Health Workforce in Australia and Factors for Current Shortages

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1 Health Workforce in Australia and Factors for Current Shortages

2 Current Shortages Contents Author s Note 1 Executive summary 3 1 Introduction Scope Approach Defining the Australian health workforce 10 2 Demand for the health workforce Australian demographic trends Australian burden of disease Changes in service delivery 21 3 Characteristics of current health workforce in Australia The total Australian workforce The Australian health workforce Description of health workforce characteristics 29 4 Supply drivers for shortages in the health workforce Competing demand for labour Shrinking workforce pool Changing workforce intentions and availability Nurses Workforce expectations and availability Education and training of health workforce professionals Workforce specialisation 60 5 Emerging strategies 62 Glossary 65 A Clinical training placement calculation 66 B Reference list 70 National Health Workforce Taskforce - 6 May 2009 i

3 Current Shortages Figure 2.1: Australian population by age and sex from 1996 forecast to Figure 2.2: Australian population aged over 85years from 2006 forecast to Figure 2.3 Differentials in Burden (DALYs) by geographic region for ten leading cause groups Figure 2.4: Differentials in Burden (DALYS) by state/territory for the leading 10 cause groups Figure 2.5: Prevalence of Long Term Health Conditions Figure 2.6: Proportion of Australians with obesity by age group Figure 2.7: Public and private hospital admissions Figure 3.1: Total employed and unemployed workers in Australia forecast Figure 3.2: Number of Australians employed in health workforce occupations as a proportion of the total Australian workforce Figure 3.3: Number of Australians employed in health workforce occupations Figure 3.4: Summary of GP characteristics Figure 3.5: GP workforce in Australia 1986 and Figure 3.6: Nurse workforce in Australia 1986 and Figure 3.7: GP, Nurse and Specialist health workforce - average age 2002 and Figure 3.8: GP, Nurse and Specialist health workforce - average hours worked 2002 and Figure 3.9: Average hours worked by nurses and medical practitioners by state and territory Figure 3.10: Average age for nurses and medical practitioners by state and territory Figure 4.1: Duration of current job Figure 4.2: Student characteristics entering higher education medical degrees Table 2.1: Australia s ethnic mix Table 2.2: Causes of Burden (DALYs) by Sex Australia 2003 and MALES Table 2.3: Causes of Burden (DALYs) by Sex Australia 2003 and FEMALES Table 3.1: Nurse and Specialist health workforce - average hours worked and average age 2001 and Table 4.1: Separation of doctors from the Australian Medical workforce Table 4.3: Separation of nurses from the Australian medical workforce Table 4.4: Employed doctors: country of first qualification, states and territories, Table 4.5: Country of qualification of doctors in medical labour force in Australia, 1998 and Table 4.6: Number of Australian doctors not in the medical labour force National Health Workforce Taskforce - 6 May 2009 ii

4 Current Shortages Inherent Limitations This report has been prepared as outlined in the KPMG engagement letter dated 29 September The services provided in connection with this engagement comprise an advisory engagement, which is not subject to assurance or other standards issued by the Australian Auditing and Assurance Standards Board and, consequently no opinions or conclusions intended to convey assurance have been expressed. The findings in this report are based on a qualitative study and the reported results reflect a perception of the Australian health workforce market but only to the extent of the literature surveyed No warranty of completeness, accuracy or reliability is given in relation to the statements and representations made by, and the information and documentation provided by, the Tasmanian Department of Health and Human Services or National Health Workforce Taskforce consulted as part of the process. KPMG have indicated within this report the sources of the information provided. We have not sought to independently verify those sources unless otherwise noted within the report. KPMG is under no obligation in any circumstance to update this report, in either oral or written form, for events occurring after the report has been issued in final form. The findings in this report have been formed on the above basis. Third Party Reliance This report is solely for the purpose set out in the KPMG engagement letter dated 29 September 2008 and is not to be used for any other purpose. This report has been prepared at the request of the National Health Workforce Taskforce via a letter of engagement with the Tasmanian Department of Health and Human Services in accordance with the terms of KPMG s engagement letter dated 29 September Other than our responsibility to the Tasmanian Department of Health and Human Services neither KPMG nor any member or employee of KPMG undertakes responsibility arising in any way from reliance placed by a third party on this report. Any reliance placed is that party s sole responsibility. National Health Workforce Taskforce - 6 May 2009 iii

5 Author s Note Since the draft of this report was issued there have been a number of recent key events which are likely to have varying degrees of impact in respect to the Australian health workforce shortages. We have had no opportunity to give purposeful consideration to these events in finalising this report, but provide examples of these events to highlight the ongoing complexity of interconnected influences on health workforce shortages: (1) Council of Australian Governments additional funding In December 2008 the Commonwealth and the States committed to an unprecedented reform package of $1.6 billion investment in the health workforce, comprising $1.1 billion of Commonwealth funding and $540 million in State funding. 1 This is aimed at meeting the future challenges of the health system through workforce reform by providing $500 million in additional Commonwealth funding for undergraduate clinical training, including increasing the clinical training subsidy to 30 per cent for all health undergraduate places. The package also provides for an increase of 605 postgraduate training places, including 212 GP places, and the establishment of a national health workforce agency and health workforce statistical register to drive strategic long-term planning for the health workforce. Investment of $175.6 million over four years in capital infrastructure will also be provided to expand teaching and training, especially at major regional hospitals to improve clinical training in rural Australia. The 212 additional ongoing GP training places will boost the total number of GP training places to over 800 from 2011 onwards, and 73 additional specialist training places in the private sector. Funding will also be provided to train approximately 18,000 nurse supervisors, 5,000 allied health and other supervisors, and 7,000 medical supervisors. 1 (2) Global Financial Crisis (GFC) The GFC has been an unpredictable influencer in recent months, bringing uncertainty to a range of drivers impacting the Australian health workforce. At this stage there is limited information as to the extent of the impact (directly or indirectly) the GFC will have on aspects of the health workforce. Potential impacts may include, a declining Australian dollar that could mean that the Australian health workforce proves less attractive to international applicants, but an increasing unemployment rate within Australia may increase the employment pool from which the health workforce is drawn. 1 viewed 11 March 2009 National Health Workforce Taskforce - 6 May

6 (3) National Health and Hospitals Reform Commission The Commission s interim report agenda introduced micro-economic reform, increased workforce flexibility and greater use of competition. There was an emphasis on better use of workforce capabilities including proposals to improve the productivity of the Australian health workforce, workforce planning and training and a workforce competency-based framework. 2 (4) Deregulation of university places from 2012 Student places at Australian universities will be deregulated from Under this change, universities will be able to decide how many students they admit to each course, funding will follow the student rather than being allocated to universities for a capped number of places. 3 (5) National recruitment approach for foreign doctors COAG's National Health Workforce Agency has been given the task of consolidating six separate state and territory recruitment schemes into a single program. The new scheme will be given $63-million over the next four years to advertise the thousands of health vacancies and also to train overseas recruits so they meet registration requirements ummary%20of%20the%20interim%20report.pdf viewed 11March viewed 11 March Ryan, Siobhain. unite to entice overseas health professionals. The Australian. 10 March 2009 National Health Workforce Taskforce - 6 May

7 Executive summary Introduction KPMG was commissioned at the request of the National Health Workforce Taskforce via a letter of engagement with the Tasmanian Department of Health and Human Services to prepare this document that outlines the factors influencing current and projected workforce shortage and that considers the implications that these factors may have on workforce development strategies. It is generally accepted that Australia will continue to experience increasing demand for health care workers and at a rate that will challenge Australia s training and service delivery systems without significant change to it s approach to workforce development. At the broadest level, this is evident from the projected increase in health care expenditure that will grow at a rate greater than the nation s Gross Domestic Product (GDP) which is the consequence of the increasing need for health care services, the introduction of a diverse range of health service interventions and the increasing cost of delivery of some services. The underlying health service demand drivers include; population growth, ageing of the population, changing nature of the burden of disease and greater focus on health prevention, which taken together with consumer and workforce expectations, combine to result in increasing demand for health care services and for healthcare workforce. The current and projected shortage in the Australian health workforce are driven by a complex interaction of demographic, socio-cultural, clinical and professional factors that exert influences on both the demand for health workers services, and the supply of health workers. These shortages are not uniformly distributed, but vary by health profession, specialty, jurisdiction and geographical location (metropolitan, rural, remote). They also occur within a broader international context in which it has been estimated that there is currently an absolute shortage of 2.3 million physicians, nurses and midwives across 57 countries. Over recent years, there have been numerous strategies and initiatives that seek to address workforce shortages and their impact upon the provision of health care services. Since the factors driving the shortage are multifaceted, and the nature of the shortage is itself variable, it is not surprising that these strategies tend to be partial in focus. Ironically, many in turn become yet another factor within the complexity of interconnected influences resulting in particular shortages. It is clear that a multi-dimensional and coordinated approach to address health workforce shortages is needed one that not only focuses on strategies to manage/reduce demand and increase supply, but also considers the actual structure, composition and training of the workforce itself. National Health Workforce Taskforce - 6 May

8 Factors influencing demand and supply The interconnected factors driving workforce shortages in Australia are generally well understood. These factors broadly relate to one of the following three themes: 1) The escalating demand for health care workers. 2) Labour market competition - the health care system is competing for skilled and professional labour internationally and with other sectors that will constrain its ability to recruit into the Australian health care worker market. 3) A constrained training system - that has limited capacity and structure to accommodate the increasing number of students entering the system sufficiently to meet their training requirements and provide workers in a timely manner to meet demand. The escalating demand for health workforce There are a number of factors that are expected to escalate demand for health workforce: The burden of disease in the Australian population the burden of disease is contributing to the demand for health services and is driven by the ageing population, environmental and lifestyle factors. Chronic diseases such as Type II diabetes and coronary heart disease, comorbidities and complex care needs associated with illnesses in older age such as dementia, contribute to the increasing demand for services. Together with other diseases not solely associated with older age such as cancer, anxiety, depression and asthma, all contribute to the requirements for particular skill mixes within the health workforce, and new models of care. Changes in service delivery numerous factors such as new technologies, pharmaceuticals and treatment modalities, coupled with policy drivers contribute to a changing pattern of health service delivery, and the skill mix required within the health workforce. Same day hospital admissions have substantially increased, both increasing the acuity of overnight admissions and influencing the skills required of the acute sector workforce. Concurrently, increasing management of chronic diseases within the primary care setting increases the demand for workforce within this setting. Community expectations the Australian population has been well served by a quality health care system and has expectations about ready access to the services they need at the time they require such services. Workforce shortages pose significant challenges for health decision-makers in addressing these expectations, with lengthy waiting times in an emergency department, ambulance by-pass and difficulties in getting an appointment to see a GP (i.e. examples of the impact of workforce shortages) creating a strong imperative for action. Workforce expectations the expectations within the existing health workforce about their work, and in particular the hours they are prepared or able to work, are changing, influencing overall supply as workers opt for fewer hours and/or working hours more conducive to participating in family/social life. Factors contributing to this change include the increased feminisation of the workforce, Generation Y and an increased general cultural interest in a work/life balance. Workforce specialisation over time the health workforce has become increasingly diversified and specialised in response to numerous factors such as professionalisation, scientific and technological developments, credentialing, changing models of care and National Health Workforce Taskforce - 6 May limited by a scheme approved under Professional Standards Legislation

9 identified needs. As the workforce has increasingly fragmented into professions, and into sub-specialities within these professions, each group delineates and protects its own role through mechanisms such as controlling the entry criteria, registration, industrial action, and political influence. The greater control each group has, the greater its potential to influence the supply of its own discrete contribution within the health workforce. Unintended effects of workforce strategies strategies implemented to address workforce shortages may, in turn, create new or additional shortages, or shift the shortage from one region or sector to another, due to the complexity and interconnected nature of the health workforce. For example, hospital demand management strategies can result in shifting demand from the acute to the community sector. Increased recruitment of nurses into general practice, to bolster shortages in the capacity to manage demand, may lure nurses away from the acute sector. Attracting international medical graduates to fill vacancies in Australia potentially increases the supervisory burden on the existing workforce. The workforce impacts will not only be for more health care workers but also on the composition of the workforce, the range of skills required and how health care workers interact. For example, the growth in prevalence of long-term health conditions require multi-disciplinary support and long term care plans and support will change the nature and requirements of the health workforce as well as respective burden. Workforce competition Australia has relied upon two main sources to increase the number of healthcare workers, namely, recruiting from international sources and increasing the number of Australian recruits into the education and training system together with various strategies to increase the retention rate. Australia is only one of a number of countries seeking health workers in an international market characterised by general labour shortages. The ability of Australia to attract international workers is expected to be challenged given a range of factors beyond the control of the Australian health system. These include the strength of the Australian dollar (currently declining), strategies adopted by other nations to recruit international health workers, and strategies adopted by other nations to address the historical drain of health workers from less developed nations to developed nations, such as the UK and Malawi. The UK Department for International Development is now funding local wage increases and benefits to enable Malawi to keep and bolster its health workforce. As international economies develop and opportunities change Australia should not rely too heavily on international markets to address workforce shortages at home. There has been a recent substantial increase in medical school places in response to health workforce shortages. The number of domestic medical graduates expected to enter the Australian workforce each year is projected to rise from 1,586 graduates in 2007 to 2,945 graduates in 2012 an 85.7 percent increase. However, the Australian labour market is forecast to grow by 0.8 percent per annum (to 2016) in comparison to 1.7 percent per annum forecast growth for the health workforce labour market (to 2018). This suggests that the pool from which these graduates are recruited is not going to be able to keep up with demand for them within the health workforce. National Health Workforce Taskforce - 6 May

10 The training system s capacity and structure Numerous factors associated with undergraduate and postgraduate professional education influence the supply of graduates able to participate in the workforce. These include the number of places available and the entry score necessary to achieve a place (based on competition): the course requirements and the individual s ability to meet these requirements; the availability of clinical placements through which the individual can acquire the requisite skills necessary for subsequent practice. The existing workforce is required to contribute to the future workforce through supervision of the supernumerary undergraduates, thereby increasing the demand on their time and availability for actual service provision. The training system has limited capacity and structure to accommodate the increasing number of students entering the system to sufficiently meet their training requirements and provide workers in a timely manner to meet demand. There is continuing focus on meeting the needs of the acute sector in nurse training, despite the steady shift towards other settings of care which are increasingly managing complex health care conditions (long term and chronic conditions), such as general practice and community settings. There is a lack of identified supervisors and respective clinical environments available to accommodate the increase in number of students graduating from medical school moving into specialist and clinical training. In part this is due to the heavy reliance on the public sector for specialist and clinical training environments, effectively limiting the opportunity for training to a sector already resource constrained. For example a variety of conditions are now managed predominantly in the private sector and are not accessible to specialist trainees who are primarily working only in the public sector, this includes aspects of ophthalmology, dermatology, radiology and pathology. There is also a reliance on pro bono provision by senior clinicians for aspects of clinical training, which could often mean that the priority for provision of clinical training is not given due precedence. Projections of workforce need based on continuation of existing demand, service and workforce models, suggest that regardless of recent increases in training numbers for occupations such as General Practitioners and nurses, there will not be sufficient numbers of professionals trained and available to deliver services within existing service and workforce models over the short to medium term. Implications for future workforce strategies The factors driving the shortages within the Australian health workforce are multi-dimensional, with the levels of shortage varying across professions, specialties, jurisdictions, sectors and regions. Decision-makers at all levels within the health system (e.g. health authority, organisation, organisational sub-unit) face significant challenges in addressing these shortages. Strategies developed tend to be partial in nature. They tend to focus on either reducing demand or increasing supply through focussing on a specific targeted aspect, such as a single profession, a type of location (rural/remote), a sector (acute or primary care) or form of demand (e.g. chronic disease (self)-management). These strategies tend to have flow-on implications for supply in other areas outside their specific targets, due to the overall workforce shortage. It is clear that a coordinated and integrated approach to the development of future workforce strategies is needed in which the implications for each targeted strategy for other components of National Health Workforce Taskforce - 6 May

11 the overall health care system and the workforce are considered. This approach needs to consider all aspects contributing to the shortage, focussing not only on demand reduction factors, or mechanisms to increase supply, but also on the workforce itself. This includes workforce structure (e.g. the roles and relationships between roles) and the educational preparation for such roles (e.g. time required, entry criteria, clinical placement requirements). It is possible that new ways of structuring and preparing a future health workforce can be developed that contribute to addressing the predicted future workforce shortages in Australia. National Health Workforce Taskforce - 6 May

12 1 Introduction 1.1 Scope This project aims to develop an evidence base for the current factors that are influencing and impacting on the workforce shortages experienced in the Australian health sector, and outline why reform is required. It is widely known that there are health workforce shortages within Australia. These shortages vary in their intensity by health profession, specialist and geographically, by state and territory and by metropolitan, regional, rural and remote area. There are a range of factors driving current shortages in the health workforce, which require consideration in outlining why reform is required. We have categorised these factors into supply and demand factors. Supply Factors: are those factors driving the supply of health workers and would include the structure of education and training programs, competing demands for labour, workforce intentions and availability, migration of health workers into and out of Australia, workforce choices made by health workers, clinical training provision aspects of programs and changing profile of entrants into the health workforce. Demand Factors: are those factors driving demand for health worker service provision and would include changes to the general population demographics (age, sex, ethnicity), prevalence of long-term conditions and contributory factors such as obesity, changes in clinical practice and models of care, growth in new treatment options and therapies, number of visits to allied health, community health and primary care providers. The National Health Workforce Taskforce has a particular interest in further understanding the Supply Factors as a major driver for the current health workforce shortages. The premise is that the current system will not be able to supply enough health professionals to meet demand if they continue to be trained, recruited, deliver care and utilise staff in the traditional ways which have occurred to date Approach This report contains findings and evidence obtained using a desk based literature research methodology. The perspective and analysis undertaken in this report is from a general population, jurisdictional and sector/specialist perspective. The literature review was conducted on government, academic and medical workforce papers, surveys and reports with support from the National Health Workforce Taskforce. Key areas focused on and described in the review are: Demand for services provided by the health workforce - Australian population growth and changes in demographics 5 Project Brief, Health Workforce the case for change, National Health Workforce Taskforce, August 2008 National Health Workforce Taskforce - 6 May

13 - Australian changes in burden of disease - Australian growth in prevalence of long term health conditions The changing ways in which services are delivered - Service settings - Service delivery Characteristics of current health workforce - Total Australian workforce growth - Proportion of total workforce that is health workforce (historic and forecast growth) - Growth in (FTEs) health workforce by occupation (historic and forecast growth) - Growth in OHPs, representing more detailed breakdown of health workforce occupation - Description of health workforce characteristics GP Nurses OHPs - Generation Y Supply drivers for health workforce shortages - Competing demand for labour - Education and training systems The findings from the desk-based review provide a broad evidence base for the supply and demand factors influencing health workforce shortages in the context of forming the basis of a case for change with respect to existing service and workforce models. This report has not sought to explore in detail every state, region and health workforce speciality and associated supply and demand factors. Instead, it provides examples of particular health workforce trends by speciality, geographic and functional locations. National Health Workforce Taskforce - 6 May

14 1.3 Defining the Australian health workforce For the purposes of this project, the Australian health workforce has been defined as all those professionals who work in the health sector, State, Commonwealth and privately funded in: acute health care, rehabilitation, aboriginal health care, pharmacy, care for people with disability, young people, maternity care, care for families, mental healthcare, care for people with alcohol and drug issues, aged care, care for people who are dying. A broad definition of the setting of care and health workforce provision of care includes acute hospitals, people s homes, residential facilities, workplaces and schools. Geographic location of residence is defined as cities, outer metropolitan areas, rural areas and remote areas. National Health Workforce Taskforce - 6 May

15 2 Demand for the health workforce It is generally accepted that the increasing demand for health care workers will continue well into the future. At the broadest level, this can be seen from the expected increase in health care costs which are the consequence of the increasing demand for health care services and the increase in the cost of those services. This encompasses a broad range of factors which include; population growth, population demographics, burden of disease and interest in health promoting activities. In addition to illness and injury, the way in which health services are delivered will also be considered a demand driver; as delivery methods and settings change, this will place differing demands for services provided by the health workforce. A recent study 6 estimated that total health expenditure (including residential aged care) will increase by 127 percent over the three decades between and , from $71 billion to $162 billion (in constant prices), an increase of $91 billion. Over the same period, GDP is predicted to increase by 97 percent 7, thus health expenditure is projected to increase from 9.4 percent of GDP to 10.8 percent. While health authorities have embarked on a wide range of initiatives to dampen the rate of increase in demand for health care services and to improve productivity of health service delivery, the need for workforce growth is inevitable. This section explores the three main service demand drivers that have implications for the level of workforce growth and implications for the composition and nature of the health workforce. Australian demographic trends. Australian burden of disease. Service delivery. 2.1 Australian demographic trends The demand for health care services is driven by not only an increase in the Australian population but also by the changing demographic characteristics of the population: Growth of the population as the population increases, more health services will be required as a result of increasing prevalence of illness, increasing incidence of injury and increasing need for preventative health care services. Ageing of the population Australia is expected to experience an increase in the proportion of the population that are aged, an increase in the number of aged persons and an increase in life expectancy, all of which will create a demand for not only more health services but also impact on the type of health services required to meet these needs. Cultural and linguistic diversity Australia is experiencing a change in the cultural and linguistic diversity of its population which is expected to continue into the future; different 6 Vos T, Goss, J, Begg, S & Mann N (in press). Projections of health care expenditure by disease for Australia to Canberra: AIHW. 7 Treasury Intergenerational report. Canberra: The Treasury National Health Workforce Taskforce - 6 May

16 ethnicities have differing health needs which have an impact on health services demand and impacts on the skill requirements of health care workers. This is also the case with linguistic diversity, there are impacts on the skills requirements and way health care is communicated by health care workers which require consideration. The following information outlines how the demographic profile has changed in recent years and how it is expected to change in the near future for Australia nationally as well as by state and territory A growing population In 1996, there were some 18.3 million people in Australia. By 2021, this is projected to reach 25.6 million. 8 This represents a growth of 7.3 million or an average annual percentage change of 2.7 percent An ageing population In 1996, the most populous age cohort in Australia was (Figure 2.1). This cohort accounted for 2.9 million persons, or 15.8 percent of the Australian population. By 2021, the age cohort is still projected to be the most numerous, accounting for 3.6 million persons but representing a smaller proportion of the total population (14.2 percent). However, the proportion of the population 70 years and over is expected to increase substantially, both in actual number and proportionally; namely, people of 70 years of age and over are projected to account for 12.1 percent of the total population by the year 2021 (compared to 8.3 percent of the population in 1996). Figure 2.1: Australian population by age and sex from 1996 forecast to % % 6% 4% 2% 0% and over Males Females 8 viewed 5 December 2008 National Health Workforce Taskforce - 6 May

17 Source: viewed 15 October 2008 The growth rate of those aged 85years and over is projected to be even more significant. Between 2006 and 2016 alone, the number of people over 85years will have grown by over 60 percent to 521,000; by 2036, this is expected to have more than doubled again to 1.1 million (Figure 2.2). This represents a growth in the proportion of those aged 85years and over from 1.6 percent of the population in 2006 to 3.3 percent of the population in 2036 (based on an estimated total population of 33.1m people in ). Figure 2.2: Australian population aged over 85years from 2006 forecast to Total Number ('000s) Aged 85+ yrs Source: ABS publication Population Projections, Australia, (2008) Increasing cultural and linguistic diversity The Australian population increased in cultural, linguistic and ethnic diversity between 1996 and Based on data for country of birth (from ABS), it can be seen that the proportion of those living in Australia and born in Australia has fallen from 74.5 percent in 1996 to 70.9 percent in 2006 (Table 2.1). Of those people born outside of Australia, the proportion of people born in the UK and now living in Australia has fallen from 6 percent to 5.2 percent over the 10 years 1996 to Those born in New Zealand and now living in Australia has risen from 1.6 percent in 1996 to 2 percent in 2006 and the proportion born in China has increased from 0.6 percent in 1996 to 1 percent in viewed 5 December 2008 National Health Workforce Taskforce - 6 May

18 Table 2.1: Australia s ethnic mix Country % Country % United Kingdom 6.0 United Kingdom 5.2 New Zealand 1.6 New Zealand 2.0 Italy 1.3 China 1.0 Vietnam 0.9 Italy 1.0 Greece 0.7 Vietnam 0.8 Australia 74.5 Australia 70.9 Source: viewed 15 October 2008 More recent migration trends that have seen an increase in migration from African countries, for example, will further add to the changing cultural diversity of the population. An increasing cultural, linguistic and ethnic diversity will drive changes in demand for health services. Different cultures have different health needs, driven by a wide range of factors such as diet, number of children per family unit, cultural values and ability to speak English. The data shown here does not seek to analyse how these factors change demand on the services provided by health workers, but highlights that demands on health workers will be affected by changing cultural, linguistic and ethnic diversity of the Australian population. 2.2 Australian burden of disease The burden of disease has multiple and interrelated impacts on demand for health services and therefore on the health workforce: The increasing prevalence of chronic conditions drives both the need for more health workers in primary health care and acute care as well as influencing the role of health workers. The changing nature of burden of disease drives the demand for specific types of health workers. The variation in burden of disease, geographically and demographically and, in some cases, the widening of gaps in health status, influences varying demand for health services across regions in Australia. Policy decisions formulated in response to the changing nature of burden of disease in turn has implications for the types of health workers, distribution of health workers and training and education of health care workers. The current burden of disease is well understood and documented in Table 2.2 and Table 2.3. These tables summarise the top 10 diseases affecting the Australian population by male ( Table 2.2) and female ( Table 2.3) and the change in burden of diseases between 1996 and As is generally known, the conditions that affect women are different to those that affect men, though, in general, ischaemic heart disease, anxiety and depression and Type II diabetes had the National Health Workforce Taskforce - 6 May

19 largest impact on healthy years lost for both sexes in There has been a shift however, in the conditions contributing to healthy years lost by both sexes. For males, although ischemic heart disease continues to be the dominant cause of burden between 1996 and 2003, conditions like lung cancer, stroke and COPD have declined as primary causes of burden of disease, whereas conditions like prostate cancer, diabetes, anxiety and depression have all seen significant growth as primary causes of burden of disease. Table 2.2: Causes of Burden (DALYs) by Sex Australia 2003 and MALES Males DALYs % of Total DALYs % of Total Ischaemic heart 151, , disease 2 Type II diabetes 71, ,438 3 Anxiety & 65, , depression 4 Lung cancer 55, , Stroke 53, , COPD 49, , Adult-onset 42, , hearing loss Suicide & selfinflicted 38, , injuries 9 Prostate cancer 36, , Colorectal cancer 34, , Source: Begg S, Vos T, Barker B, Stevenson C, Stanley L, Lopez AD, The Burden of Disease and Injury in Australia 2003, Cat. no. PHE 82, Canberra, Mather, C, Vos, T, Stevenson, C, The Burden of Disease and Injury in Australia 1999, Cat. No. PHE 17, Canberra Note: The Disability Adjusted Life Years also known as DALYs measures the impact that long term conditions have on the public in terms of the years of healthy life lost due to disability. There has been an observed change in the burden of disease for females between 1996 and 2003 (Table 2.3). Anxiety and depression has seen significant increase from 1996 to 2003, becoming the primary burden of disease for females in Australia in Breast cancer and diabetes have also seen growth as a burden of disease. But, while still dominant contributors to the burden of disease, conditions such as ischaemic heart disease and stroke have seen a large decline between 1996 and 2003 for females. While it is beyond the scope of this paper to consider the factors underlying this increase in and the changing nature of burden of disease, the trends themselves have implications for health care workforce demand. National Health Workforce Taskforce - 6 May

20 Table 2.3: Causes of Burden (DALYs) by Sex Australia 2003 and FEMALES Females DALYs % of Total DALYs % of Total 1 Anxiety & 126, , depression 2 Ischaemic heart 112, , disease 3 Stroke 65, , Type II diabetes 61, , Dementia 60, , Breast cancer 60, , COPD 37, , Lung cancer 33, , Asthma 33, , Colorectal cancer 28, , Source: Begg S, Vos T, Barker B, Stevenson C, Stanley L, Lopez AD, The Burden of Disease and Injury in Australia 2003, Cat. no. PHE 82, Canberra, Mather, C, Vos, T, Stevenson, C, The Burden of Disease and Injury in Australia 1999, Cat. No. PHE 17, Canberra Note: The Disability Adjusted Life Years also known as DALYs measures the impact that long term conditions have on the public in terms of the years of healthy life lost due to disability. Figure 2.3 highlights the differences in burden of disease by geographic location. The cause that contributed the greatest difference between geographic categories was injuries. Intentional and unintentional injuries contributed a far higher burden in remote geographies than major cities. Diabetes and chronic respiratory disease also contributed significantly higher burdens in remote geographies than major cities or regional areas. This highlights the fact that, not only do burdens of disease vary over time, but they also vary by geography, and that the consequential number, specialties provided and distribution of health workers in Australia must reflect this. National Health Workforce Taskforce - 6 May

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