Lesson 6 · How healthy are Australians?
The third condition: choosing, profiling and comparing a condition of your own
The dot point names cardiovascular disease and cancer, and then says “ONE other condition”. Choosing it is a real decision, not a formality: a condition you cannot describe a trend for, or cannot name protective factors for, will cost you marks in every question that mentions it for the rest of the course.
Name a health condition, other than cardiovascular disease and cancer, that you think is a major issue in Australia.
Now try to answer, without looking anything up: is it becoming more or less common? Who does it affect most? And what would reduce it? Note which of the three you could not answer.
- Choose a third condition you can profile completely, using a defensible set of criteria.
- Build a data profile for it across mortality, morbidity, prevalence and incidence.
- Identify its risk and protective factors, and say which it shares with cardiovascular disease and cancer.
- Describe where and for whom it is changing.
- Compare it with the other two conditions, which is what most extended-response questions actually ask.
- Chronic condition — a condition that is long-lasting, usually with persistent effects, and generally managed rather than cured.
- Comorbidity — the presence of more than one condition in the same person at the same time.
- Type 2 diabetes — a condition in which the body becomes resistant to insulin or does not produce enough, so blood glucose rises.
- Chronic obstructive pulmonary disease — long-term airflow limitation, most often caused by smoking.
- Dementia — a group of conditions causing progressive decline in cognitive function; strongly age-related.
- Injury — harm from an external cause, including road trauma, falls, and intentional self-harm; unlike most chronic disease it is concentrated in younger age groups.
- Under-reporting — a condition appearing less common in data than it is, because of stigma, diagnosis practice or how records are coded.
Four criteria, in priority order. A condition that fails the first two should not be chosen no matter how important it is.
- You can state a trend. If you cannot say whether it is rising, falling or flat, and over roughly what period, you cannot answer the first sub-point.
- You can name risk and protective factors with mechanisms. Not a list of words — a reason each factor changes the probability.
- You can say where and for whom it is changing. The distribution sub-point is where the higher marks are, and some conditions have much clearer distributions than others.
- It contrasts usefully with the other two. A condition that behaves exactly like cardiovascular disease adds nothing to a comparison question; one that behaves differently gives you something to say.
Choose for contrast. The best third condition is the one that makes cardiovascular disease and cancer look different from each other and from it — because comparison is what extended-response questions ask for.
Quick check: Which is the strongest reason to choose a third condition that behaves differently from cardiovascular disease and cancer?
Type 2 diabetes
Trend: prevalence rising over decades, driven by population ageing and by rising overweight and obesity; better management means fewer people die of it directly and more live with its complications.
Risk: overweight and obesity, physical inactivity, diet, age, family history, and gestational diabetes.
Distribution: a clear gradient by socioeconomic position and remoteness, and much higher rates and earlier onset among Aboriginal and Torres Strait Islander Peoples.
Contrast value: high. It shares risk factors with cardiovascular disease, and it is also a risk factor for it, which lets you write about comorbidity.
Mental health conditions
Trend: a large and rising share of total morbidity, especially in young people; mortality is low relative to the burden except through suicide, which makes it the clearest case of the mortality–morbidity divergence.
Risk: adverse experiences, social isolation, financial and housing insecurity, discrimination, substance use, family history.
Distribution: higher in younger age groups, in disadvantaged areas, and in groups experiencing discrimination.
Contrast value: very high, because it breaks the pattern of the other two almost completely.
Chronic respiratory conditions
Trend: chronic obstructive pulmonary disease mortality broadly falling with smoking, and lagging behind it by decades; asthma prevalence high and comparatively stable.
Risk: tobacco smoking above all, occupational and air pollution exposure, and for asthma a mix of genetic and environmental factors.
Distribution: strong socioeconomic gradient, tracking historical smoking patterns.
Contrast value: moderate. Very clean demonstration that today's disease reflects yesterday's exposure.
Injury, and dementia
Injury trend: road deaths fell dramatically with regulation and vehicle design; falls in older people are rising with the ageing population; intentional self-harm has not fallen with the others.
Injury contrast value: very high — it is concentrated in the young, it is not a chronic disease, and it is the clearest example of regulation producing a health gain.
Dementia trend: rising as a cause of death and of care demand, because it is strongly age-related and the population is ageing.
Dementia contrast value: high, and it links directly to the ageing-population dot point in the next lesson.
Any of these five satisfies the syllabus. What matters is that you can complete the profile in the next card for whichever you choose.
True or false: Mental health conditions are the clearest example of the divergence between mortality and morbidity, because they account for a large share of the burden of illness while causing comparatively few deaths.
Six rows. Fill every one, in trend language, with no requirement to find a current figure.
- Mortality. Is it a leading cause of death? Rising, falling or flat? If it kills few people, say so — that is a finding, not a gap.
- Morbidity. How much illness and disability does it cause? For several of the candidates above, this row is far larger than the mortality row.
- Incidence. Are new cases increasing? Distinguish a real rise from better detection or changed diagnostic criteria.
- Prevalence. How many people live with it? Rising prevalence with stable incidence means longer survival or longer duration.
- Risk and protective factors. Split modifiable from non-modifiable, and mark which are shared with cardiovascular disease and cancer.
- Where and for whom it is changing. By age, sex, socioeconomic position, remoteness, and for Aboriginal and Torres Strait Islander Peoples.
Two honesty rules that mark out a serious answer:
- Say when a measure is uncertain. Mental health prevalence depends heavily on how it is surveyed and on whether people report; injury data depends on what is coded as an external cause. Naming that uncertainty is analysis, not weakness.
- Distinguish a rise in the condition from a rise in the counting. Broader diagnostic criteria, a new screening test or reduced stigma all increase recorded cases without any change in underlying health.
Fill the gaps. The presence of more than one condition in the same person at the same time is called . A condition appearing less common in data than it truly is, because of stigma or coding practice, is described as under- .
Once you have three conditions profiled, compare them on four axes. Each axis is a ready-made paragraph.
- Mortality against morbidity. Which condition kills, which disables, and which does both? This is where mental health conditions and injury separate sharply from cardiovascular disease.
- Prevention against treatment. Which has improved because exposure fell, and which because treatment improved? Cardiovascular disease is the prevention case, cancer the treatment case; your third condition will sit somewhere on that line and you should say where.
- Age pattern. Conditions concentrated in older people behave completely differently from conditions concentrated in the young — in years of life lost, in service demand, and in what a strategy should target.
- Shared risk factors. Where your third condition shares modifiable factors with the other two, one prevention measure buys three reductions. Where it does not, it needs its own strategy. That distinction is a strong closing argument in an evaluation.
One further idea worth a sentence: comorbidity. These conditions are not independent. Type 2 diabetes raises cardiovascular risk; chronic illness raises the risk of depression; depression reduces the likelihood of managing a chronic condition well. A person with several conditions has a worse outcome than the sum of the individual conditions would predict, and a system organised by single conditions handles that badly — which is a point you will use again in the healthcare system lessons.
Odd one out. Three of these would raise the recorded number of cases without any change in underlying health. Which one would not?
A model to copy for whichever condition you choose.
- Mortality. A contributing cause far more often than an underlying one, because people with diabetes most often die of its complications, particularly cardiovascular and kidney disease. So the death certificate under-represents its role, and reading mortality alone understates it.
- Morbidity. Large and growing: vision loss, kidney failure, nerve damage, foot complications and amputation, and a substantial burden of daily self-management.
- Incidence. Rising over decades, alongside rising overweight and obesity and an ageing population; some of the recent rise reflects earlier detection through routine testing.
- Prevalence. Rising faster than incidence, because people diagnosed live for decades with the condition. This is the classic falling-mortality, rising-prevalence pattern from Lesson 5.
- Risk and protective factors. Modifiable: overweight and obesity, physical inactivity, diet, and for gestational diabetes, care in pregnancy. Non-modifiable: age, family history, ethnicity. Protective: physical activity, dietary quality, weight management, and early detection through routine testing so that treatment begins before complications develop. Every modifiable factor here is shared with cardiovascular disease, which is the point.
- Where and for whom. A pronounced socioeconomic gradient; higher with remoteness; substantially higher rates and earlier onset among Aboriginal and Torres Strait Islander Peoples; rising in younger adults, which is new and matters because earlier onset means more years of exposure to complications.
Note the shape of the strongest sentence in that profile: “the death certificate under-represents its role”. Knowing what a measure cannot see is worth more than knowing what it says.
Text description
- A map with two axes, followed by a note on each condition.
- The vertical axis runs from mostly mortality at the top to mostly morbidity at the bottom.
- The horizontal axis runs from gains mostly from prevention on the left to gains mostly from detection and treatment on the right.
- Cardiovascular disease is placed upper left, cancer upper right, injury on the left below cardiovascular disease, type 2 diabetes low and towards the centre, and mental health conditions lower left.
- Beneath the map, each condition has a note: cardiovascular disease, exposure fell so mortality fell; cancer, screening and treatment improved survival; injury, regulation and design, concentrated in the young; type 2 diabetes, shares every modifiable risk factor with cardiovascular disease; mental health conditions, large burden and comparatively few deaths.
- A dashed box notes that comorbidity connects the points: diabetes raises cardiovascular risk, chronic illness raises depression risk, and depression worsens chronic disease management.
- A final box explains that a third condition is chosen for its distance from the other two, because that distance is what a comparison question is asking about.
Activities · build and defend a profile
For each, say where it sits on the two axes in the diagram and give the one-sentence reason.
Chronic obstructive pulmonary disease.
Dementia.
Falls in older people.
Asthma.
Match each profile row to the question it answers.
- Mortality
- Morbidity
- Incidence
- Prevalence
- Is this a leading cause of death, and is that changing?
- How much illness and disability does this cause among the living?
- Are new cases increasing, and is that real or better detection?
- How many people are living with this, and so how much care is needed?
Choose your condition using the four criteria from card 04, then fill all six profile rows. Finish with one sentence comparing it to cardiovascular disease and one comparing it to cancer.
Lock it in. In one sentence, explain why a condition's death certificate data can understate how much harm it causes.
Examine the prevalence, risk factors and changing distribution of type 2 diabetes in Australia.
Examine asks you to inspect the condition closely across the measures named in the stem — prevalence, risk factors, and distribution — and bring out what the inspection shows.
Plan: inspect each of the three in turn, then say what they show together.
Type 2 diabetes is one of the fastest-growing chronic conditions in Australia, and the recorded prevalence understates the true figure because a substantial proportion of cases remain undiagnosed for years. It also carries a large indirect burden, since it is a major contributor to cardiovascular disease, chronic kidney disease, vision loss and lower-limb amputation.
The dominant modifiable risk factors are overweight and obesity, physical inactivity and poor diet, particularly diets high in energy-dense processed foods. Non-modifiable factors include age, family history and ethnicity, with Aboriginal and Torres Strait Islander Peoples and several culturally and linguistically diverse populations at markedly higher risk.
The distribution is shifting in two ways. Prevalence rises with socioeconomic disadvantage and with remoteness, so the condition is concentrating in the groups least able to absorb its costs, and age at diagnosis is falling, with type 2 diabetes now appearing in adolescents and young adults where it was once a condition of later middle age.
Because onset is occurring earlier, each case now accumulates complications over a longer period, so the future burden grows faster than the prevalence figure alone suggests — the condition is becoming both more common and more costly per case.
Type 2 diabetes is one of the fastest-growing chronic conditions in Australia, and its recorded prevalence understates the true figure because many cases remain undiagnosed for years; it also carries a large indirect burden as a major contributor to cardiovascular disease, chronic kidney disease, vision loss and lower-limb amputation. Its dominant modifiable risk factors are overweight and obesity, physical inactivity and poor diet, particularly diets high in energy-dense processed foods, alongside the non-modifiable factors of age, family history and ethnicity, with Aboriginal and Torres Strait Islander Peoples and several culturally and linguistically diverse populations at markedly higher risk. The distribution is shifting in two ways: prevalence rises with socioeconomic disadvantage and remoteness, concentrating the condition in the groups least able to absorb its costs, and age at diagnosis is falling, with the condition now appearing in adolescents where it was once a disease of later middle age. Because onset is occurring earlier, each case accumulates complications over a longer period, so the future burden grows faster than the prevalence figure alone suggests — the condition is becoming both more common and more costly per case.
Analyse why the burden of type 2 diabetes falls unevenly across Australian population groups.
Analyse requires you to break the pattern into its parts and show how they relate. Naming the affected groups is description; showing what produces the unevenness is analysis.
Plan: identify the components, state what links them, relate them across the situation, then draw the implication.
The unevenness has three components: differences in exposure to the risk factors, differences in access to early detection and management, and differences in the capacity to sustain the behavioural changes treatment requires.
All three are governed by socioeconomic position. Income determines the affordability of fresh food and of the time and facilities for physical activity; it also determines the affordability of the ongoing medication, monitoring equipment and allied health appointments that management requires, so the same determinant sets both the likelihood of developing the condition and the likelihood of controlling it once it exists.
Remoteness compounds this independently, because distance from primary care and allied health reduces the frequency of monitoring, so complications are detected later and progress further before intervention. For Aboriginal and Torres Strait Islander Peoples these operate together with the ongoing effects of colonisation and with services that may not be culturally safe, producing the highest burden of any group.
The limiting case demonstrates the mechanism: an individual with the same genetic risk and the same diagnosis faces a substantially different prognosis depending on income and location, because the condition is managed continuously rather than cured, and continuous management is precisely what socioeconomic position and geography make easy or hard.
The uneven burden of type 2 diabetes has three components: differences in exposure to the risk factors, differences in access to early detection and management, and differences in the capacity to sustain the behavioural change treatment requires. All three are governed by socioeconomic position, since income determines the affordability of fresh food and of the time and facilities for physical activity, and equally determines the affordability of the ongoing medication, monitoring and allied health appointments management requires — so the same determinant sets both the likelihood of developing the condition and the likelihood of controlling it. Remoteness compounds this independently, because distance from primary and allied health care reduces monitoring frequency, so complications are detected later and progress further before intervention. For Aboriginal and Torres Strait Islander Peoples these factors operate together with the ongoing effects of colonisation and with services that may not be culturally safe, producing the highest burden of any group. The mechanism is clearest in the limiting case: two individuals with identical genetic risk and an identical diagnosis face substantially different prognoses according to income and location, because the condition is managed continuously rather than cured, and continuous management is exactly what socioeconomic position and geography make easy or hard.
Go back to card 01. You named a condition and found one of the three questions you could not answer. Is it the same condition you chose in Activity 2? If it is, check that the gap is now filled; if it is not, write one line explaining what made you change, because that reason is the selection criterion working.
Multiple choice · 5 questions
MC 1. Type 2 diabetes often appears as a contributing rather than an underlying cause of death because:
- A. it is rarely diagnosed before death
- B. people with the condition most often die of its complications, particularly cardiovascular and kidney disease
- C. it is not classified as a chronic condition
- D. death certificates do not record chronic conditions
MC 2. Recorded cases of a condition rise sharply in one year with no change in mortality. The most likely explanation is:
- A. a sudden increase in exposure to a risk factor
- B. a change in detection, diagnostic criteria or reporting rather than in underlying health
- C. an error in the mortality data
- D. an increase in the total population that year
MC 3. Injury contrasts most usefully with cardiovascular disease and cancer because it:
- A. has no identifiable risk factors
- B. is concentrated in younger age groups and is not a chronic disease
- C. cannot be prevented by regulation
- D. produces no long-term disability
MC 4. A person with several chronic conditions typically has a worse outcome than the individual conditions would separately predict. The main reason is that:
- A. each condition is diagnosed less accurately when others are present
- B. the conditions interact, and a system organised around single conditions manages that poorly
- C. treatments for chronic conditions cannot be combined
- D. comorbidity is not recorded in health data
MC 5. Which is the most defensible first criterion for selecting a third condition to study?
- A. That it is the condition causing the most deaths in Australia
- B. That you can state a trend for it, because the first sub-point asks what the data tells us
- C. That it is unrelated to cardiovascular disease and cancer
- D. That it affects only one population group
Short answer · exam style
SA 1. Understand Band 4 For ONE condition other than cardiovascular disease and cancer, describe what the data tells us about its prevalence and morbidity in Australia. (4 marks)
SA 2. Analyse Band 5 Explain the risk and protective factors for ONE condition other than cardiovascular disease and cancer, identifying which of them are shared with those two conditions and why that matters. (5 marks)
SA 3. Evaluate Band 6 Compare cardiovascular disease, cancer and ONE other condition in terms of where and for whom they are changing in Australia. Evaluate what this comparison indicates about the health status of Australians. (6 marks)
📖 Comprehensive answers (click to reveal)
Multiple choice: 1 → B. 2 → B. 3 → B. 4 → B. 5 → B.
Activity 1 model placements: 1 → Chronic obstructive pulmonary disease: prevention side, mortality-weighted; its fall tracks the fall in smoking decades earlier, which makes it the clearest lagged-exposure case. 2 → Dementia: treatment side is weak because there is no curative treatment, and it is heavily morbidity-weighted with rising mortality as the population ages; its main strategy lever is care rather than cure. 3 → Falls in older people: prevention side and morbidity-weighted, and it is rising with the ageing population, so it is a demand problem as much as a disease problem. 4 → Asthma: morbidity-weighted with low mortality, and its gains came from management rather than from removing the cause, so it sits toward the treatment side.
SA 1 (4 marks): Condition named, other than the two specified [1]. Prevalence described as a trend, with a reason for the direction [1]. Morbidity described in terms of the illness or disability it produces, not only its existence [1]. An accurate observation about how the two relate — for example, that prevalence rises as people live longer with the condition, so morbidity accumulates [1].
SA 2 (5 marks): At least two risk factors with mechanisms, split into modifiable and non-modifiable [2]. At least two protective factors with mechanisms, ideally from more than one level — individual, health system, structural [2]. The shared factors identified and their significance explained: because the factors overlap, one prevention measure reduces several conditions at once, which makes shared factors the highest-value targets [1].
SA 3 (6 marks): Three conditions named and their distributions described by age, socioeconomic position, remoteness, and for Aboriginal and Torres Strait Islander Peoples [2]. Genuine comparison rather than three descriptions in sequence: for example, all three show a socioeconomic gradient, but the age pattern differs sharply, and the mechanism of the gradient differs — exposure for cardiovascular disease, stage at diagnosis and access for cancer [2]. An evaluation of what this says about health status: Australians are improving on most measures, the improvement is real, and it is unevenly distributed, with the same groups appearing at the poorer end for every condition, which points at shared upstream determinants rather than at condition-specific failures [1]. A judgement about what follows for strategy [1].
You now have a third condition and a six-row profile you can reuse. Keep it somewhere you can find it: every remaining lesson in this module can be answered better with a concrete condition to point at, and the SDG lessons at the end explicitly ask you to name a health issue for a community.
Before moving on, check your profile for the honesty rules: have you said anywhere that a measure is uncertain, or distinguished a rise in the condition from a rise in the counting? If not, add one sentence. It is the cheapest mark in this dot point.
Mark lesson as complete
Tick when you've finished the practice and review.