Australia Yearbook - 2001

Chapter 9—Health 379
There continue to be success stories with new
and effective infant vaccines. In 1980s
Haemophilus influenzae (Hib) was the most
serious infection in young children (graph 6.12).
Invasive Hib disease (meningitis, septicaemia)
had a high case fatality, particularly among
Indigenous infants, and left many surviving
children with severe intellectual and physical
disabilities (Hanna 1992).
Parents’ fear of polio in the 1950s and of
meningitis in the 1990s resulted in high levels of
participation in these vaccination programs. As
the incidence and severity of infections has fallen,
parents have become apathetic about vaccination
and some actively oppose it. Because of its very
effectiveness, vaccination is regarded by a
significant proportion of the community as
unnecessary or dangerous. Yet its success to
prevent disease depends upon high rates of
participation. Current rates of vaccination in
Australian children are less than those in Viet
Nam; this is another public health challenge for
us in the 21st century.
Sulphonamides to treat infections were introduced
in early 1940 and penicillin, dramatically effective
against Streptococcal infections including bacterial
meningitis, became available immediately after
World War II. Other antibiotics followed, and the
death and complication rates of all bacterial
infections fell markedly (Williams 1989). However
the excessive use of antibiotics has resulted in
increasing numbers of organisms resistant to their
effects. This situation is extremely worrying and
makes the case for primary prevention even more
powerful.
From 1945 until 2000, with infectious disease
rates very low, and other public health measures
almost taken for granted, medical care began its
revolutionary impact on illness and death.
Children were to be beneficiaries of new
knowledge in biomedical science as well as from
the specialisation in paediatric care.
The sciences of physiology, biochemistry and
pathology blossomed throughout the 20th
century, following fast on the tracks of
bacteriology. Knowledge about how the body
worked and how diseases were caused meant
that diagnosis became accurate and treatments
more focused and effective. X-rays, surgery and
anaesthesia, fluid and electrolyte metabolism,
chemotherapy and other drugs such as those for
epilepsy, pain relief and many disorders, have
been so effective that many now believe that
everything can be cured or will be very soon.
Public health, once centre stage and still vital,
is often ignored.
Child illnesses in the 20th
century
Morbidity and disability
While death rates in the early decades of 20th
century probably reflected the occurrence of
illness reasonably well, the rarity of death
among children now means that death rates
do not reflect the burden of illness and
disability affecting our children and youth.
Morbidity data for all Australian children are
available via surveys, such as the National
Health Survey, and from data collated by
AIHW. And some States, such as WA, have
good record-linked and special survey data to
describe the recent pattern of child and
adolescent morbidity (Stanley, Read et al.
1997).
The rise of complex disease—the
challenge of the late 20th century
Improvements in social and economic
circumstances in Australia have changed the
face of child health. Similar to other
developed countries, we have observed
increases in ‘complex’ diseases in the cohorts
of children born in the last three decades.
Suicide and mental health morbidities have
been described already and appear to be
related to the social changes in our
communities. The increased rates of cerebral
palsy in very preterm and low birthweight
survivors following the introduction of
intensive care are an unwelcome outcome of
effective technologies aimed at reducing
deaths (Stanley, Blair et al. 2000).
Two other examples are asthma and juvenile
diabetes, both of which have increased
considerably. They head a list of complex
disorders which have taken over from
infectious diseases as the most serious
threats to the health of our young people.
A review of population data and national
health surveys (Bauman 1993) showed an
increase in asthma symptoms, such as recent
and cumulative wheeze and diagnosed asthma
between the 1970s and 1990s (graph C6.13).