$Unique_ID{COW00199} $Pretitle{369} $Title{Australia Chapter 4A. Living Conditions} $Subtitle{} $Author{Donald P. Whitaker} $Affiliation{HQ, Department of the Army} $Subject{health state australia medical states australian income diseases percent public} $Date{1974} $Log{Table 7.*0019901.tab Table 8.*0019902.tab Table 9.*0019903.tab Table 10.*0019904.tab } Country: Australia Book: Australia, A Country Study Author: Donald P. Whitaker Affiliation: HQ, Department of the Army Date: 1974 Chapter 4A. Living Conditions When measured by standards of buying power, food consumption, death rate, housing, and ownership of consumer durables, Australian society in the early 1970s enjoyed a standard of living that was one of the highest in the world. Moreover, the general evenness of income distribution throughout the society made this standard available to all but a few. A wide range of social services and welfare programs were provided by private organizations and state and federal governments. Government in general appeared to be actively engaged in ensuring a continued high standard of living for the population and in extending it to those who might be disadvantaged. Most Australians lived in and owned individual suburban houses. The desire to own and furnish a house comfortably was a prime goal for most people. A slowly increasing, although minor, proportion of the population lived in apartments, some through choice and others through necessity. The general state of health in Australia was similar to that in other highly developed industrialized societies. Apart from a shortage of dentists, medical personnel and facilities were readily available. Conditions of nutrition, sanitation, disease control, and medical technology were good, resulting in a low incidence of infectious disease. Heart diseases, stroke, and respiratory diseases were mostly responsible for mortality, a pattern shared by other highly developed countries. There was a broad scope of social services in health; and although it was not uniform from state to state, there appeared to be no critical deficiencies. At the end of 1973 there were increasing possibilities that medical insurance would be nationalized and brought to conform to uniform standards. Most Australians adhered to values that placed the responsibility for the health and welfare of the population in the hands of recognized institutions-which has increasingly come to mean the federal government. It was widely felt that no individual willing and able to work should be allowed to fall below a minimal level of conditions commensurate with a moderately comfortable existence. Proposals were advanced in 1973 which, if enacted, would considerably extend health care benefits and retirement pensions. HOUSEHOLD ECONOMY Wages and Prices During the two decades preceding the 1970s, consumer retail prices rose considerably more slowly than did most wages, permitting a general rise in the amount of disposable income available to most families. Much of this increased disposable income was translated into consumer durables, such as automobiles, television sets, refrigerators, and washing machines. Consumer prices did rise, however; the cost of housing increased the most sharply, more than doubling between fiscal year 1954/55 and 1970/71. The price of food, which took the largest bite out of the average family's household budget, rose at a much slower rate, as did the prices of household supplies and furnishings, clothing, and other consumer needs. While consumer prices were increasing, wages more than kept pace with inflation, helped largely by Australia's unique system of wage arbitration that permits rapid adjustment to changing economic conditions (see ch. 13). The average male working at a manufacturing job at the end of October 1971 earned A $88.90 (for value of the Australian dollar-see Glossary) per week; nonmanufacturing industrial workers earned over A $90 per week. Full-time management and staff personnel did considerably better; manufacturing management and staff earned an average of A $141 weekly, and their counterparts in the nonmanufacturing industry earned only about A $4 less. Women industrial workers were earning considerably less; as a group they earned only an average of A $54.40 weekly. During the 1950s and 1960s farm producers generally kept well above national averages in yearly income. In the early 1970s, however, rising farm costs, along with rising consumer prices and slowly rising food costs, sharply reduced farm income; by 1971 the average income of farm taxpayers was below the average of wage earners and salaried employees (see ch. 12). Income tax statistics from fiscal 1969/70 revealed that the average taxpayer earned about A $3,378 per annum. Many families had more than one wage earner. The amount of disposable income available to each family in 1968 averaged A $4,145, and in 1970 it was considerably more. Household disposable income increased sharply in fiscal 1970/71, an average of 12.6 percent over the previous year (14.2 percent for non-farm families). Household disposable income continued to rise through 1973, national averages in the first quarter reaching a 14.2 percent increase over fiscal 1971/72. These increases were owing not only to increased wages and salaries but also to higher rates of social services payments (see Social Services and Welfare, this ch.). Consumer spending during the early 1970s increased rapidly, attaining what was called a "historically high rate." Part of this reflected increases in prices, but it was felt that a large portion of the greater spending was due to the increase in real disposable income and to improved consumer confidence in light of improving employment opportunities. By the end of 1973, however, inflation, reaching a reported annual rate of increase of over 14 percent, had begun to make substantial inroads against the buying power of the average family (see ch. 11). The Pattern of Household Expenditures The only extensive analysis of Australian household expenditures readily available at the end of 1973 was made on the basis of a survey completed in 1968 (see table 7). It revealed a pattern that was typical, if not an exaggeration, of equivalent patterns in other highly developed industrial countries. The proportion of an average family's disposable income that was spent on food was remarkably low, compared to other industrialized countries. Australian urban families spent around 28 percent of their income on food compared, for example, with their Japanese counterparts, who spent well over one-third of their income on food. Another unusual feature of Australian consumption patterns was the relatively high proportion of disposable income that was spent on consumer durables. After having attained the goal of homeownership, many families tended to spend a large proportion of their income on home furnishing and purchasing labor-saving devices, such as refrigerators and washing machines. Housing costs, mostly mortgage payments, took up almost as much of the household budget as did spending on consumer durables. The predominant pattern of suburban living-often a considerable distance from place of work-made automobile purchase a major component of consumer durable purchases; transportation expenditures (largely automobile operating and maintenance outlays) were the fourth largest proportion of household spending (see Housing, this ch; ch. 3). A relatively high proportion of disposable income was put into savings. The increase in real disposable income that took place in the early 1970s most likely enabled Australians to save more than the proportion that was put into savings in 1968 (5.55 percent). HOUSING The preference of Australians to live in privately owned houses has given rise to a pattern of predominantly suburban housing. Australian social critic Craig McGregor has called his country "extraordinarily suburban" and has rather caustically referred to the population as "a race of bungalow dwellers." In 1966 over 84 percent of dwellings were private houses (see table 8). Most of these (70 percent in 1970) were owner occupied. In the late 1960s and early 1970s a shift toward apartment living slowly began to emerge. This was brought on by a combination of factors: increasing urban density and the consequently higher land prices and a greater tendency for young unmarried persons and recently married couples to leave the natal home before being able to buy a house. Nevertheless, 1971 estimates placed apartments as constituting only about 12.3 percent of total dwellings-only a slight increase over the 1966 percentage. [See Table 7.: Pattern of Household Expenditure in Australia, 1968 (in A $ and percent of total disposable income)] Privacy and spaciousness in housing are preferred. In 1971 the average dwelling had five rooms accommodating an average of only 0.7 persons per room, a ratio comparable to that found in Western Europe and the United States. As did many other nations, Australia entered the post-World War II period with a serious housing shortage brought on by rapid population growth and a slowdown in housing construction during the war. A vigorous building program with heavy government participation was undertaken, and nearly 2.2 million houses and apartments were built between 1947 and mid-1972 (see ch. 13). Since 1945, operating under four separate agreements with state governments, the federal government has provided substantial grants and loans to the states for the financing of housing construction; between 1945 and 1970 it advanced roughly A $2 billion to the states. When the last agreement was concluded in 1971, the government shifted to a new program of direct grants to the states that was to last until 1976. The federal government also operated the Home Savings Grant Scheme and the Housing Loans Insurance Scheme as means of directly aiding the purchase or building of houses by private citizens. Housing built by government financing was available at relatively low rental rates and was highly coveted; the number of applicants always exceeded the number of dwellings. Federal housing policies were administered by the federal Department of Housing, but it was announced in December 1973 that the department was to be abolished and its functions merged with the Department of Works. The materials used in housing construction varied, as did styles of architecture (see ch. 7). Roughly three-quarters of the houses in Australia were built of either brick or wood, brick predominated in urban areas, and wood was favored in rural areas. Electrification was virtually universal throughout Australia; only 1.6 percent of the dwellings in 1971 were without electricity. In some cases urban expansion had outpaced water and sewerage services, but only 1.1 percent of dwellings were without any toilet facilities, and most (89.3 percent) had flush toilets. HEALTH Life Expectancy There has been a general pattern of increasing life expectancy; the latest available data showed that a male born in 1962 could expect to live for nearly sixty-eight years, and a female born in the same year could expect to reach an age of slightly more than seventy-four years. This was an increase of more than twelve and fifteen years respectively over men and women born in the early twentieth century. [See Table 8.: Australian Housing by Kind of Dwelling, 1961 and 1966 (percentage of total)] The increase in life expectancy can be attributed to a sharp reduction in tuberculosis and other infectious diseases as causes of death, a similarly sharp drop in the infant mortality rate, and generally improved health conditions. The infant mortality rate (deaths of infants under one year of age per 1,000 live births) of 17.88 in 1970 compares with a rate of approximately seventy-five in 1910. Both the infant mortality rate and life expectancy were comparable to the rates found in other highly developed societies. Illnesses The kinds and frequency of diseases were generally characteristic of those found in other postindustrial societies. According to a 1968 survey of five Australian states, eighty-nine out of every 1,000 Australians suffered from one or more chronic diseases (see table 9). Comparable surveys taken earlier were unavailable, but if Australia has followed a pattern observed in other highly developed countries, such as Japan, this rate was probably significantly higher than it had been ten years earlier. The generally good conditions of health care, nutrition, and sanitation are indicated in the relatively low levels of such infectious diseases as cholera, dysentery, and tuberculosis and diseases resulting from malnutrition. Diseases of the respiratory system and diseases of the circulatory system were the most common chronic illnesses, of which asthma, bronchitis, and hypertension (high blood pressure) were the most frequent. [See Table 9.: Australia, Chronic Illnesses Reported, Selected States, 1968] In most modernized societies the pattern of respiratory and circulatory diseases has been attributed to a relatively high median age of the population; a larger segment reaches the age at which high blood pressure, heart disease, and other noninfectious diseases are more prevalent. An additional factor that may account for the greater frequency of respiratory disease is the air pollution associated with concentrations of heavy industry, especially inasmuch as most pollution-producing industry is situated in densely populated areas. The pressures and pace of life associated with living in an industrialized society have also been associated with hypertension and heart disease. Mortality In 1971 the crude death rate in Australia was 8.68 per 1,000 population, a rate comparable with or lower than that of most other highly developed countries. The true death rate (a rate adjusted to take account of the age distribution of the population) dropped steadily during the twentieth century from between seventeen and eighteen deaths per 1,000 population at the beginning of the century to roughly 14.8 males and 13.5 females per 1,000 population in the early 1960s; the rates remained relatively constant thereafter. The single largest cause of death in 1970 was ischemic heart disease (heart attack), which at a rate of 271 per 100,000 population accounted for nearly 30 percent of all deaths. The various forms of cancer were the second largest cause of death, accounting for 16 percent of the total, and cerebrovascular diseases (principally stroke) were responsible for more than 14 percent. Accidents; other forms of heart disease; and respiratory diseases, such as bronchitis, emphysema, and asthma, were additional main causes of death. As was the pattern of chronic illness, the rate and distribution of the causes of death were characteristic of a highly industrialized society having a relatively older mean population and a high life expectancy. Two of the largest causes of death, heart attack and stroke, are diseases that typically strike middle-aged and older individuals. Unlike the inhabitants of underdeveloped countries, where infectious disease kills a significant proportion of the population at an early age, Australians were more likely to avoid such diseases and live long enough to contact non-infectious diseases common to older individuals. No single infectious disease, with the exception of pneumonia, accounted for as much as 2 percent of the deaths in 1970. Although the overall mortality rate in Australia had declined, there have been slight increases in the death rates of heart disease; stroke; other circulatory diseases; cancer; and various forms of violence, such as accident and homicide. But even when taken over a twenty-year span these increases have been negligible, and the pattern established by 1970 seemed relatively stable. Medical Personnel The approximately 17,000 physicians in Australia in 1972 provided the country with a relatively favorable ratio of doctors to population; there was one physician for every 865 people, a ratio that was better than Japan's but less than that in the United States. The availability of registered dentists was considerably less than that of physicians. As there were only about 4,300 registered dentists in the country in 1972, there was only one dentist for every 3,000 people, a condition that would have to be considered a significant shortage. Recent data on the number of registered nurses and midwives were not available. In 1966 they totaled 77,237, and if the number of nurses working in public hospitals in 1970 was indicative of the national norm, they were in adequate supply. In addition, in 1966 there were over 8,000 registered pharmacists. There were a variety of professional organizations and associations in the medical field. The largest was the Australian Medical Association, analogous to the American Medical Association in the United States. Most Australian physicians were members of the association, which had branches in all the states. Organizations concerned with specific fields of medicine included the Royal Australian College of Surgeons, the Royal Australian College of Physicians, and the Regional Council in Australia of the Royal College of Obstetricians and Gynecologists. In addition, there existed the Australian Postgraduate Federation of Medicine, organized to provide lectures and revision courses for practicing physicians. Since 1928 the Australian Dental Association has coordinated the activities of the various state dental associations. The Australian College of Dental Surgeons, created in 1965, served to provide dentists with postgraduate opportunities. There was a wide variety of nursing associations; it was felt by some that there were more associations than was required by the number of actively working nurses. Australian physicians were licensed by the medical board of each state. A prospective doctor must pass a six-year course of study at a qualified medical school and serve at least one year's residency in an approved hospital before applying for registration to a medical board. A physician must be registered in order to practice medicine. Dentists must complete a five-year course of study before applying for registration. Registration boards in each of the states and territories administered the laws regulating the nursing profession, except in Victoria, where this was done by the Nursing Council. Each of these administrative bodies was responsible to the state minister for health in their respective states. In 1973 nine out of the fifteen Australian universities had faculties of medicine, in addition to which there was also the School of Public Health and Tropical Medicine, attached to the University of Sydney, and the Victoria College of Pharmacy. There were also a number of nursing schools, almost all of which were attached to particular hospitals. Facilities were also available for the training of therapists, psychiatric social workers, and other specialized medical personnel. There were two colleges for advanced training in nursing and two dental schools, one of which was attached to the University of Adelaide and the other to the University of Melbourne. The medical profession is held in high regard by the population. As a group, physicians were accorded the most occupational prestige (see ch. 5). A public opinion poll, conducted in February 1968, revealed that nearly 65 percent of those questioned believed that physicians served to the best of their ability, although a significant minority (over 17 percent) felt that physicians were more concerned with lining their own pockets than they were with serving their patients. Farmers tended to be even more trusting of physicians than their urban counterparts. Doctors tended to be fairly conservative, especially with regard to plans for socialized medicine; the Australian Medical Association has been in the vanguard of the opposition to Prime Minister Edward Gough Whitlam's plans in 1973 for a universal health care scheme (see Social Services and Welfare, this ch.). Medical Facilities The availability of hospital and other medical facilities in the mid-1970s was among the best in the world. In 1969 there was one hospital bed for every eighty-three Australians. Most of the hospital facilities available were public, deriving their income from federal subsidies, contributions from state and local public bodies, and patient fees. Most public hospital revenue, approximately three-fifths, came from governmental sources, including state and municipal governments and the receipts of pharmaceutical and other welfare health benefits (see Social Services and Welfare, this ch.). This aid amounted to over A $324 million in fiscal 1969/70, an amount that has increased over the years with the number of hospitals and the increasing costliness of medical care and equipment. Public hospitals treated over 1.6 million individuals in 1969/70, an average of 56,255 inpatients per day. Public hospitals provided a range of accommodations from open wards to private rooms, and the prices were fixed accordingly. They were generally administered by local municipal boards or by state governments. The federal Department of Health administered the several public hospitals in the Northern Territory and one in the Australian Capital Territory; a second large hospital in the latter territory was nearing completion in 1973. Although more numerous than public hospitals, private hospitals and nursing homes were characteristically smaller and provided fewer beds (see table 10). Individuals preferring treatment at private hospitals were fully entitled to hospital benefits in accordance with the National Health Act of 1953-71. Detailed information concerning the staffing and administration of private hospitals was not available. One of the more interesting and colorful aspects of medical facilities and personnel in Australia was the medical service provided to the inhabitants of the thinly populated Outback. The Royal Flying Doctor Service was founded in 1927 to provide emergency medical service to those individuals living in isolated parts of the country. Ambulance aircraft and physicians are located in a network of about fifteen stations scattered throughout the Outback. Patients in need of care contact the service by radio; if immediate attention is not required, physicians are able to provide consultation by radio and, referring to a standard government-subsidized medicine chest, prescribe treatment for nonemergency illnesses or accidents. Organization of the Royal Flying Doctor Service varies from state to state, as does financing, but both the federal and state governments subsidize the operations of the service. A number of smaller similar services are operated in Queensland, New South Wales, and South Australia, and the federal government operates a service for the Northern Territory. Public Health Administration and Programs Activities of the State Governments The majority of public health administration and service was undertaken by the various state governments. Organization, jurisdiction, and procedures varied from state to state but by and large followed the same pattern. Each of the states had a department devoted to the administration of health and health-related laws. The public health organization in each of the states, with the exception of South Australia, was headed by an officer of cabinet level in the state government. The administration of public and government- supported hospitals in each of the states was accomplished either through a subsidiary organization of the state health department (New South Wales, South Australia, and Western Australia) or by hospital boards appointed or elected for each of the hospitals (Victoria, Tasmania, and Queensland). All but one of the states (Tasmania) had divisions specifically devoted to administering programs designed to serve the needs of expectant mothers or preschool infants. All state public health organizations included auxiliaries specifically concerned with the detection, prevention, and treatment of tuberculosis, a factor that has probably been instrumental in the rapid decline of the incidence of that disease in the twentieth century. Similarly, numerous programs existed in each of the states, often under the purview of specific subsidiary organizations, for the control of other infectious disease, notably poliomyelitis, venereal diseases, diphtheria, and other diseases where the potential for an epidemic exists. [See Table 10.: Australia, Medical Facilities, 1970] Only South Australia was without a specific mental health or psychiatric services program. All of the state health departments were responsible for administering state food and drug purity laws; regulating paramedical professions, such as optometry, pharmacology, and nursing; and overseeing various aspects of environmental health, such as sanitation and air and water pollution. Half of the states (New South Wales, Victoria and Queensland) administered programs and laws concerned with industrial and occupational health. All state departments of health operated ambulance services within their jurisdictions. All the states and both the Northern Territory and the Australian Capital Territory had programs providing for the care of infants. In 1971 a total of 2,000 permanent and temporary infant welfare centers were operated throughout Australia, several states also provided mobile centers. In 1970 over 4 million children were treated at infant welfare centers, and in 1971 over half a million visits to private homes were made by infant welfare nurses. All states provided for the medical examination of schoolchildren at least once during their school careers, usually upon entrance to primary school. School dental services were also provided by all states to give schoolchildren in the primary schools regular dental check ups and treatment. Although the state departments of health were generally concerned with the same areas of public health, the scope and kinds of service provided were not uniform. In several of the states, notably the more sparsely populated ones, such as South Australia and Western Australia, the administration of public health laws and programs was relatively decentralized; South Australia in particular was decentralized, and local and municipal boards were responsible for the administration of most public health laws. Victoria had a particularly comprehensive program with regards to the regulation of hospitals and charitable organizations, promoting interhospital cooperation. Queensland had a program of clinics providing for the diagnosis and treatment of emotional and behavioral disorders among children, and provisions existed within the department of health for medical and psychiatric social work.