Australia’s National Chronic Disease Strategy states that “the global burden of chronic disease is increasing rapidly and...by the year 2020 chronic disease will account for almost three quarters of all deaths. In Australia, the burden of chronic disease and its consequent effect on disability and death is growing in line with this trend.”

In 2004-05, more than 9/10 Australians had at least one chronic disease risk factor, and more than 4/10 had at least three. Many of the risk factors for chronic disease are preventable.

Employers bear some of the financial burden of chronic disease through increased rates of absenteeism, reduced productivity and a smaller pool of potential employees, since people with chronic disease are less likely to be in the workforce.

Employers also have an opportunity to help reduce these costs, by raising awareness of risk factors that increase the likelihood of chronic disease, and encouraging workers to live healthfully.

According to the National Chronic Disease Strategy: “The effectiveness of health messages will be enhanced if consistent messages are reinforced in multiple settings—through media, community settings, workplaces, educational settings and health services.”

This briefing paper provides a general introduction to chronic disease in Australia, and focuses on the interaction between chronic disease and work. Most of the information is drawn from reports sourced on this Australian Institute of Health and Welfare website.

Definition

According to the Australian Institute of Health and Welfare, chronic diseases:

• Have complex and multiple causes;
• Usually have a gradual onset, although they can have sudden onset and acute stages;
• Become more prevalent with age (although they may occur at any point across the life cycle);
• Are long term and persistent, leading to a gradual deterioration of health; and
• While usually not immediately life threatening, are the most common cause of premature mortality.

Chronic diseases are unlikely to have a cure (although treatment and management is possible), and do not tend to resolve of their own accord.

Examples

The World Health Organisation’s 2005 report, “Preventing Chronic Diseases: a vital investment,” lists the following chronic diseases, which are of global significance:

• Cardiovascular diseases, mainly heart disease and stroke;
• Cancer;
• Chronic respiratory diseases;
• Diabetes;
• Mental disorders;
• Vision and hearing impairment;
• Oral diseases;
• Bone and joint disorders; and
• Genetic disorders.

The Australian government has identified five national health priority areas which relate to the following chronic diseases:

• Asthma;
• Cancer;
• Diabetes;
• Heart, stroke and vascular disease; and
• Osteoarthritis, rheumatoid arthritis and osteoporosis.

Stats about chronic disease in Australia

Just over 7 million Australians have at least one chronic condition.

In 2004-05, of the approximately 10.5 million Australians aged 25–64 years, about 33% (close to 3.5 million) reported at least one of the following chronic diseases: arthritis, asthma, coronary heart disease, chronic obstructive pulmonary disease, depression, diabetes, osteoporosis or cerebrovascular disease (stroke). The most commonly reported chronic diseases were arthritis, asthma and depression.

Australians are not equally prone to developing chronic diseases:

• As people age they are more likely to suffer from chronic disease, and more likely to suffer from more than one such disease: 54% of 55–64 year olds compared with 21% of 25–34 year olds have a chronic disease; and
• Indigenous Australians experience higher levels of certain chronic conditions than non-Indigenous Australians, including hypertensive disease, other diseases of the heart and circulatory system, asthma, diabetes, arthritis and kidney disease.

Chronic disease and work

Overall, people without chronic disease are more likely to be in full-time employment than those with chronic disease (61% compared with 48%).

Amongst those who are working, chronic disease prevalence is highest, for males and females, among labourers and related workers (31% and 38%, respectively) and among advanced clerical and service workers (29% and 38%, respectively). Managers and administrators show the lowest prevalence of chronic disease among males and females (22% and 29%, respectively).

According to “Chronic Disease and Participation in Work,” a report released by the Australian Institute of Health and Welfare in 2009:

• Chronic disease affects about one-third of the approximately 10.5 million working-aged Australians.
• People with chronic disease average nearly half a day (0.48) off work in the previous fortnight compared with a quarter of a day (0.25) for people without chronic disease.
• People with multiple chronic diseases have, on average, more days away from work than people with no chronic disease or one chronic disease. Overall, people with three or more chronic diseases have, on average, 1.7 days away from work in the fortnight, compared with 0.4 days for people with one chronic disease. On average, males and females with three or more chronic diseases had 2.0 days and 0.9 days off, respectively, in the previous fortnight, compared with 0.5 and 0.4 days for those with one chronic disease.
• Arthritis, asthma and depression are associated with 76% of the total loss due to days away from work (29% associated with depression, 24% with arthritis and 23% with asthma).

Why are more and more people suffering from chronic disease?

During the twentieth century, chronic diseases replaced infectious diseases and injuries as the dominant health concern. According to Australia’s National Chronic Disease Strategy, this shift is due to a range of factors, including:

• Major advances in the prevention and treatment of infectious diseases and injuries;
• Demographic changes, i.e. the ageing population; and
• Lifestyle changes, for example, the increasing risky use of alcohol.

What are the preventable risk factors for chronic disease?

About one third of Australia’s burden of chronic disease is attributable to the following seven, largely preventable risk factors:

• Tobacco smoking;
• Risky and high alcohol use;
• Physical inactivity;
• Poor diet and nutrition;
• Excess weight;
• High blood pressure; and
• High blood cholesterol.

In 2004-05, more than nine in ten Australian adults had at least one chronic disease risk factor with 44% having at least three modifiable risk factors:

• 86% reported inadequate vegetable consumption;
• Almost 46% reported inadequate fruit consumption;
• 54% reported being overweight or obese;
• 34% were sedentary;
• 21% reported they were daily smokers; and
• 13% reported that they drank alcohol at risky levels.

Some of these risk factors are increasing:

• The proportion of adults who carry excess weight increased from 35% in 1995 to 54% in 2004-05, and the proportion of adults falling into the obese category increased from 11% in 1995 to 16% in 2004-05; and
• Risky alcohol consumption increased from 8% in 1995 to 13% in 2004-05.

Managing chronic disease: it’s not just about symptoms...

In 2001, the now-superseded National Public Health Partnership stressed that there are no ""magic bullet" solutions for chronic diseases. Prevention efforts need to be sustained over the long term; optimal disease management requires effective management across many boundaries."

When assisting those who already suffer from a chronic disease, experts recommend a collaborative approach that focuses on psychosocial issues.

According to the Royal Australasian College of General Practitioners, “It is always important to listen to patients' ideas and feelings about their illness, but this is especially true when the patient has a chronic or longstanding condition. Because patients live with the illness on a daily basis over a long period of time, their ideas, thoughts and behaviours will have an impact on how successfully they and their GP are able to work together to manage it.”

This sensible advice is worth keeping in mind when helping workers manage chronic disease in the workplace.

Encouraging workers with chronic disease to become increasingly effective "self-managers" of their condition is also recommended.

There is also an opportunity for employers to fly the flag for prevention, by focusing workplace health and wellbeing programs on preventable risk factors such as smoking, poor diet and physical inactivity.