Australia

1Lt S. Erin Elarton, USAF, MSC

HCA 5312 Issues in International Health

Agenda• Areas of responsibility• Peer nations • Topography • Climate• Water and natural resources• Natural disasters• Comparisons• Index of Economic Freedom• Wellbeing Index• Transparency corruption Index• Human Development Index• National demographics• Population pyramid • Aging• Muslim population • poverty• immigrants and refugees• vaccinations

• health status • Morbidity & mortality statistics • HIV/AIDS • tuberculosis• national health services • structure of health care system • healthcare providers • Costs/financing of health care • pharmaceutical expenditures• health care reform• external debt • politics and elections • telecommunications • utilization of technology promoting

health care • size of military/armed forces • military health services system• implications for military planners  

Geography & Environment• Geography

– Mainly desert or semi-desert– 40% of the landmass is covered by sand dunes– South-east and South-west corners have a temperate climate – The northern part of the country has a tropical climate

• Environmental issues– Soil erosion from overgrazing– Clearing for agricultural purposes threatens the natural habitat of many unique

animal and plant species– The Great Barrier Reef, the largest coral reef in the world, is threatened by increased

shipping and its popularity as a tourist site

• Water Resources– Global Water Supply and Sanitation Assessment 2000 Report

• Australia’s sanitation coverage is relatively good• 93% of the population having access to improved sanitation• 88% of the population having access to improved water supply

http://en.wikipedia.org/wiki/Australia

http://www.countrywatch.com

Natural Disasters

Disaster Date Affected

Extreme temp

Feb-1993 3,000,500

Wind storm 7-Nov-1994 2,500,104

Drought 1994 1,750,000

Drought 1992 1,750,000

Drought 1993 1,750,000

Drought Oct-1995 1,750,000

Extreme temp

Dec-1994 1,000,034

Extreme temp

Nov-1995 500,100

Wind storm 31-Aug-1996

450,220

Wind storm Dec-1995 400,045

Hazards: cyclones along the coast, severe droughts, and forest fires

http://www.cred.be/emdat/profiles/natural/australi.htm

Index of Economic Freedom (2003)• Categorized as “Free”

1 Hong Kong 2 Singapore 3 New Zealand 4 Luxemburg 5 Ireland 6 Estonia 7 United Kingdom 8 Denmark 9 Switzerland 10 United States 11 Australia

http://www.heritage.org/research/features/index/countries.html

Human Development IndexMeasures achievements in terms of life expectancy educational attainment, and adjusted real income (2003)

1 Norway2 Iceland3 Sweden4 Australia5 Netherlands6 Belgium7 United States

http://www.undp.org/hdr2003/pdf/presskit/HDR03_PKE_HDI.pdf

National Demographics

Australia United States POPULATION

Population Total 19.386,820 285,318,000 Population Growth Rate (annual %) 1 1.1

AGE STRUCTURE 0 - 14 Years (% of total) 20.2 20.9

15 – 64 Years (% of total) 67.1 66.7 65+ Years (% of total) 12.7 12.4

Total Fertility Rate 1.76 2.07

http://devdata.worldbank.org/hnpstats http://www.odci.gov/cia/publications/factobook/geos/as.html#Issues

(2001)

(2003)

Ethnicity & Religion• Ethnicity

– Caucasian 92%– Asian 7%– Aboriginal and other 1%

• Religions– Anglican 26.1%– Roman Catholic 26%– Other Christian 24.3%– Non-Christian 11%– Other 12.6%

• 251,100 Muslims reside in Australia

http://www.islamicpopulation.com/australia-Oceania.html

http://www.cia.gov/cia/publications/factbook/geos/as.html

Population Pyramid

http://www.census.gov/cgi-bin/ipc/idbpyrs.pl?cty=AS&out=s&ymax=250

Predicted Urbanization in 2015

http://www.nationmaster.com/graph-T/peo_urb_in_201

1 Hong Kong

2 Singapore

3 Belgium

4 Kuwait

5 Bahrain

6 Luxembourg

7 Qatar

8 Australia (98%)

Politics• Constitutional monarchy

– Head of State is Her Majesty Queen Elizabeth II of UK is also Queen of Australia

– Head of Government is The Honorable John Winston Howard, Prime Minister

• System of government representative democracy. – Federal parliament comprised of House of

Representatives and the Senate• 1999 a referendum was held on constitutional change to a

republic, with an appointed President replacing the Queen as head of state, but this was rejected

http://en.wikipedia.org/wiki/Australia

Transparency International Corruptions Perceptions Index (2003)

1 Finland

2 Iceland

3 Denmark (tied with New Zealand)

4 Singapore

5 Sweden

6 Netherlands

7 Austria

8 Australia (tied with Switzerland and Norway)http://www.transparency.org/pressreleases_archive/2003/dnld/cpi2003.pressrelease.en.doc

Australia’s Top Exports & Their Destinations

• Top Exports– Coal is the largest export commodity– Crude petroleum, non-monetary gold, iron ore,

aluminum

• Main Export Destinations– Japan 18.8%– United States 9.0%– Republic of Korea 7.9%– China 7.6%– New Zealand 7.0%

http://www.dfat.gov.au/geo/fs/aust.pdf

http://www.dfat.gov.au/trade/negotiations/us.html

Foreign Debt

• Australia’s external debt totaled $176.8B ($U.S.)• Australia’s foreign direct investment encompassed

nearly $28B ($U.S.)

http://www.heritage.org/research/features/index/countries.htmlhttp://www.cia.gov/cia/publications/factbook/geos/as.html

ECONOMY Australia U.S. GDP (2002) $525B $10.5T

GDP real growth rate (2002) 3.6% 2.4% GDP per capita (2002) $26,900 $36,300

Population below poverty line (2001) 17% (1995) 12.7

Expressed in U.S. Dollars

Immigrants & Refugees

http://www.islamicpopulation.com/australia-Oceania.html

http://www.immi.gov/au/facts/22health.htm

Settler arrivals, by region of birth, between July 2001 and June 2002

Oceania 19 152 21.5%

Europe & former USSR 17 411 19.6%

Middle East & North Africa 6 000 6.7%

Southeast Asia 14 464 16.3%

Northeast Asia 10 716 12.1%

Southern Asia 9 190 10.3%

Northern America 1 730 1.9%

South America, Central America & the Caribbean

900 1.0%

Africa (excl. Nth Africa) 9 311 10.6%

TOTAL (including 'not stated') 88 900

Migration Regulations• Most immigrants from Afghanistan, Iran, and Iraq, and numbering about

5,000 annually– Australian government imprisons them in bleak detention camps and subjects them

to a lengthy immigration process

• “Pacific solution”– re-routes boat people from Australian shores to camps in

Papua New Guinea and Nauru

• Comprehensive Health Examinations for people who want to migrate to Australia– Radiological exam for TB (over age 11)

• TB positives must undergo treatment

– Screening for Hepatitis B– HIV/AIDS testing (over age 15)

• Positives will be investigated to estimate potential costs

http://www.immi.gov.au/search_for/index1.htm

Well-being Index (2003)

1 Sweden 2 Finland 3 Norway 4 Iceland 5 Austria 6 Dominica 7 Canada 8 Switzerland 9 Belize

10 Guyana11 Uruguay12 Germany13 Denmark14 New Zealand15 Suriname16 Latvia17 Ireland18 Australia

http://www.iucn.org/info_and_news/press/wonrank.doc

Health Status Indicators Australia United States

HEALTH STATUS INDICATORS % of total life expectancy lost

due to poor health Men 9.4

Women 11.4 Men 10.8

Women 13.5 Infant Mortality Rate (deaths per

1,000 live births) 4.83 6.75

Adult Male Mortality Rate 141 100 Adult Female Mortality Rate 82 53

Female Life Expectancy at Birth 83.13 80.05 Male Life Expectancy at Birth 77.27 74.37

Low-birth weight Babies 7 7 Smoking Prevalence, Males, % of adults 21.1 25.7

Smoking Prevalence, Females, % of adults

18 21.5

http://devdata.worldbank.org/hnpstats http://www.odci.gov/cia/publications/factobook/geos/as.html#Issues

http://www3.who.int/whosis/country/indicators.cfm?country=AUS&language=english

Vaccinations

2002

DTP3 93%

HepB3 95%

Hib3 95%

MCV 94%

Pol3 93%

Vaccine Schedule includes Influenza 65 years; (annual dose given to >65 years and >50 years for aboriginal & Torres Strait Islander people)

http://www.who.int/vaccines/globalsummary/immunization/countryprofileresult.cfm?C='AUS

World Health Report 2000

• Australia ranks #32 – Overall health system performance #32– Overall health level #2

http://www.who.int/whr2001/2001/archives/2000/en/statistics.htm http://www.photius.com/rankings/healthranks.html

Poverty, HIV/AIDS, Tuberculosis

• There were over 3.4 million Australians (18%) living in poverty in 1995-96

– 1 million of whom were dependent children

– 646,000 were elderly

• 12,000 people living with HIV/AIDS

• Tuberculosis incidence 8 (5.4 in U.S.)

http://www.abs.gov.au/ausstats/abs@.nsf/0/5A7B6C246E6F3303CA2569AD000402C2?Open&Highlight=0,poverty,statistics

Australian Defense Force

Armed Forces Personnel (1998)

Strength

World

Ranking

Australian Army 25,400 #37

Royal Australian Air Force 17,700 #20

Royal Australian Navy 14,300 #25

http://www.nationmaster.com/graph-T/mil_arm_per

Military Spending Australia United States Military Expenditures per % GDP

(FY02-Australia, FY99-US) 2.9% 3.2%

Military Expenditures Dollar Figure US-FY99, Australia-FY02)

$11.39 M $276.7 B

http://www.odci.gov/cia/publications/factbook/geos/as.html#Issues

Expressed in U.S. dollars

Australian Involvement in Operation Iraqi Freedom

• In early 2003, Australia deployed troops to the Persian Gulf in support of OIF• This move resulted in massive public protests throughout Australia

– Mainly questioning the United States intelligence reports of Saddam Hussein possessed weapons of mass destruction

• Prime Minister John Howard was passed resulting from his handling of the Iraq crisis.

– First time the Senate's ever voted no-confidence against a serving leader in Australia

• In August 2003, however, Australia's parliament launched another unprecedented act by opening up an inquiry into Australia's participation in the war. Principal issues to be considered in the inquiry include claims that Australia's intelligence network was pressured to manufacture links between Saddam Hussein,

• weapons of mass destruction and terrorism. As well, Prime Minister Howard's government is accused of deception and exaggeration in regard to the threat posed by Iraq's supposed weapons program.

• Operation Catalyst is Australia's contribution to the rehabilitation of Iraq, which commenced on 16 July 2003

http://www.defence.gov.au/index.cfm

Telecommunications

• Telephones: main lines in use: 10.05 million (2000); mobile cellular: 8.6 million (2000)

• Radio broadcast stations: AM 262, FM 345, shortwave 1 (1998)

• Radios: 25.5 million (1997)• Television broadcast stations: 104 (1997)• Televisions: 10.15 million (1997)• Internet Service Providers (ISPs): 603 (2001)• Internet users: 10.06 million (2001)

http://www.infoplease.com/ipa/A0107296.html

National Health System

• Tax-financed National Program– MEDICARE

• Universal health insurance

• Free public hospital care

• Assistance with cost of out-of-hospital care

• Subsidized pharmaceuticals

• Private health insurance is used mainly for dental, optical pharmaceuticals, private hospital care

• Medical profession comprised mainly of private practitioners who provide care predominantly on a FFS basis

http://www.hic.gov.au/yourhealth/our_services/am.htm

MEDICARE

• Services MEDICARE does NOT cover– ambulance services

– home nursing

– physiotherapy, occupational therapy, speech therapy, eye therapy, chiropractic services, podiatry or psychology

– glasses and contact lenses

– hearing aids and other appliances

– cost of prostheses

– medical services which are not clinically necessary

– surgery solely for cosmetic reasons

http://www.hic.gov.au/yourhealth/our_services/am.htm

Private Health Insurance

• Financial Incentives to encourage people to take out private health insurance– 30% rebate on private health insurance premiums

– 1% tax levy for high income earners who don’t take out private health insurance

• Lifetime Health Cover– Private Insurance for hospital coverage membership

• Lower premiums throughout individual’s lifetime

• Must enroll before the age of 30

http://www.hic.gov.au/abouthic/our_organisation/other_programs/fg30prphi.htm

Healthcare Costs & Finance

• Public financing provides universal access– Public hospital spending provided by government

• Substantial private financing (32%)– Private hospitals provide better choice

• Total health expenditures from all sources $66.6 billion ($Australian)– 9.3% of the Gross Domestic Product (GDP)– $3,397 per person ($Australian)– Public acute care hospitals $15.3 billion ($Australian)

• 26.9% of total recurrent health expenditure

– Medical services with $10.3 billion (18%) ($Australian)– Pharmaceuticals with $8.1 billion (14.2%) ($Australian)

http://www.immi.gov.au/settle/health/cover.htm

http://www.hic.gov.au/abouthic/our_organisation/pop_health_expenditure.htm

Health Care Statistics

HEALTH CARE FINANCE Australia United States Total Health Expenditures (% of GDP) 8.3% 13%

Physicians per 1,000 people 2.5 2.8 Average Length of Stay (days) 16 7

Hospital Beds per 1,000 population 7.9 3.6 Healthcare Spending per capita per person (1998) $1,714 $4,217

http://devdata.worldbank.org/hnpstats http://www.nationmaster.com

Expressed in U.S. dollars

Australia’s Defense Health System• Surgeon General Australian Defense Force• Four components

– The Defense Health Service Branch (DHSB)– Joint Health Support Agency (JHSA)– Defense Force Psychology Organization (DFPO)– Components of the Defense Personnel Executive (DPE)

• Joint Health Support Agency – Coordinates the provision of high quality health support

within the National Support Area – Health staff within HQAST and the environmental

commands are responsible for health aspects of deployable capability

http://www.defence.gov.au/dpe/dhs/

Issues in Healthcare

• Escalating healthcare costs• Deteriorating quality• Inequality and access• Private health funds are struggling to maintain

members • More and more people opt to rely on the public

system

http://www.cota.org.au/healthcover.htm

2000 Olympics

• 2000 Olympics were held in Sydney

• Australia was the fourth largest winner of the most medals (58)– Behind US, Russia, & China

http://www.dartmouth.edu/tuck/alumni/publications/w2001_fac_news3.html

Implications for Military Planners

• Focused on security and combating terrorism

• Continuous economic growth

• Australian/US Free Trade Agreement

• Economically powerful and growing

• Desire to be autonomous from UK

• Large partially-uninhabited landmass

• Focused on different definition of health (WHO)