Non-technical summary
In the last 50 years, there have been substantial increases in longevity worldwide. Girls (boys) born in Australia today are expected to live to 85.0 (80.9) years – 10.8 (13.3) more years than those born 50 years ago (ABS 2020). These numbers place Australia’s combined male and female life expectancy sixth-highest in the world, above countries with similar per-capita GDP, such as the US, UK and Canada.
However, these are average life expectancy figures, across diverse populations. There is growing evidence that these gains are not being shared equally among the rich and the poor. In wealthy countries such as Canada and the US, rich people are living longer than poor people, and for some age and gender groups these differences have been increasing over time (Baker et al 2019; Milligan and Schirle 2018; Currie and Schwandt 2016a, 2016b; Chetty et al 2016).
In this paper, we examine the evolution of longevity trends in Australia during the period 2001-2018. More specifically, our research questions are: (i) Is there inequality in mortality rates across people with different levels of lifetime income and access to economic resources in Australia, and if so, (ii) how has this inequality changed over time? Moreover, (iii) what are the social and economic factors underlying the trends?
Our findings for all-cause mortality inequality over the period 2001-18 are three-fold. First, for many age groups among both males and females, there is no significant change in the level of mortality inequality. While a zero result, it should not be considered a negative result. Second, for middle-aged Australians mortality inequality is increasing. For men, this can largely be explained by differences in mortality rates across urban and rural populations, however this is not the case for women. Third, for teenagers and young people, there is a convergence in death rates between the rich and the poor.
Looking at specific causes of death provides further insight into these trends. For middle-aged males, it appears that diabetes is the major factor generating higher mortality inequality, and for women it is cancer. We find that for young people, the greater equality is driven largely by falling mortality due to external causes of death. There has also been a welcome convergence between male and female death rates due to these external causes of death, particularly due to motor vehicle accidents. This cause-specific data also reveals trends that are not picked up by the all-cause results. One example is the positive development of decreasing mortality inequality for coronary heart disease, which is a leading cause of death for adults over 45, and particularly men.
Examining data on the number of per capita doctors in different regions suggests that there are inequalities in access to healthcare across different regions in Australia, and there has been no significant improvement on this front from 2001-18. This problem may be contributing to the persistent and growing diabetes mortality inequality that exists for males aged 45-54. Our analysis suggests that improving access to doctors in poor regions and regional Australia is an avenue policymakers could target if seeking to reduce mortality inequalities.