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force participation but also on labour productivity. It may not be feasible to eliminate these chronic diseases especially in the short term, although reducing some of the risk factors for diabetes and cardiovascular disease may also be important for other serious chronic disease such as cancer, arthritis and mental illness that affect labour market outcomes.

There is a number of promising approaches to the primary and secondary prevention of diabetes and cardiovascular including lifestyle (smoking reduction, weight reduction and physical activity increasing) as well as pharmacological interventions. Some of these have been shown to be successful in experimental studies and to offer value for money at least in simulations. For example it has been suggested that making pharmaceuticals that are widely regarded as effective such as antihypertensive and lipid-lowering pharmacologic therapy available to a wider group of patients for the primary prevention of cardiovascular disease would be a cost effective way of reducing cardiovascular disease (Kostis 2007). Strong, consistent evidence from large, well-designed trials has definitively shown that maintenance of modest weight loss through diet and physical activity prevents the progression from early diabetes (Pan, Li et al. 1997; Tuomilehto J 2001; Diabetes Prevention Program Research Group 2002; Eddy, Schlessinger et al. 2005) and can reduce the incidence of type 2 diabetes in high-risk persons by about 40-60% over 3 to 4 years (Centers for Disease Control and Prevention Primary Prevention Working 2004). While studies such as these that focus on multiple risk factors using individual health practitioner based counselling and educational methods are useful, there has been a recognition that interventions based on lifetime risk are more likely to be effective. In particular the importance of early life factors (in utero and early childhood) in creating predispositions to chronic disease in adulthood has been recognised. What this implies are broader strategies that involve a wider range of agents (e.g. transport, education, tax system, market regulation) to change social norms, in the case of obesity for example to a norm of more active living and healthy life habits.

The current study does not provide any new evidence on the cost effectiveness of measures to reduce the prevalence of chronic disease, but it does illustrate that the effective implementation of chronic disease prevention programs could have a significant effect on the stock of human capital particularly for those aged 55 years and over where the risk of chronic disease and the potential loss of human capital is highest. The last decade has seen tremendous advances in the treatment of heart disease and cardiovascular disease risk factors. There is now an large body of evidence supporting the use of ACE inhibitors, antihypertensive medications, and lipid lowering agents for both primary and secondary prevention of cardiovascular disease events in high-risk populations, including those with diabetes (UKPDS 1998; HOPE 2000; MRC/BHF 2002). The AusDiab survey data here shows that only 11.5% of those with elevated lipids were on medication. Only 50% of those with elevated blood pressure were on medication, and only 50% of either group got sufficient exercise. There has been a substantial rise in the use of cardio protective drugs in Australia in the last few years, but there is still likely to be a substantial number of people who would benefit from medication.

It has to be recognised that our ability to forecast just how effective a lever on labour force participation these interventions might be is limited by the cross sectional nature of the data used here and the robustness of the translation of the evidence on the effectiveness of interventions into practice in Australia. The analysis suggests a potentially significant effect of chronic disease prevention and treatment on labour market outcomes, but the current data do not allow us to take account of the history of respondents in terms of risk and treatment or the dynamics of treatment effects. The 1999- 2000 AusDiab survey is the first wave of a panel and future research can take advantage of the follow up data to confirm these results and shed light on the labour market outcomes of changes in disease status over time.

Chronic disease and labour force participation in Australia: an endogenous multivariate probit analysis of clinical prevalence data


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