How healthy is your city? This is what the census tells us...

A new census question reveals the physical and mental stresses affecting communities across Australia for the first time.

About one-third of the Australian nation (35 per cent) reported some form of long-term health condition.

Every so often the census includes new questions that reflect changes in Australian society. A new question added to the 2021 census asked about long-term health conditions, which is precisely the kind of information needed to manage the wellbeing of an ageing community. Indeed, this information helps allocate resources and better delivers appropriate care.

The question asked about 10 long-term conditions, namely arthritis, asthma, cancer, dementia, diabetes, heart disease, kidney disease, lung condition, mental health conditions including depression and anxiety, stroke and “other”. It’s a comprehensive list and there was the option of ticking multiple boxes.

About one-third of the Australian nation (35 per cent) reported some form of long-term health condition. Since this is a new question, we don’t know if this figure is rising or falling.

And because the census was conducted at the 18-month mark of a pandemic we don’t know the extent to which Covid anxiety contributed to the response.

We will have a better context within which to view the 2021 census responses to this question and others after completion of the next census.

To some extent the question about long-term health conditions confirms a self-evident truth about the nature of life: health conditions generally worsen later in life. This is evidenced in the “spaghetti chart” tracking the proportion of the population reporting long-term health conditions by single year of age.

Dementia, for example, rises exponentially after 80. Arthritis is the most common affliction from the mid-50s onwards.

From the mid-60s onwards there’s a series of ascendant health concerns, namely kidney disease, then diabetes, then heart disease. Asthma, on the other hand, is reported as peaking in the teenage years before plateauing and trailing off in the 50s and beyond.

With the possible exception of asthma and kidney disease, the long-term health condition that most afflicts the young is poor mental health. The census shows that this condition increases sharply across the teenage years, then peaks at 13 per cent of the population in the 20 to 24 cohort.

Across the life cycle, 7 per cent of males and 11 per cent of females report long-term mental health conditions. And while these conditions tend to subside later in the life cycle there is a worrying uptick in mental health concerns in life’s later years.

What can we do to ease this burden of anxiety and depression (and more besides) amid the frail elderly, let alone across an entire generation of young people coming through?

Capturing this information via the census is an important first step. Surely a next step is for clinicians and other health professionals to develop and/or to finesse responses (including funding) to manage long-term health conditions.

Mapping collective long-term health conditions reinforces the point that these afflictions, generally, accrete with age since aggregate hotspots hover over retirement communities.

However, mapping reported long-term mental health conditions tells a different story, a story that largely speaks to the anxieties of young Australians.

The census reports high incidences of long-term mental health concerns in places such as Sebastopol in Ballarat and Leichhardt near Brisbane’s Ipswich, where this affliction affects 20 per cent of the population in both communities. In other states the peak is lower; for example, the Northern Territory peaks at just 10 per cent in the Darwin suburb (as opposed to the islands) of Tiwi.

The mapping shows that mental health concerns are endemic across much of regional Australia, affecting between, say, 10 and 14 per cent of the population. In industrial cities such as Newcastle and Geelong there are hotspots in suburbs such as Mayfield (18 per cent) and Norlane (19.6 per cent). In Ravenswood on the eastern edge of Launceston this proportion is 18 per cent.

In Canberra’s university suburb of Acton mental health concerns affect 17 per cent of the population.

Across the capital cities yet another story unfolds; indeed, I see a key difference between Melbourne and Sydney and the rest.

Mental health concerns are moderate across central Perth, although there are more intense clusters along the coast between Rockingham and Mandurah.

The same logic applies to Adelaide, where this issue peaks in both the north (Elizabeth, 17.5 per cent) and in the south (Hackham West, 19 per cent).

Brisbane’s mental health concerns cluster on the city’s edges to the north, south and southwest.

In Australia’s biggest, and some might say most locked down, cities of Sydney and Melbourne there are hotspots on the edges and especially on the Central Coast and at Frankston North. But it is in the centre of these vast cities where mental health concerns escalate.

For Sydney, the mapping identifies a cluster in the inner west centred on Newtown (15 per cent) where mental health conditions peak.

For Melbourne the equivalent hotspot is broader; it skirts the city; it extends to the west and along the bayside; it envelops Brunswick South (17 per cent).

It could be that communities reporting higher than average long-term mental health conditions are skewed towards the vulnerable 20 to 24 population cohort. More residents from this age group boost the proportion of the population reporting mental health conditions.

Plus it could be that the congested cores of Sydney and Melbourne create a kind of Manhattanesque anxiety, especially at a time when socialising is limited by Covid restrictions, that manifests in poor mental health outcomes.

Perhaps the data reflects anxiety around job security in industrial cities at the time of the census.

And maybe social housing in places such as Norlane has attracted a community that needs social assistance and support. Indeed, restricted access to support services and networks also may diminish metal health outcomes.

Another way of examining this question is to identify those communities in each state and territory where the highest proportion of the population claimed no long-term health conditions.

These places tend to comprise specialist communities such as a military college, universities, young family suburbs and mining towns. In these communities between 60 per cent and 90 per cent of the population report no long-term health conditions.

The question on long-term health conditions is a welcome addition to the census. It may be based on a self-assessment methodology, but it adds value because it paints a picture of our quality of life, of the stresses and strains, of the age-specific challenges affecting communities across Australia and throughout the life cycle.

Later, when more census data is released, it will be possible to cross-tabulate these long-term health conditions with income, employment status and a range of other variables.

These insights will help policymakers direct resources to some of the most vulnerable cohorts within the Australian community.

But perhaps more important than establishing mere metrics around these conditions, including mental health concerns among the young, is the fact that placing this question on the census raises the profile of all of these conditions. It proves the adage that if something isn’t measured then it cannot garner attention, support or funding.

I am already looking forward to the 2026 census to see how Australians respond to this question – hopefully by then fully outside the context of a pandemic.

Bernard Salt is executive director of The Demographics Group. Research and data by Hari Hara Priya Kannan.