Australia Yearbook - 2001

Chapter 9—Health 373
caused so many babies to die in 1901–1920. The
modern causal pathways to postneonatal death
start early in development, and while some may
still be socially related, they are complex and
preventive solutions are not currently obvious.
Neonatal mortality has always been influenced by
pregnancy complications and fetal growth and
development. Thus its reduction had to await
new methods to treat the end-stage
complications in the neonate, as primary
prevention was not possible in ignorance of
causality. Most neonatal deaths occurred in the
first days of life and this pattern is still seen today.
Neonatal mortality rates have fallen steadily from
the 1920s as better knowledge resulted in
effective treatments for high risk pregnancies,
obstetric care in labour and, particularly since
1970s, neonatal care of preterm and low
birthweight babies. As graph C6.5 also shows, in
the late 1990s the neonatal mortality rate was
under 4 per 1,000 live births (now 62% of infant
deaths); 60% of these occurred on the day of
birth. Most were due to extreme prematurity and
poor fetal growth, congenital malformations and
complications of pregnancy.
Thus the challenges facing us to further reduce
neonatal mortality are similar to those for
postneonatal deaths. Both demand research into
the many causes of preterm birth, intra-uterine
growth restriction and developmental anomalies.
As most children born with these problems today
do not die, but have significant morbidity and
disabilities, knowledge leading to prevention is of
considerable importance. While neonatal
mortality in certain low gestation and birthweight
categories has been used in the past to evaluate
the quality of newborn intensive care, this is no
longer a reasonable index.
Recently in Australia, there has been a tendency
in the media to use infant mortality, as well as
mortality at older ages, to judge the appropriate
levels of expenditure on medical, particularly
hospital, services. This is inappropriate as the
antecedents and major contributors to these rates
today have little to do with hospital services. As in
1901, the causal pathways to infants dying in the
1990s commenced well before hospital services
have any influence. Preventive solutions thus lie
elsewhere and demand investment in research in
early causal pathways.
Deaths in childhood
The death rates in children (1–4 and 5–14
years) have always been far lower than those
among infants and are now very low in
Australian children (only 14 deaths occur in
every 100,000 5–14 year olds) (graph C6.1).
However the major causal grouping, i.e.
childhood accidents, poisoning and violence
(nearly 50% of all deaths), is of public health
importance as these are potentially
avoidable. The commonest causes of
accidental death in children are motor
vehicle accidents, drowning and inhalation of
foreign bodies. Decreases in accidental
deaths due to traffic accidents and drowning
in the 1980s and 1990s followed legislation to
restrain young children in cars and to make
swimming pool fencing compulsory.
Changes in Western Australia which have
relaxed the policing of swimming pool
fencing have resulted in increases in child
drowning in that State recently (Eastough
and Gibson 1999; Silva, Palandri et al. 1999).
Children in poorer families and in
Indigenous families are more likely to have
accidents than those in other families.
Other causes of childhood deaths include
congenital anomalies (particularly those of
the heart and nervous system, and
chromosomal defects such as Downs
Syndrome) and cancers. Medical science has
made significant contributions to falls in all
these causes of death by more accurate
diagnosis, improved surgical techniques and
chemotherapy.
Causes of death in teenagers
The causes of death in older children (5–14
years) and teenagers (15–19 years) were
dominated in the early part of the century by
infectious diseases. And particularly among
males, accidental and violent death has
always been an important contributor. The
most common causes of death in the age
group 15–19 years in the 1990s were
accidents and suicides. The most worrying
trend in all of those shown in this article is
the increasing rate of suicides in young
Australian males.