitating learning from the failures and 
vulnerabilities of the health care system. Reporting is fundamental to detecting patient safety hazards; 
however, it cannot alone provide a complete picture of all the sources of risk to patients. Incidents are 
reported into the Advanced Incident Management System (AIMS), a computerised database system used 
to support the reporting, investigation and analysis of clinical incidents. Analysis of incidents and their 
contributing factors at the local and statewide level helps to identify areas where improvements can be 
made to prevent recurrence. Over 22 000 incidents were reported to AIMS during 2004 05.

The South Australian Sentinel Event Reporting System was introduced in 2003, hence the lower number 
of reported events in the initial year. Records for subsequent years demonstrate a maturing reporting system 
with increases in reporting of sentinel events. Better understanding of reporting requirements (for example, 
including reporting of wrong side radiological incidents that did not cause harm) indicates a robust reporting 
culture essential for uncovering the underlying causes for these events occurring. The reporting of sentinel 
events is expected to rise as awareness surrounding sentinel event reporting continues to increase and more 
attention is drawn to reporting.

Sentinel events Notifications Notifications
 received 2003 04 received 2004 05

Procedures involving the wrong patient or body part 0 10

Suicide/suspected suicide of a patient in an inpatient unit 2 4

Retained instruments or other material after surgery requiring another 

operation to remove them or further surgical procedure 0 4

Intravascular gas embolism resulting in death or neurological damage 1 1

Haemolytic blood transfusion reaction resulting from ABO (blood type) incompatibility 1 0

Medication error leading to the death of a patient, and reasonably believed 

to be due to incorrect administration of drugs 0 0

Maternal death or serious morbidity associated with labour or delivery 1 1

Infant discharged to wrong family 0 0

Total 5 20

 

Table 11.6.1  Notification of sentinel events



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Each of these adverse events affects a patient and his/her family and also can affect the health care worker(s). 
SA Health is committed to the thorough investigation of these events and to implementing actions to prevent 
their recurring. Root Cause Analysis (RCA) is the primary means of investigating serious adverse events. 
Events that involve a criminal act, an intentionally unsafe act, patient abuse, or an impaired practitioner 
do not use the RCA process but, rather, are investigated using alternate methods. RCA is a rigorous method 
of investigation to identify system weaknesses and gaps that may not be immediately apparent at initial 
review. The methodology focuses on system improvement, and not on individual performance management, 
which is managed separately.

Core principles of this investigation process include: 

literature review &gt;

extensive examination of the events to uncover underlying contributing factors &gt;

 the potential to lead to procedure and system change; this can occur through system redesign or the  &gt;
introduction of a new process to prevent recurrence

 an interdisciplinary approach   staff on the RCA team have knowledge about the event and the process  &gt;
of care

 a primary focus on systems   staff dig deeper asking what and why until all aspects of the event are  &gt;
reviewed and contributing factors are considered

an environment that is safe from blame and retribution. &gt;

Policies and procedures (18 per cent), staff factors (15 per cent) and communication (13 per cent) were 
the most common contributing factors to adverse events in 2004 05. Some examples of improvements 
in health services introduced as a result of RCA investigations in 2004 05 are: 

 development of an antenatal risk assessment guide and referral plan that sets out the medical referrals  &gt;
needed if complications arise during pregnancy

 change to documentation used in the emergency department that records the assessment of the level of  &gt;
risk of harm in a mental health patient; this incorporates an observation chart and mental health care plan 

 introduction of a form used when providing one-on-one care to mental health patients, which addresses  &gt;
the needs of caring for a patient with suicidal ideation 

establishment of a MET (Medical Emergency Team) as a permanent initiative at a health service &gt;

educating hospital staff on caring for and observing patients with suicidal tendencies &gt;

standardisation of emergency resuscitation trolleys in both layout and content throughout a hospital &gt;

a risk assessment in all ward areas to identify potential hanging points  &gt;

 installation of night lights to assist visibility and reduce risk of falling when patients are walking to  &gt;
the bathroom

introduction of a new form collecting data that alerts staff to patients with allergies &gt;

implementation of the correct patient, correct site, correct procedure policy in operating theatres. &gt;

SA Health supports the review of all deaths that occur during perioperative care. The Royal Australasian 
College of Surgeons (South Australia/Northern Territory), in collaboration with South Australian anaesthetists, 
has been commissioned to conduct the South Australian Audit of Perioperative Mortality. 



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11.7  Falls, fall-related injuries and falls incidents

Fall injuries are an important threat to the continued independence of older people and place significant 
demand on health services. The Safety and Quality Unit recognises that good data are essential to inform 
planning, and to develop and monitor strategies; to this end, a falls and fall-related injury indicator report 
was completed in 2007.5 The data presented here extend and complement those presented in chapter eight, 
Older People, of this publication.

11.7.1 The impact on health services
The rate of falling is known to increase ten-fold between 65 and 90 years of age. Older people use health 
services at a higher rate than those aged under 65. The proportion of resources taken up by falls and 
fall-related injury is expected to rise until 2050, particularly as there will be an increasing number of people 
in the older, high risk band.6 

Table 11.7.1 shows the impact of falls and fall-related injuries on health services within the context of the 
demand generated by first, the total population, and second, those over 65+ years. Hospitalisation represents 
the most visible layer of the service demand of fall injury. It is important to note that these data do not include 
any inward transfers for rehabilitation or convalescence, although estimates based on national data suggest 
that these will add 36 per cent to bed days.4 

There are no systematic statewide data currently on fall injuries presenting to either emergency departments 
or general practitioners; however, South Australian Monitoring and Surveillance System (SAMSS) data indicate 
that nearly 30 per cent of older people report one or more falls in a given year, with 12.1 per cent of those 
requiring medical treatment. Hospital separations due to falls accounted for 5.4 per cent of all separations 
of older people.

SA Ambulance Service data for 2006 show that 9 745 persons over 65 were carried by ambulance after 
a fall (65 per cent female, 35 per cent male). Ambulance attendance for  lift only  without transport also are 
believed to represent a smaller, but significant demand on this service. Data analysis shows that the most 
common place for falls requiring ambulance attendance was the home, followed by places of medical or 
nursing care   including residential aged care. Older people also fall while outdoors and in places of business 
(for example, in shops) indicating that falls are not limited to those who are most frail and housebound.

Injuries and deaths as a result of falls from a height, particularly ladders, have been reported by AIHW to 
be an increasing problem, particularly among older men. A recent study conducted at the Royal Adelaide 
Hospital7 concurs with national data and trends. Two-thirds of hospitalised injury incidents from ladder falls 
in Australia in 2004 05 resulted in fractures, most occurred at home, and they resulted in a mean length 
of stay of 5.3 days.8

Population Hospital separations Hospital bed days

Total population 390 616 1 606 320

People over 65 years 144 528 803 160
 37 per cent for total separation 50 per cent for total bed-days

Fallers over 65 years 9 095 87 012
 5.4 per cent of 65+ separations 7.8 per cent of 65+ bed-days
 2.3 per cent for total separations 5.4 per cent for total bed-days
  Average length of stay (LOS)   9.6 days

Source:  SA Health, Integrated South Australian Activity Collection (ISAAC).
 

Table 11.7.1  Separations and bed-days for fall-related injury, 2006 07



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11.7.2 The impact of falls injury on older people
Falls have a major effect on older people, in addition to the demand placed on health services. 
The international literature has demonstrated that falls, and the injuries they cause, contribute to a rapid 
decrease in independence, severely reduced mobility and are a major reason for the decision to seek 
supported residential care.9

Hip fractures are of particular concern because they can have a major impact on mobility, independence and 
mortality, despite the length of stay being similar to that of other falls-related injury episodes. Hip fractures are 
present in approximately 20 per cent of fall-related hospital separations. The pattern of increasing numbers 
of cases between 2002 and 2006, and with increases in age, is clearly evident in the Table 11.7.2.

11.7.3 Fall injury risk during acute care
Data extracted from the Advanced Incident Management System (AIMS) provide sufficient evidence that 
there is a need to manage risk while people are receiving inpatient treatment (Table 11.7.3). Falls are the most 
commonly reported incident (28 per cent). A comparison of falls incident data for all South Australian health 
services was made between two six-month periods, 1 January to 30 June in both 2006 and 2007. There was 
a 9 per cent increase in the recorded number of falls incidents in 2007, compared to 2006, with most of this 
increase occurring in the metropolitan regions. This change could be predicted by increased use of inpatient 
services and increasing population age, but also may be attributable to interventions designed to increase 
incident reporting. AIMS collects data through voluntary reporting of hazards and adverse incidents occurring 
in health facilities. This form of reporting is not designed to define denominator based injury rates. It can be 
well used, however, for monitoring and managing falls incidents.

Table 11.7.2  Fractures of femur, hospital separations for persons aged 65+ years by year of separation, 

       gender and age group.

 Male Female

Year 2002 2003 2004 2005 2006 Total 2002 2003 2004 2005 2006 Total

      Male      Female

Age
group
65 to 69 23 15 21 35 35 129 43 54 38 45 46 226
70 to 74 54 37 45 59 44 239 113 106 86 90 118 513
75 to 79 85 86 82 80 96 429 222 228 207 224 221 1 102
80 to 84 114 139 119 119 134 625 319 384 366 381 386 1 836 
85+ years 195 165 175 175 211 921 666 684 616 673 741 3 380

Total 471 442 442 468 520 2 343 1 363 1 456 1 313 1 413 1 512 7 057

Note: ICD-10 codes for fracture type (primarily neck of femur) specified by Vit D Working Party.
Source: SA Health, Integrated South Australian Activity Collection (ISAAC).
 



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No injury (46 per cent) resulted from 1 537 falls in the six months January to June 2007. However, 931 
superficial wounds, open wounds and damage to joint structures, blood vessels and muscles or tendons were 
reported, with 25 fractures. Some incidents resulted in more than one injury.

11.7.4 Fall injury risk in residential aged care
People in residential aged care are very vulnerable to fall injuries. Supplementation with Vitamin D and 
calcium are known to reduce the rates of fracture injury from falls in the residential aged care population, 
where there is almost universal deficiency in Vitamin D, through improving both bone and muscle strength. 
The Osteoporosis and Fracture Prevention Working Party is promoting prescription of Vitamin D and calcium 
through training doctors and staff of residential aged care. Sales of a Vitamin D and calcium preparation with 
the recommended dosage have risen steadily all over Australia, but particularly in South Australia where the 
per capita sales are now 250 per cent of the per capita sales in the rest of Australia. However, the proportion 
of the preparation s uptake in residential aged care is unknown. This important initiative is critical in reducing 
the mortality and morbidity associated with falls in older people, especially those in residential care.

SA Ambulance Service data in Graph 11.7.1 show how important fall injury is in residential aged care. 
Rates vary from approximately 150 to 275 ambulance transport journeys per 1 000 residents annually. Risk 
management in Residential Aged Care is an Australian Government responsibility, but fall injuries in this 
setting clearly have an effect on state run services such as SA Ambulance Service and hospitals.

Health service location Number of incidents, Number of incidents,
 January to December 2006 January to December 2007

Metropolitan 1 491 1 762

Country 1 534 1 568

Total 3 033 3 339

Source: Australian Patient Safety Foundation (APSF).
 

Table 11.7.3  Total number of falls reported through AIMS



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11.7.5 Data initiatives
The Safety and Quality Unit is planning the following data initiatives as a consequence of the drafting of 
the SA Falls Prevention and Management Strategic Plan and the completion of the report on falls indicators.5 

A consultant will be commissioned to work with the Osteoporosis and Fracture Prevention Working Party 
to establish whether the hip fracture rate in South Australia is falling compared with other states and plan to:

 further interrogate SAMSS data to establish trends in service utilisation after falls, fall-related behaviours  &gt;
and risk factors among older people residing in the community

further improve AIMS reporting processes and audit prevention programs to better identify those at risk &gt;

explore establishing consistent emergency department data in relation to falls injuries &gt;

explore data around ambulance attendance for  lift only  attendances without transport, and repeat fallers. &gt;

0

50

100

150

200

250

300

Age groups (years)

Ra
te

 p
er

 1
 0

00

65 69 70 74 75 79 80 84 85 89 90 94 95+ years

Graph 11.7.1  Ambulance transport journeys from Residential Aged Care facilities for people aged 65+ years 

         as a result of a fall, 2006   

Source:  SA Ambulance and AIHW nursing home population data.

Male

Female



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11.8  Initiatives

Statewide initiatives in safety and quality form a coordinated approach to risk management and quality 
improvement in health. Initiatives are led by the Department of Health in collaboration with health services, 
driven from local needs and enabled throughout SA Health. The system also is responsive to safety priorities 
that are identified proactively and corrected by system redesign when appropriate. 

11.8.1 Safety and Quality Overview
The South Australian Safety and Quality Framework &amp; Strategy 2007 2011, with its five action areas, is available 
at &lt;www.safetyandquality.sa.gov.au&gt;.

Three new groups were formed in 2007 to support and guide safety and quality improvements in the 
state. The South Australian Council for Safety and Quality in Health Care (the Council) is an advisory body 
to the Ministers for Health, and Mental Health and Substance Abuse. The Council comprises senior 
clinical and management leaders in health care and consumers, and is led by an independent Chair. 
A consumer-based body   the South Australian Safety and Quality in Health Care Consumer and Community 
Advisory Committee   provides advice to the Council on the consumer perspective of safety and quality 
issues in health care. The South Australian Safety and Quality in Health Care Clinical Governance Committee, 
with representation from heads of clinical governance from South Australia s health system, assists in 
planning the implementation of the SA Safety and Quality Framework &amp; Strategy 2007 2011.

A Patient Safety Workshop incorporating Root Cause Analysis training has been provided by 
the Safety and Quality Unit to SA Health clinicians since 2003 and is ongoing. A report on patient 
safety   Improving the System: South Australian Patient Safety Report   was released in 2007 (available at 
&lt;www.safetyandquality.sa.gov.au&gt;).



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11.8.2 Clinical links
Many of the initiatives discussed in this chapter are examples of significant programs with ongoing work. 
The following is a summary of links, reports and current projects.

BloodSafe , web site at &lt;http://www.health.sa.gov.au/BloodSafe&gt;. &gt;

 Implementation of the National Inpatient Medication Chart (NIMC) was completed across all  &gt;
South Australian hospitals in March 2007. Further work is underway now to develop a number of speciality 
charts and to deliver an electronic version. More information is available at &lt;http://www.safetyandquality.
sa.gov.au/nimc&gt; and &lt;www.safetyandquality.gov.au&gt;

 Staged implementation of Pharmaceutical Reforms will continue in 2007 08. More information   including  &gt;
a copy of the national medication management guidelines   is available at &lt;http://www.safetyandquality.
sa.gov.au/pharmreforms&gt;

 Delivery is underway in 2007 08 of a hand hygiene information package and education tools to health care  &gt;
facilities, other government departments, businesses and schools. This program aims to raise awareness of 
the importance of hand and respiratory hygiene in preventing the spread of respiratory and gastrointestinal 
illness within the community and hospitals.

 The draft South Australian Pressure Ulcer Point Prevalence Survey Report, 2007 will be released after its  &gt;
ratifi cation. A copy will be available at &lt;http://www.safetyandquality.sa.gov.au&gt;. Recommendations that 
may become future initiatives are listed in the report.

 The Patient Evaluation of Health Services (PEHS) is a survey initiative in place to continuously monitor  &gt;
and respond to patient needs to enhance service delivery and improve patient outcomes, available at 
&lt;http://www.health.sa.gov.au/pros&gt;.

 Sentinel events are analysed primarily using the Root Cause Analysis (RCA) model; this ongoing cycle,  &gt;
including expert stakeholder input, facilitates both local problem  solving and the establishment of more 
widespread solutions such as the Medical Emergency Team (MET) approach.

 The Osteoporosis and Fracture Prevention Working Party is implementing activities to help reduce the  &gt;
harmful impact of falls by promoting the supplementation of Vitamin D and calcium for people who are 
living in residential care.

 The South Australian Falls Prevention and Management Plan has been drafted, as has a program for  &gt;
implementation of national guidelines for falls prevention in acute and residential aged care.



page 248 South Australia: Our Health and Health Services

chapter 11

11.9  Notes

1  Australian Council for Safety and Quality in Health Care, Second National Report on Patient Safety: 
Improving Medication Safety, Commonwealth Department of Health, Canberra, 2002, viewed 28 
November 2007, &lt;http://www.safetyandquality.gov.au/internet/safety/publishing.nsf/Content/
F0FD7442D1F2F8DDCA2571C6000894FF/$File/med_saf_rept.pdf&gt;

2  Australian Pharmaceutical Advisory Council, Guiding principles to achieve continuity in medication 
management, Commonwealth of Australia, Canberra, 2005 viewed 4 December 2007, 
&lt;http://www.health.gov.au/internet/wcms/publishing.nsf/Content/D900D825B95328DACA25705A
00181F55/$File/guiding.pdf&gt;

3  Department of Health South Australia, South Australian Pressure Ulcer Point Prevalence Survey Report 2007, 
Department of Health South Australia, Adelaide, 2007, will shortly be available to be viewed at 
&lt;http://www.safetyandquality.sa.gov.au&gt;

4  C Bradley and J E Harrison, 2007,  Hospitalisations due to falls in older people, Australia, 2003 04.  
Injury research and statistics series number 32. AIHW cat. No. Injcat 96:Adelaide.

5  J Moller, 2007, Falls and fall-related injuries among older people: Indicators for planning and monitoring. 
A preliminary review of South Australian Health approaches, in draft.

6  J Moller, 2002, Patterns of fall injury in an ageing population in South Australia: A challenge for 
prevention and care. South Australia DHS.

7  A Kent and A Pearce, 2006,  Review of morbidity and mortality associated with falls from heights among 
patients presenting to a major trauma centre.  Emergency Medicine Australasia, 18: 23 30.

8 C Bradley, 2007,  Ladder-related fall injuries , AIHW, Number 11, August 2007, Injcat No 105.

9  L Z Rubenstein, 2006  Falls in older people: epidemiology, risk factors and strategies for prevention.  
Age and Ageing 35 (Supplement2:ii37 ii41;doi:10.1093/ageing/afl084).



page 249South Australia: Our Health and Health Services

appendices

Appendices

Appendix 1   Glossary

Acute Of relatively short duration and relatively high severity.

Adverse event  A situation in which an individual receiving health care has been 
harmed in some way, as a direct or indirect effect in relation to 
that care.

Age-sex standardisation  A technique which allows more meaningful comparisons of two 
or more populations by adjusting for the effects of age and sex.

Anxiety conditions  Mental disorders in which anxiety, as a normal response to stress, 
becomes exacerbated into an  excessive  reaction, ranging from 
pervasive low-level feelings of dread to panic attacks; this family 
of conditions includes social phobia, generalised anxiety disorder, 
obsessive compulsive disorder, post-traumatic stress disorder, and 
panic disorder.

Available beds  Those beds in a hospital that are staffed and available for use by 
overnight stay admitted patients as required.

Average length of stay  The average number of days patients stay in hospital; admissions 
and separations from hospital on the same day count as one day.

Avoidable mortality  The deaths of people aged between birth and 74-years-old, of causes 
that led to deaths that could have been avoided by preventative or 
therapeutic means.

Baby boomer  An Australian born between the mid-1940s and the mid-1960s, 
which was a post-war period of increased fertility.

Birth weight  The weight of a newborn, immediately after birth.

Burden of disease  The complete effect of disease on society measured by years of 
life lost to ill-health (see YLL) and  healthy  years of life lost due to 
disability (see YLD).

Caesarean section  As distinct from vaginal birth, the delivery of a fetus by surgically 
removing the fetus from the uterus through the abdomen.

Cardiovascular disease (CVD)  Diseases of the circulatory system, including the heart, veins, arteries 
and capillaries; for example, myocardial infarction (heart attack), 
congestive heart failure, and trans ischaemic attack (stroke).

Cerebrovascular disease  Stroke, in which the brain is damaged by the effects of blocked, burst 
or malfunctioning blood vessels in the head.

Chronic diseases  Diseases and disorders characterised by being of relatively long 
duration and persistence, often with low-level and/or ongoing 
symptoms that are not immediately life-threatening.

Clinical urgency  A clinical assessment of the urgency within which a patient requires 
elective hospital care; there are three urgency categories: urgent, 
semi-urgent and non-urgent.

Cohort  A group whose individuals have defined characteristics in common, 
such as age and risk factors, or age and gender; used in statistics 
to limit the parameters of a generational group for the purposes 
of study (for example, all children born in 1999, women within 
childbearing age).



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Co-morbidity  Diseases and/or disorders that exist together in the same patient; 
for example, obesity and Type 2 diabetes.

COPD  The acronym for chronic obstructive pulmonary disease, a respiratory 
disease in which breathing becomes forced and laboured, such as 
in emphysema.

Crude birth rate  The number of live births per 1 000 population in a given year; 
the term  crude  is used because the calculation does not account 
for age and sex differences (see age-sex standardisation).

Crude death rate  The number of deaths per 1 000 population during a given period, 
usually a year.

Depression  A disorder characterised by prolonged periods of sadness, despair, 
and feelings of inadequacy, in which sufferers may experience 
symptoms ranging from pronounced ennui and lack of energy, 
disinterest in the normal activities of life, and an inability to see an 
end in sight to feeling low, through to suicidal thoughts and action.

Disability adjusted A way of measuring the combined effect of morbidity (disease and 
life year (DALY) disorder) and mortality (loss of life) that shows the  burden of disease .

Elective care  Treatment that is clinically necessary but does not require immediate 
attention or admission to a hospital within 24 hours.

Elective surgery  Elective care in which patient procedures are listed in the surgical 
operations section of the Medicare Benefits Schedule, excluding 
specific procedures performed by non-surgical clinicians as well 
as some procedures where the associated waiting time is strongly 
influenced by factors other than the supply of services.

Endemic  A disease or condition that is indigenous to an area or a population.

Epidemic  A contagious disease (such as influenza) that is not normally 
endemic, characterised by a rapid spread throughout a population 
and affecting atypically large numbers (although not necessarily all) 
of them.

Episode of care  The period of admitted patient care characterised by one type of care, 
(for example, acute care and maintenance care). 

External cause  The environmental event, circumstance or condition that has caused 
an injury or illness; for example, pollution or poison (environmental) 
or car accident (circumstance).

Fertility rate  The number of children an (imaginary) individual woman could 
bear if the age-specific rates of the year shown continued during her 
child-bearing lifetime, typically regarded as being between 15 44 
years or 15 49 years of age.

Health  The condition in which an individual enjoys not just the absence 
of disease or injury in both body and mind, but also experiences 
the presence of vigour, strength and good function, as a normal 
or usual state.

Health adjusted life A measure of quality of life, as well as quantity (also referred to 
expectancy (HALE) as `Healthy life expectancy ), defined by the Australian Institute of 
 Health and Welfare as an estimate of the average years of equivalent 
  healthy  life that a person can expect to live at various ages.



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appendices

Hospital  A health care facility established under Commonwealth, state or 
territory legislation as a hospital or a free-standing day procedure unit 
and authorised to provide treatment and/or care to patients.

ICD-10  The tenth revision of the International Classification of Diseases 
developed by the World Health Organization. The suffix of AM 
(ICD-10-AM) means Australian modifications, the version in use in 
Australian hospitals.

Incidence  The number of instances of illness, or individuals who fall ill, 
during a specified period in a particular population.

Infant mortality  The death of a child before his or her first birthday.

Ischaemic heart disease  Disease characterised by reduced blood supply to the heart muscles, 
often because of blockages in the arteries; it may lead to angina 
(chest pain) and heart attack; also known as coronary heart disease. 

K10  A diagnostic tool called the Kessler Psychological Distress 10 item 
scale (K10), involving a scale of 10 questions, the answers to which 
identify the level of psychological distress (anxiety and depression) 
in the individual over the four weeks preceding questioning.

Labour force  Those members of the population who either are employed or, 
while unemployed, are seeking employment.

Length of stay  The duration of a patient s stay in hospital from admission to 
separation, minus any time the patient was  on leave . Patients 
admitted and separated on the same day are assigned a stay of 
one day.

Life expectancy (LE)  The likelihood of living an average number of further years at a 
particular age.

Maternal death  The death of a woman during her pregnancy or within 42 days of 
the pregnancy s end, due to any cause arising from or worsened by 
the pregnancy but excluding both accidental and incidental causes.

Median The middle point in a series of values.

Morbidity  A term that refers both to an individual s ill health and to ill health 
within a population or group; usually expressed as a rate or incidence.

Mortality rate  The rate of death in a population in a given area and period of time, 
expressed as a ratio of deaths per 1 000 people.

Neonatal death An live born infant who dies within 28 days of birth.

Neonatal morbidity  Any condition or disease diagnosed in an infant within 28 days 
of birth.

Neoplasm  A new growth within the body (often called a tumour), which may 
be either malignant or benign, but which serves no purpose.

Neurotic  An encompassing term describing behaviours often associated with 
anxiety conditions, and manifesting either or both emotional or 
physical symptoms that may be self-harmful or socially inappropriate.

Pandemic  A term describing an epidemic that affects large numbers of 
people across geographic areas on a scale ranging from national to 
continental to planetary.

Perinatal  The period around birth, from the 20th week of gestation to 28 days 
after delivery.



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appendices

Postnatal  Matters concerning newborn infants, in the period immediately 
after birth.

Potentially preventable Hospitalisations for conditions which might be avoided if appropriate, 
hospitalisations necessary and timely care is given elsewhere.

Prevalence  The total number of instances of a particular disease or condition 
in a specified population at a defined time.

Principal diagnosis  The diagnosis established after study to be chiefly responsible for 
occasioning an episode of admitted patient care.

Private hospital  A privately owned and operated institution, catering for patients 
who are treated by a doctor of their own choice. Patients are 
charged fees for accommodation and other services provided by 
the hospital and relevant medical and paramedical practitioners. 
Acute care and psychiatric hospitals are included, as are private 
free-standing day hospital facilities.

Public hospital  A hospital controlled by a state or territory health authority. 
Public hospitals offer free diagnostic services, treatment, care and 
accommodation to all eligible patients.

Quintile  One fifth of the total sample, obtained by dividing into five equal parts 
the total of a population that has been organised by specific criteria.

Remoteness Area  The division of Australian into five levels of remoteness based 
on Accessibility/Remoteness Index of Australia. The categories of 
remoteness are: Major cities, Inner regional, Outer regional, 
Remote, and Very remote.

Schizophrenia  Mental illness characterised by an individual s disconnect with 
and removal from reality through delusions and hallucinations, 
accompanied by problems around mood and motivation.

Self-assessed health status  The way in which a person perceives (and reports) his or her own 
health and wellbeing.

Separation  The point at which a patient s episode of care in hospital has ended, 
either through discharge, transfer to another health facility, death or 
change in episode of care.

Socioeconomic disadvantage  A situation where one or more groups in a community has fewer 
financial and material resources, as measured against others 
within that community; individuals who are socioeconomically 
disadvantaged typically have reduced access to education, health, 
information, food and housing, and so on, compared to others of 
their age and gender in the same community.

Statistical Local Areas (SLAs)  Defined geographical areas based on the boundaries of incorporated 
bodies of local government where these exist; these bodies are the 
Local Government Councils and the geographical areas which they 
administer are known as Local Government Areas (LGAs).

Triage category  A method of indicating the urgency of the patient s need for clinical 
care in Emergency Departments. Patients are triaged into one of five 
categories specified in the Australian National Triage Scale.



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appendices

Years lost to disability A measure of the morbidity burden of a disease in a population. 
or illness (YLD) YLDs represent the number of  healthy  years of life lost due to 
 disability. Disability refers in this definition to any departure from an 
 ideal health state. Each stage of each condition is given a severity 
 weight between 0 and 1 (for example, 0.5 or 0.3 or 1); in this severity
 weight 1 is the most severe. YLD are the product of the number of 
 incident cases of the condition in the reference period, the severity 
 weight for the condition and the average duration in years of the 
 condition; for example, 10 incident cases of a disease which has a 
 severity of 0.5 and lasts on average for two years would have a 
 morbidity burden of 10x0.5x2=10 YLD.

Years of life lost (YLL)  A measure of the burden of premature mortality in a population, 
equal to the number of years of expected life not lived due to death 
from a given condition. For example, if there are 10 deaths from 
a certain disease in the female 45 54 age category, the average 
age at death for deaths in the 45 54 age female category is 50, 
and the standard life expectancy for 50-year-old women is taken as 
32 years, then the burden of premature death from that disease is 
10x32=320 YLL.



page 254 South Australia: Our Health and Health Services

appendices

Appendix 2   Data sources

This section provides a brief description of the major data sources used to produce the information presented 
in this report.

Confidence intervals are not shown throughout the report for data taken from the surveys. Surveys are based 
on a limited numbers of participants/respondents and hence the level of reliability of the data is variable.

SA Health data collections
The quality of data used throughout this report is good overall. Attention has been paid to data quality to 
ensure clean and standardised information. However, in some cases, errors or inconsistencies in the data may 
be present. Data used from earlier years may be less reliable than that produced more recently.

Collection Description

Advanced Incident  Collection based on adverse events/incidents that occur in major
Management System (AIMS) metropolitan and country public hospitals.

Booking List Information Monthly data provided by seven major metropolitan hospitals around 
System (BLIS) patients who are on a waiting list for elective surgery.

Child Adolescent Mental Client-level collection based on services provided by South Australia s 
Health System two units that provide specialist child and adolescent mental 
 health services.

Central Cancer Registry  Collection designed to monitor trends in cancer incidence, mortality 
and survival.

Community Based Data on all non-inpatient contacts with the mental health system.
Information System (CBIS) 

Country Consolidation Client and activity data from country Community Health Centres, 
CME (CCC) including mental health and palliative care contacts.

Emergency Department Patient-level collection based on services provided in emergency 
Data Collection departments in major metropolitan hospitals.

Health Omnibus Survey  Population health survey (face-to-face) conducted annually for 
government and non-government organisations responsible for 
servicing the health needs of the South Australian community; 
surveys conducted on a user-pays basis.

Home and Community Care Survey of HACC services provided by public health units and the 
(HACC) Data Collection non government sector; conducted in May and November each year.

Integrated South Australian Hospital morbidity database covering inpatient separations from 
Activity Collection (ISAAC) all public and private hospitals, including day surgery facilities, 
 in South Australia.

Monthly Management A monthly summary of activity, workforce, finance and patient 
Summary System (MMSS) account data from all public health units.

Patient Evaluation  Statewide survey designed to monitor, analyse, benchmark and 
of Health Services (PEHS)  respond to patient needs, to enhance service delivery and improve 
Overnight Survey patient outcomes.

South Australian Burden Describes the amount of ill health and premature death in South 
of Diseases Study Australia for a comprehensive list of illnesses and injuries, using 
 summary population health measures: Years of life lost (YLL), 
 Years of healthy life lost to disability (YLD), Disability adjusted life 
 years (DALY) and Health adjusted life expectancy (HALE) measures.



page 255South Australia: Our Health and Health Services

appendices

South Australian Monitoring Representative population data for South Australians collected via  
and Surveillance System telephone surveys (minimum 600 interviews per month); provides  
(SAMSS) Survey trend information on risk factors and chronic diseases.

South Australian Pressure A snapshot of the current number of patients in hospital with a 
Ulcer Point Prevalence pressure ulcer at any one time; measures the extent of the pressure  
Survey (PUPPS) ulcer problem.

Sentinel Events Collection for monitoring a core set of sentinel events in major  
Reporting System metropolitan and country public hospitals; recently expanded to  
 include mental health reportable events.

Other data sources

Collection Description

Active Australia Survey (AAS)  Survey conducted by the Australian Institute of Health and Welfare 
(AIHW) designed to measure participation in leisure-time physical 
activity and to assess knowledge of current public health measures 
about the health benefits of physical activity.

Bettering the Evaluation and Information about the clinical activities in general practice in Australia,  
Care of Health (BEACH) Survey including characteristics of the general practitioner, patients seen,  
 reasons people seek medical care, problems managed, and data  
 around problem managed.

Child Dental Health An annual monitoring survey of the oral health of children under  
Surveys (CDHS) care of the eight state and territory school dental services, providing  
 descriptive yearly epidemiological and service provision data  
 concerning children s dental health in Australia.

Deaths data  Coded deaths data provided by the Australian Bureau of Statistics 
(ABS); a primary source for analysing deaths data.

National Aboriginal and Provides information about the health circumstances of Aboriginal  
Torres Strait Islander Health and Torres Strait Islander Australians from remote and non-remote  
Survey (NATSIHS) areas across Australia, and about how these circumstances have  
 changed compared with results from Aboriginal and Torres Strait  
 Islander components of the National Health Surveys.

National Dental Telephone An annual survey which collects data on basic features of oral health  
Interview Survey (NDTIS) and dental care within the Australian population.

National Health Survey (NHS)   A series of regular population surveys designed to obtain national 
benchmark information on a range of health-related issues and to 
enable health trend monitoring over time.

National Survey of Adult An oral health examination survey aimed to describe levels of oral  
Oral Health (NSAOH) disease, perceptions of health and patterns of dental care within  
 a representative cross-section of adults in all states and territories  
 in Australia.

National Survey of Mental Gathers information on the prevalence of mental illness in the  
Health and Wellbeing Australian population, the amount of associated disablement, and the 
(NSMHW) use of health and other services by people with mental disorders or  
 mental health problems; comprises three components: an adult study,  
 a child and adolescent study, and a study of low-prevalence  
 (psychotic) disorders such as schizophrenia.

Socio-Economic Indicators Dataset that defines the socioeconomic wellbeing of Australian 
for Areas (SEIFA) communities at the small area level; derived from ABS Census data.



For more information 

Policy &amp; Intergovernment Relations Division 
SA Health 
PO Box 287 Rundle Mall 
ADELAIDE 5000 
Telephone: +61 8 8226 7329 
www.health.sa.gov.au

Non-English speaking: (08) 8226 1990 for information in 
languages other than English, call the interpreting and 
Translating Centre and ask them to call The Department 
of Health. This service is available at no cost to you.

 Department of Health, Government of South Australia.  
All rights reserved. ISBN: 9780730898207   
Printed June 2008.




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