Adelaide PHN Access & Equity Framework

Access and Equity Framework Adelaide Primary Health Network (Adelaide PHN) December 2024

Document details

Owner

Executive Manager, Primary Care and Integration

Steering Group

Access and Equity ISG

Date Developed

December 2024

Status

External

Privacy Classification Date of Next Review Review Type /Responsibility File path/link

December 2027

Contents About this framework

1

1.1 Framework at a glance 1.2 How it was developed 1.3 Why health access and equity is a priority for Adelaide PHN 1.4 Health inequities in the Adelaide region - A case for change

2 3 3 4

Context

6

2.1 Defining health equity (and inequity) 2.2 Exploring the drivers of health inequity 2.3 How we work as an ecosystem to drive greater access and equity

6 7 11

Understanding and addressing access and equity in the Adelaide region

13

3.1 Guiding principles 3.2 Our key action areas for promoting equity

13 14

Governance, implementation and evaluation

18

4.1 Governance 4.2 Reporting and evaluation 4.3 Framework review process

18 18 19

References

20

Appendices

22

Appendix A: Glossary Appendix B: Adelaide PHN Strategic Focus Areas Appendix C: Policy context in Adelaide Appendix D: Roles and responsibilities to address health inequities Appendix E: Understanding social determinants of health

22 23 24 26 27

1.0 About this framework

Our Access and Equity Framework is our roadmap to improve health outcomes for all members of our community, focusing on the most vulnerable and underserved.

This framework outlines how APHN is targeting efforts to drive health equity and access as part of our overall strategic direction.

It articulates how we'll embed equity into our decision-making and commissioning processes, ensuring it remains at the heart of everything we do.

Page 1

1.1 Framework at a glance Our why for access and equity

Health Access and Equity matters to us because...

At Adelaide Primary Health Network, we believe everyone deserves the opportunity to achieve their best possible health and well-being.

It's about human potential.

Everyone deserves the opportunity to achieve their best possible health and wellbeing

This framework is our roadmap to improve health outcomes for all members of our community, focusing on the most vulnerable and underserved.

It's a human right.

Access to health is not a privilege but a fundamental right for all

It breaks cycles of disadvantage.

Addressing inequity prevents further entrenchment of health disparities It has a ripple effect.

Improving health equity benefits not just individuals but entire communities and our healthcare system as a whole

How we’re partnering together Our vision for health equity is built on a simple yet powerful idea: we are stronger together.

We rely on a connected ecosystem involving our staff, partners, providers, and communities to improve access to services and address the root causes of health disparities.

Cultivating partnerships through

Academic partnerships: Leveraging research to inform evidence-based practices and evaluate our impact

Cross-sector collaborations: Linking health services with education, housing, employment, and social services

Business alliances: Engaging local businesses in creating healthier work environments and communities

What this means for our focus Access & Equity vision

An accessible and inclusive health system for a healthy community

Our focus areas and objectives To ensure socially responsible, accessible and equitable funding decisions are made, we focus on:

Key focus area #1

Key focus area #2

Key focus area #3

Leadership Commitment Authentic Community Embedding an Equity Lens Demonstrate Engagement Across the Support staff in applying organisational dedication Commissioning Cycle equity considerations to to health equity Partner with diverse their work Embed an 'equity lens' stakeholders to address Foster understanding of across all operations health inequities inequity, place-based Ensure funded services Develop local pathways approaches, and social are equitable, to improve primary care determinants of health accessible, and access for vulnerable culturally responsive groups

Key focus area #4

Key focus area #5

Building Capacity and Skills Enhance ability of staff, providers, and stakeholders to deliver equitable and accessible services

Utilising Quality Data and Evidence Leverage data to identify inequities, inform practices, and evaluate equity interventions

Our Access & Equity enablers Partnering to address social determinants of health inequity

Leveraging our network to advance the system

Supporting those who need it most

Our guiding principles for Access & Equity Embedding place-based thinking We co-create localised solutions through shared partnerships, stewardship, and accountability.

Co-creating solutions We engage community as equal partners, utilising lived experiences expertise.

Nurturing authentic partnerships We foster intersectoral collaborations for systemic improvements.

Addressing broader social determinants of health We work with partners, providers and communities to tackle broader life factors influencing health inequities, including social and emotional wellbeing.

Removing barriers to health equity We actively collaborate to remove and reduce barriers to accessing optimal health and well-being.

Driving quality improvement We use feedback and data to enhance access and service delivery.

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1.2 How it was developed The development of this Access and Equity Framework has been a collaborative effort led by our CEO, Executive and Board as a key health equity action in the Adelaide PHN Strategic Plan and Adelaide PHN Business Plan.

To create a framework that truly serves our community, we engaged in consultations with a diverse range of stakeholders.

This collaborative process included our Board, Adelaide PHN Clinical Council, Community Councils, Aboriginal and Torres Strait Islander Health Council and key Aboriginal and Torres Strait Islander and multicultural community bodies. We also sought input from our staff, partners, providers and broader community members, placing particular emphasis on engaging people with lived experiences of health inequity.

Our approach was enriched by collaborations with subject matter experts, including the Centre for Inclusive Design, Strategic Momentum Group, and Northwest Melbourne PHN who have developed and are implementing an Access and Equity Framework 2021-2024¹ and drew upon academic research and population health data. This process reflects our commitment to creating a framework that is representative of and responsive to the needs of our diverse community.

1.3 Why health access and equity is a priority for the Adelaide PHN Addressing health inequities requires more than providing healthcare services – it demands a comprehensive strategy that tackles the broader social and economic factors influencing health outcomes.

At Adelaide PHN, we're committed to a multifaceted approach to improving access and equity.

Our focus is clear: support everyone in our region in accessing affordable, appropriate, high-quality healthcare, regardless of their background or personal circumstances.

We place particular emphasis on addressing the needs of the most disadvantaged and those at greater risk of poor health outcomes.

Health equity matters to us because…

It's about human potential.

Everyone deserves the opportunity to achieve their best possible health and wellbeing It's a human right.

Access to health is not a privilege but a fundamental right for all It breaks cycles of disadvantage.

Addressing inequity prevents further entrenchment of health disparities It has a ripple effect.

Improving health equity benefits not just individuals but entire communities and our healthcare system as a whole

¹ North Western Melbourne Primary Health Network.

'Access and Equity Framework.' NWMPHN, 2021

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1.4 Health inequities in the Adelaide region – A case for change The Adelaide PHN region is full of diverse communities, each with its own unique health story.

From bustling urban centres to quiet suburban streets, our region encompasses areas of relative advantage alongside pockets of significant disadvantage. This diversity isn't just demographic – it translates into real differences in health outcomes for our community members.

As we examine key demographic and health data, we uncover more than just statistics. We see families facing different health realities despite living just kilometres apart. These insights allow us to identify areas of greatest need and tailor our approach to address the specific challenges each community faces.

Total population of Adelaide PHN region

1,321,481 (id profile 2023)

People in the Greater Adelaide area who identify as

25% or 262,656 residents

in the Adelaide region were born overseas, predominantly from non-English speaking countries (MC NA 2024)

Over half of the Aboriginal and Torres Strait Islander population in the region is under the age of 24 years (PHIDU 2019)

The Kaurna People are the Traditional Custodians of the Adelaide metropolitan region

Aboriginal and Torres Strait Islander,

comprising 1.7% of the population compared to 2.4% in South Australia and 3.2% in Australia (id profiles 2021)

The 10 birthplaces of people from non-English speaking countries were: India, China, Italy, Vietnam, Philippines, Greece, Germany, Malaysia, Afghanistan and Poland

(ABS 2017)

The Adelaide metropolitan region is comprised of 17 Local Government Areas (id profiles 2023)

44,334 (3.5%) people in the Adelaide PHN region who spoke a language other than English at home reported difficulty with speaking English (id community 2021).

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Key markers of health inequality in the Adelaide PHN region

Socioeconomic disparity

The region includes both the most advantaged and disadvantaged areas in South Australia Playford, in the outer northern suburbs, has the lowest SEIFA score (852) in the region, placing it in the lowest 8% in Australia Other areas with significant socioeconomic disadvantage include parts of Salisbury, Port Adelaide Enfield and Onkaparinga

Mental health

Psychological distress levels vary widely, with some areas experiencing rates nearly double the national average In Playford, 22.8% of residents report high psychological distress, compared to the national average of 11.4% Elizabeth, Davoren Park and parts of Salisbury show particularly high rates of mental health issues

Chronic disease

In Playford, the percentage of people with three or more long-term illnesses is 98% higher than the national average Areas in Port Adelaide Enfield, such as Kilburn and Blair Athol, also show high rates of chronic diseases like diabetes and heart disease

Access to healthcare

The outer northern suburbs, including parts of Playford and Salisbury, have fewer GPs per capita compared to inner city areas Southern areas like Aldinga in Onkaparinga face barriers to accessing specialist services due to distance and transport issues

Early childhood development

In Davoren Park (Playford), the rate of children with developmental vulnerabilities is nearly three times the state average Parts of Salisbury and Port Adelaide Enfield also show higher rates of developmental vulnerability in young children

Health behaviours

Smoking rates in parts of Playford and Port Adelaide Enfield are double those in more advantaged areas like Burnside and Unley Obesity levels are significantly higher in outer suburban areas, particularly in the north and south, compared to eastern suburbs.

Life expectancy

There's a gap of up to seven years in life expectancy between the most advantaged areas (like Burnside and Unley) and the most disadvantaged (parts of Playford and Port Adelaide Enfield)

Australia

Adelaide PHN region

14.7% self-reported fair-to-poor health

16.1% self-reported fair-to-poor health

11.7% self-reported psychological distress

14.1% self-reported psychological distress

These disparities highlight the complex interplay of social determinants of health in our region. They remind us that improving health outcomes isn't just about providing services – it's about understanding and addressing the unique challenges our communities face.

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2.0 Context

While

equality

gives everyone the same resources...

2.1 Defining health equity (and inequity) Health equity is not the same as health equality.

...equity

Equality refers to each individual or group of people being given the same resources or opportunities. Equity recognises that not all individuals or groups have the same needs and therefore require access to different resources and opportunities to fully realise their best health and wellbeing.

recognises that individuals and groups have diverse needs and may require different resources to achieve their best health and wellbeing.

Figure 1: Visualising the difference between equity and equality² Health equity is about ensuring everyone has the opportunity to reach their full health potential, regardless of their social, economic or other circumstances.

This requires: Fair access to the conditions that support good health, like medical care, healthy food, adequate housing, quality education, and stable employment; and Addressing unfair and avoidable differences between population groups, whether they are defined by social, economic, demographic, geographic, or other dimensions of inequality³.

² Barlow, J. 'We Used Your Insights to Update Our Graphic on Equity.' RWJF Robert Wood Johnson Foundation, 2022 ³ World Health Organisation. 'Social determinants of health.' WHO, 2024

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2.2 Exploring the drivers of health inequity Imagine two children born on the same day in different parts of our region. One grows up in a safe neighbourhood with good schools, nutritious food and easy access to healthcare. The other faces unsafe housing, underfunded schools, food insecurity and limited healthcare options.

Despite their equal potential at birth, these children are likely to face vastly different health outcomes throughout their lives.

This scenario illustrates health inequity – unfair differences in health between groups of people. These inequities stem from the social conditions we experience from birth to old age, including where we live, our education, jobs and access to healthcare. They're not just personal tragedies; they're societal challenges that affect us all.⁴ To understand these factors, we need to consider both the broader societal structures and the more immediate influences on our health.

Structural determinants: The root causes At the deepest level, health inequities are driven by structural determinants. These include: Socioeconomic and political context: The policies, cultural values and governance structures that shape our society Socioeconomic position: Factors like social class, gender, race/ethnicity, education, occupation and income These structural factors create and reinforce social hierarchies, influencing the distribution of power, resources and opportunities within our community. They’re the reason why some neighbourhoods have better schools, safer streets and more accessible holistic care than others.

Intermediary determinants: The bridges to health Stemming from these structural factors are intermediary determinants – more immediate factors that directly impact our health. These include:

Material circumstances

Housing quality, neighbourhood conditions, working conditions and food security

Psychosocial factors Stress, social support, coping strategies, navigating the health system, housing, employment, education and non-clinical care coordination

Behavioural factors

Nutrition, physical activity, tobacco and other drug use and alcohol consumption

⁴ World Health Organisation. 'Health Inequities and Their Causes.' WHO, 2018

Biological factors

Genetic predispositions and age-related factors

Health system

Availability of and access to quality healthcare services

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These intermediary determinants can be categorised as protective or risk factors.

Protective factors, like community safety, supportive relationships and financial stability help prevent health problems Risk factors, such as unsafe living conditions, food insecurity and poverty are more likely to lead to negative health outcomes Figure 2. Some common risk and protective factors⁵

Some common risk and protective factors (AMWA 2024) Risk factors Spiritual Views being as flawed Perception of insignificance Conflicting religious beliefs Socio-economic Living in poverty Unemployed and job uncertainty Lack of housing and safe environment Low level education Discrimination and exclusion

Protective factors

Some common social determinants of health

Spiritual Future orientated Achievement Set of moral beliefs Socio-economic Social connection Supportive family Participation in sports, club, community or religious group Economic/financial security Employment/job security Stable housing

Psychological Stressful situation (financial, law) Trauma Low self-esteem Poor academic achievement

Psychological Reliable support Discipline from caregivers Emotional self-regulation Sense of self-sufficiency

Biophysical Family history of mental illness Chronic medical condition Poor nutrition and lack of sleep

Biophysical Secure attachment as child Healthy diet, exercise and development

Interestingly, not everyone exposed to adverse conditions experiences worse health outcomes. Protective factors, especially strong social and family support, can provide a buffer against negative impacts. This resilience highlights the importance of not just addressing risk factors but also actively building and strengthening protective factors in our communities.

Health inequity is complex, arising from the interplay of these structural and intermediary determinants. By understanding these drivers of health inequity, we can develop more effective, comprehensive strategies to create a fairer, healthier community for everyone. (See Appendix E)

Did you know?

Social determinants of health – the conditions in which we're born, grow, work, live, and age – can account for 30-55% of health outcomes. That's more impact than healthcare or individual lifestyle choices alone.

At Adelaide PHN, we recognise our unique position to influence both structural and intermediary determinants.

Through policy advocacy, cross-sector partnerships and community empowerment, we can address the root causes of health inequities and contribute to a health system and society where everyone, regardless of where they’re born or grow up, has the opportunity to live their healthiest lives.

⁵ American Mental Wellness Association. 'Risk and Protective Factors.' AMWA, 2019

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The critical role of access as a means to health equity In the context of health, access is more than just the availability of services – it encompasses the ability of all individuals and communities to easily reach, afford, understand and effectively use health services when, where and how they need them.

For us at Adelaide PHN, improving access means breaking down the barriers preventing people from receiving the care they need when they need it.

Across our diverse region, from the bustling streets of Adelaide's CBD to the quieter suburbs of Tea Tree Gully or the coastal communities of Onkaparinga, access to health services varies dramatically. When people can easily reach, afford and effectively use health services, we take a significant step towards levelling the playing field of health outcomes.

However, for many in our community, access remains a significant challenge. Consider a newly arrived refugee family in Salisbury struggling to navigate our health system or an elderly resident in Port Adelaide facing transport difficulties to reach specialist appointments.

These aren't just hypothetical scenarios; but daily realities for many in our region.

Affordability issues, low health literacy, and cultural barriers can create significant obstacles, particularly for people from multicultural backgrounds and Aboriginal and Torres Strait Islander people. These barriers don't just inconvenience; they can lead to poorer health outcomes, widening the very gaps we're striving to close.

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The barriers to access are multifaceted Affordability In northern suburbs like Salisbury and Elizabeth, where socioeconomic disadvantage is higher, out-of-pocket expenses for specialist or allied health services can deter residents from seeking necessary care.

Cultural barriers Our Aboriginal and Torres Strait Islander communities in areas like Port Adelaide and Enfield, and large multicultural populations in suburbs like Campbelltown and West Torrens, may face culturally inappropriate services or language barriers.

Health literacy For some communities in our culturally diverse northern and western suburbs, understanding and navigating the health system can be overwhelming — particularly newly arrived migrants and refugees who may be unfamiliar with Australia's healthcare system.

Geographic barriers In outer suburban areas like Angle Vale or Sellicks Beach, the distance to specialised services in the city centre can be a significant obstacle. Public transport limitations in these areas can worsen access issues, particularly for elderly residents or those with mobility challenges.

Improving access must remain a central focus as we work towards health equity.

This means we must commission, coordinate and capacity build for better health services such as:

Addressing system-level barriers Working with healthcare providers, policymakers and community organisations to create more accessible and culturally responsive services.

Empowering communities Enhancing health literacy and providing resources to help people navigate the health system effectively.

Leveraging technology Exploring telehealth options to bridge geographic barriers, particularly for our outer suburban and rural communities.

Tailoring solutions Recognising that access challenges vary across our region and developing place-based strategies to address local needs.

By addressing the barriers to access – in both the systems influencing access and the conditions under which communities access services – we're not just enhancing healthcare delivery; we're paving the way for a fairer, healthier future for all in our region.

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2.3 How we work as an ecosystem to drive greater access and equity Our vision for health equity is built on a simple yet powerful idea: we are stronger together. This framework isn't just a document; it's our commitment to creating a connected ecosystem where every action contributes to a healthier, more equitable Adelaide.

Our core focus is improving equity of access to health services for the region's most vulnerable groups. We recognise that this goal requires a connected ecosystem involving our staff, partners, providers and communities. This framework supports us in creating a shared language and approach, guiding how we'll work together to not only improve access to services, but also address the root causes of health disparities.

By partnering across sectors, we aim to create systemic changes that foster a more equitable society and ultimately lead to better health outcomes.

The power of community engagement Our communities are not just recipients of healthcare; they are the experts of their own experiences and the architects of their own solutions. By deeply engaging with local communities, we tap into a wellspring of knowledge, creativity and resilience that is essential for creating lasting change.

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Aligning how we commission

Enabling community-driven outcomes

To enable us to effectively engage with communities and co-create aligned solutions, we are guided by the Quintuple Aims in our commissioning cycle.

The focus on Quintuple Aims of patient experience, population health, reducing costs, care team wellbeing and health equity means that APHN alone cannot achieve equity of access to primary care services – we know it will take a whole community and take an ecosystem approach.

To do this, we use the following key community engagement strategies.

Commissioning Framework

1

2

Listen first

Co-design solutions

We create spaces for community members to share their experiences, challenges and ideas.

We work alongside community members to design interventions that truly meet their needs.

3

4

Build local capacity

We invest in training and resources that empower communities to lead their own health initiatives.

Celebrate success

We recognise and amplify communityled achievements, fostering a sense of ownership and pride.

Partnering together The Adelaide PHN Partnering Framework 2024 guides us in developing purposeful and sustainable relationships critical to achieving long-term equity outcomes. It provides a shared understanding of why we partner, what we mean by partnering and how we approach partnering with others.

The types of partnerships we aim to cultivate Cross-sector collaborations Linking health services with education, housing, employment and social services.

Academic partnerships Leveraging research to inform evidencebased practices and evaluate our impact.

Business alliances Engaging local businesses in creating healthier work environments and communities.

We use an ecosystem approach, connecting partners with community and community with partners to achieve the Quintuple Aim. By focusing on and addressing all five dimensions of the Quintuple Aim — patient experience, population health, reducing costs, care team wellbeing and health equity — we can create a more resilient and equitable healthcare system that better serves our community's long-term needs.

Government collaborations Working with local and state governments to align policies and resources for health equity.

Health partnerships Working with LHNs and other health service providers to join up and connect points of access for more equitable health pathways.

Quintuple Aims

APHN strategic plan Commissioning framework Access and Equity framework

Partnering framework

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3.0 Understanding and addressing access and equity in the Adelaide region

3.1 Guiding principles To guide our approach to improving access and equity, we have six principles that drive our focus and actions

1

Embedding place-based thinking

2

Addressing broader social determinants of health

3

Removing barriers to health equity

4

Co-creating solutions

5

Nurturing authentic partnerships

6

Driving quality improvement

We take a long-term and collaborative approach to enabling communities, and through shared partnership, shared stewardship and shared accountability, we co-create localised solutions to address access and equity needs

We work together with partners, providers and communities to address broader life factors influencing health inequities, including social and emotional wellbeing

We actively collaborate to remove and reduce barriers to access for more equitable opportunities for health and wellbeing across communities in our region

We bring together community members as equal partners and contributors to co-create and co-develop solutions that meet local needs and address access and equity barriers through their lived experiences and insights

We develop and nurture intersectoral partnerships to strengthen a whole-of-system and ecosystem approach to addressing access and equity, including co-planning, co-designing, and codeveloping collaborative service delivery solutions

We embrace open feedback and monitor, evaluate and report on localised data to improve people’s access and experience of the health system and inform improvements in service delivery Page 13

3.2 Our key action areas for promoting equity To transform our vision of health equity into reality, we've identified five key action areas. These areas form the backbone of our strategy, guiding our efforts to create meaningful change across the Adelaide PHN region.

While this framework sets our overarching direction, it doesn't stand alone.

Other internal plans and frameworks, such as our Reconciliation Action Plan, Commissioning Framework, and Towards Wellness Mental Health and Suicide Prevention Plan, will make crucial contributions towards achieving the objectives outlined here. Together, these interconnected strategies form a comprehensive approach to addressing health inequities in our region.

1. Equity promoting area of action 1 – Leadership commitment Objectives Demonstrate leadership, organisational commitment and appropriate resourcing to progress equity and improve health equity in the Adelaide PHN region Take a systemic and whole organisational approach to embed an ‘equity lens’ Ensure that funded services are monitored, evaluated, and reported on through a health equity lens Activity

Action Develop and implement an equityfocused approach to resource distribution.

Develop funding models to enable appropriate resourcing to support a whole-of-health approach to service provision.

Increase the percentage of funding for services operating in socio-economically disadvantaged areas, as identified by SEIFA. Track and measure resource allocation to ensure funding models remain adaptive to respond to access and equity needs where they are needed most.

Improve understanding and identification of priority populations through the process of Health Needs Assessment.

Build an understanding across the organisation on how social determinants of health impact people’s health and wellbeing.

Ensure processes are in place to identify priority populations through a deeper analysis of intersecting disadvantages.

Ensure processes are in place that integrate the lived experience of priority populations to gain a deeper understanding of the core problems (barriers and enablers) underpinning inequity and better inform co-designed solutions.

Ensure Adelaide PHN acts as a system leader to activate diverse stakeholders around a shared vision for systemic change when building a more accessible and equitable health system.

Ensure leadership at all levels is involved in developing strategic alliances and relationships with other government sectors to promote a shared vision for broader systemic change in access and equity.

Strengthen the region's health ecosystem by connecting and working with partners to focus collective efforts on early intervention programs and to target the social determinants of health risk factors.

Lead broader system change by bringing partners, providers and community members together to share information and insights that shape policy analysis, service development and health advocacy.

Ensure that funded providers are equitable, accessible, inclusive, culturally responsive and linguistically appropriate.

Ensure commissioned services can respond to diverse whole-of-health needs as aligned to the Quintuple Aims.

Build inclusive and culturally responsive and linguistically appropriate tools/criteria that focus on being person-centred and relationship-driven into procurement, selection and contracts with commissioned providers.

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2. Equity promoting area of action 2 – Authentic community engagement across the commissioning cycle and partnerships Objectives To partner with people and communities affected by inequity, people with lived experience and organisations representing different sectors to address health inequities.

To increase access to improve the experience of vulnerable people in primary health care services and other government services by developing local pathways that improve primary care engagement with services that address the adverse social determinants of health to improve health and wellbeing and keep people out of hospitals.

Activity

Action Build diverse representation within the organisation across governance, leadership, working, and expert advisory groups.

Ensure Community Council members are well connected to groups experiencing disadvantage.

Ensure diverse experts are part of working groups and expert advisory groups.

Facilitate knowledge sharing among working groups and advisory groups, leveraging both expert insights and lived experiences to identify and utilise individual and community strengths.

Build partnerships with communities experiencing health inequities and engage with them using a placebased approach underpinned by principles of codesign.

Ensure community, people with lived experience and stakeholders are engaged in all stages of our commissioning process.

Develop place-based co-designed solutions through partnerships with the local community, people with lived experience, organisations and other stakeholders.

Strengthen partnerships with different sectors, peaks, and representative bodies to better connect local health pathways between services and industries.

Participate in a localised place-based multisectoral representative working group with partners to ensure ongoing pathways maintenance in addressing barriers to access and issues of inequity.

Develop more inclusive strategies to meaningfully engage community leaders and people with lived experience expertise.

Create channels for open information, feedback and experience sharing to inform services and shape broader system thinking at a state and federal level.

Embed mechanisms that support meaningful storytelling and sharing of those rich insights to more widely support innovations in improving access and equity as an ecosystem.

Develop and implement data dashboards/snapshots to report impact, changes and outcomes back to the communities, partners and providers.

Increase access while improving the experience of disadvantaged populations in primary health care services by developing local pathways with other services.

Ensure equity and diversity-focused tools and resources are embedded into the commissioning process to ensure increased service access to vulnerable people.

All new funding contracts include measures aligned to the Quintuple Aims

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3. Equity promoting area of action 3 – Embedding an equity lens into our work Objectives To support staff in developing and applying an ‘equity lens’ to their work.

To support staff in understanding inequity, place-based and social determinants of health.

Activity

Action Develop and apply a health equity lens to strategic documents, planning, commissioning, reporting and quality improvement processes.

Embed health equity and understanding of place-based, co-design and social determinants of health as key competencies for Adelaide PHN staff.

Incorporate a health equity lens and aligned tools into strategic documents, planning, design, commissioning, reporting and quality improvement processes.

Continue to invest in the capability of staff to identify and undertake quality improvement in processes, approaches, documents or projects that do not align with the APHN approach and philosophy to improving access and equity.

Review reporting mechanisms to incorporate outcomes-focused data that articulates the impact of activities and how APHN and partnerships are improving access and equity.

Develop aligned measures (based on the Quintuple Aim) to be used with all commissioning contracts

Provide staff with the opportunity to improve their understanding of access, inequity, place-based, co-design and social determinants of health.

Enhance staff capacity to address regional inequities through targeted learning opportunities, and provide role-specific guidance to support the practical application of equity principles in daily work.

Incorporate an equity agenda item in team meetings for ongoing staff input into identifying and improving existing inequity in processes and activities.

Incorporate open and purposeful forums/meetings that create space for staff to engage with partners and community members to consider the complex intersectionality of barriers within and between community groups.

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4. Equity promoting area of action 4 – Build capacity and skills Objectives To support the capacity of Adelaide PHN staff, funded providers, general practice teams, and stakeholders to understand and provide equitable, accessible and responsive services.

Activity

Action

Support primary care, funded providers and other services to ensure that services are equitable and accessible.

Provide opportunities for primary care providers and funded providers to improve their understanding of health equity, place-based thinking and social determinants of health.

Identify support needs of funded providers and general practice teams to apply a health equity lens to existing practices and undertake quality improvement.

Support regular training on health equity, social determinants of health, and a place-based approach, as well as other capacity-building activities for general practice teams and funded providers.

Inform general practice teams and funded providers about place-based approaches in their region and what they mean for them as primary care providers.

Support general practice teams and funded providers in understanding new referral pathways to intersectoral services to ensure equity of access.

Provide and contribute to resources on adopting a strengths-based approach in service delivery and community engagement.

5. Equity promoting area of action 5 - Use quality data and evidence to support equity actions Objectives To use data and evidence to describe health inequities, translate evidence into practice and evaluate the impact of health equity interventions and actions.

Activity

Action

Improve the data collection system and reporting requirements to better capture data related to inequity, including the intersectionality of social determinants of health.

Incorporate key lines of enquiry regarding equity and disadvantaged groups into the Health Needs Assessment.

Develop and implement clear and measurable indicators to identify priority populations.

Use evidence-informed and best-practice approaches when developing interventions to address inequity.

Improve monitoring and population health assessment data through enhanced partnerships or relationships with agencies in domains such as housing, education, social and economic development and planning information.

Use quantitative data to identify disadvantaged groups and qualitative data (kitchen tables, focus groups, interviews, etc.) to gain a more in-depth understanding of the core issues to inform solutions.

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4.0 Governance, implementation and evaluation

4.1 Governance An Adelaide PHN Access and Equity Integrated Steering Group will oversee the implementation of the objectives, activities and actions identified in the framework. The Access and Equity Integrated Steering Group will report directly to Adelaide PHN Executive Leadership.

The Access and Equity Integrated Steering Group will work closely with staff across the organisation to develop and implement a 12-month Access and Equity Action Plan. The Plan will identify: Tasks to be implemented Who will be responsible for the implementation of the task(s) Completion milestones

4.2 Reporting and evaluation Effective reporting and evaluation are crucial to the success of our Access and Equity Framework. By regularly assessing our progress and impact, we can ensure that our efforts are making a tangible difference in our communities and identify areas for improvement.

Our approach to reporting and evaluation is designed to be transparent, inclusive and action-oriented, involving stakeholders at all levels of our organisation and the broader community. This process not only helps us track our achievements but also fosters a culture of continuous learning and adaptation, enabling us to respond effectively to the evolving health equity needs in our region.

Reporting guidelines Implementation of the Framework will be monitored and reported to the Board, Executive and staff regularly The implementation status of the Framework activities and actions will be reviewed at the end of 12 months, in accordance with the 12-month Action Plan, to measure progress and inform quality improvement Access and equity performance measures will also be developed and used to establish how well Adelaide PHN improves health equity outcomes in the community Progress in implementing the Framework, including key equity achievements, will be included in the Annual report

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4.3 Framework review process The Access and Equity Integrated Steering Group will oversee regular Framework reviews and evaluation, focusing on:

Implementation progress

Assessing the status of Framework objectives and actions

Enablers and barriers

Identifying factors that support or hinder effective implementation

Impact assessment

Evaluating the Framework's impact on health equity and access in our communities through needs-driven resource allocation and stronger joined-up partnerships

Continuous improvement

Recommending adjustments to enhance the Framework's effectiveness

Stakeholder feedback

Incorporating insights from staff, partners, and community members

Capacity building

Identifying areas where additional skills or resources are needed to support implementation

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5.0 References Adelaide Primary Health Network (Adelaide PHN). 'Needs Assessment 2023 - 2025.' Mile End, South Australia, 2020 Adelaide Primary Health Network (Adelaide PHN). Adelaide PHN Strategic Plan 2023-2026, Adelaide PHN, Mile End, South Australia, 2023. Adelaide PHN Strategic Plan American Mental Wellness Association (AMWA). 'Risk and Protective Factors.' Pennsylvania, USA, 2024. Available at: https://www.americanmentalwellness.org/prevention/risk-and-protective-factors [Accessed May 2024] Australian Bureau of Statistics (ABS). 'ABS Census All Person Quick Stats. Davoren Park.' 2021. Available at: https://abs.gov.au/census/find-census-data/quickstats/2021/402021029 [Accessed May 2024] Australian Institute of Health and Welfare. 'Social determinants of health.' AIHW, 2024. Available at: https://www.aihw.gov.au/reports/australias-health/social-determinants-of-health [Accessed 14 November 2024] Australian Institute of Health and Welfare. 'What are determinants of health?' AIHW, 2024b. Available at: https://www.aihw.gov.au/reports/australias-health/what-are-determinants-of-health [Accessed 12 November 2024] Barlow, J. 'We Used Your Insights to Update Our Graphic on Equity.' RWJF Robert Wood Johnson Foundation, 2022.

Available at: https://www.rwjf.org/en/insights/blog/2022/11/we-used-your-insights-to-update-our-graphic-onequity.html [Accessed 14 November 2024] Hamilton, N., & Bhatti, T. 'Population health promotion: an integrated model of population health and health promotion.' Public Health Agency of Canada, 1996. Available at: http://www.phac-aspc.gc.ca/ph-sp/php-psp/indexeng.php [Accessed May 2024] Herbert, A. Simon. 'The Sciences of the Artificial: Design Thinking Principles.' MIT Press, Massachusetts, USA, 1968 North Western Melbourne Primary Health Network. 'Access and Equity Framework.' NWMPHN, 2021. Available at: https://nwmphn.org.au/wp-content/uploads/2021/10/NWMPHN_Access_Equity_Framework_FINAL-2.pdf [Accessed 14 November 2024] Oliveros B, Agullo-Tomas E, Marquez-Alvarez I. 'Risk and Protective Factors of Mental Health Conditions: Impact of Employment Deprivation and Social Relationships.' PubMed Central (PMC), 2022. Available at: https://pubmed.ncbi.nlm.nih.gov/35682363/ [Accessed May 2024] Profile id (.idcommunity). 'Adelaide PHN: SEIFA by Local Government Area.' 2021. Available at: https://profile.id.com.au/playford/seifa-disadvantage [Accessed May 2024] Profile id (.idcommunity). 'City of Playford: SEIFA by Local Government Area.' 2021. Available at: https://profile.id.com.au/playford/seifa-disadvantage [Accessed May 2024] Public Health Information Development Unit (PHIDU). 'Social Health Atlas of Australia, Data by Population Health Area (ASGS 2021).' Torrens University Australia, 2024. Available at: https://phidu.torrens.edu.au/socialhealth-atlases [Accessed May 2024] Queensland Council of Social Services (QCOSS). 'Principles of Place-Based Approaches for Aboriginal Torres Strait Islander peoples.' Brisbane, Queensland, 2024. Available at: https://www.qcoss.org.au/project/place-basedapproaches/ [Accessed May 2024]

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5.0 References (cont.)

Queensland Government (QLD Gov), Department of Housing, Local Government, Planning and Public Works.

'What is place-based approaches?' 2024. Available at: https://www-qcoss-orgau.webpkgcache.com/doc/-/s/www.qcoss.org.au/wp-content/uploads/2019/06/Place-Based-Guide-Toolkit-FINALprinciples-of-place-based-approaches-1.docx [Accessed May 2024] Strategic Momentum Group (SMG). 'Exploring place-based as an approach at APHN Workshop.' Adelaide PHN, 2024.

Available at: https://strategicmomentumgroup.com [Accessed May 2024] World Health Organisation (WHO). 'Health Inequities and Their Causes.' World Health Organization, 2018. Available at: https://www.who.int/news-room/facts-in-pictures/detail/health-inequities-and-their-causes [Accessed 14 November 2024] World Health Organisation (WHO). 'WHO Health Equity.' Geneva, Switzerland, 2024. Available at: https://www.who.int/health-topics/health-equity#tab=tab_1 [Accessed May 2024] World Health Organisation (WHO). 'Social determinants of health.' WHO, 2024. Available at: https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1 [Accessed 14 November 2024]

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Appendix A: Glossary The following is a glossary of key terms used throughout the Access and Equity Framework. These definitions provide a common language for discussing health equity concepts, ensuring that all stakeholders – from our staff and partners to community members – can engage meaningfully with this Framework.

Key term

Definition

Access

Accessible health services mean they are available in the right place, at the right time and delivered by the right people with the right skills.

Co-design

Co-design refers to a participatory approach to designing solutions, in which community members are treated as equal collaborators in the design process.

Equality

Equality is the state of being equal, especially in status, rights and opportunities.

Equity

Equity recognises that each person has different circumstances and allocates the exact resources and opportunities needed to reach an equal outcome.

Equity lens

An equity lens is a process to analyse the impact of the design and implementation of policies, practices, and decision-making authority on historically excluded and marginalised individuals and groups.

Inequity

Inequity means people aren't given the same resources, treatment or opportunities.

Intersectionality

Intersectionality recognises that the causes of disadvantage do not exist independently but intersect and overlap.

Person-centred

Treatment, care and support that places the person at the centre of their own care and considers the needs of the person’s carers.

Place-based

Place-based approaches are collaborative, long-term approaches to build thriving communities delivered in a defined geographic location. This approach is ideally characterised by partnering and shared agenda, shared design, shared stewardship and shared accountability for outcomes and impacts.

Primary care

Primary care is the first point of contact for people living with health problems or mental illness and their carers (GPs, Allied Health, etc.).

Social inclusion

The opportunity for people to participate in society through employment and access to services; connect with family, friends, personal interests and the local community; deal with personal crises; and have their voices heard.

Social determinants of health

The social determinants of health (SDOH) are the non-medical factors that influence health outcomes.

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Appendix B: Adelaide PHN strategic focus areas

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Appendix C: Policy context in Adelaide The Adelaide PHN Access and Equity Framework doesn't exist in isolation; it's part of a broader ecosystem of policies and plans to improve all Australians' health outcomes.

This Framework is informed by and aligns with several national and state policies, frameworks and plans that address health outcomes for diverse populations and disadvantaged groups, reflecting a broad commitment to improving our health system.

It complements our Reconciliation Action Plan and Business Processes while informing the implementation of more specific frameworks such as our Commissioning Framework and Mental Health and Suicide Prevention Plan 2020-2025.

(For more details on the policy context, please see Appendix 2.)

Policy, framework or plan

Purpose

PHN Multicultural Health Framework

The Multicultural Access and Equity Policy is about ensuring that Australian Government programs and services meet the needs of all Australians, regardless of their cultural and linguistic backgrounds.

The policy contains six commitments essential to the effective delivery of government programs and services in a multicultural society. It includes leadership, engagement, performance, capability, responsiveness and openness.

Those commitments align with the values and principles identified in the Adelaide PHN Access and Equity Framework.

Embrace Multiculturalism Mental Health Framework

The Framework has been developed to support Australian mental health services, practitioners, Primary Health Networks and others to work effectively in a multicultural context.

It is mapped against national standards to help organisations meet their existing requirements.

The domains in the Embrace Framework align with values and principles identified in the Adelaide PHN Access and Equity Framework.

Equally Well Framework

The Equally Well Framework was established to champion physical health as a priority for people living with a mental illness and to ultimately reduce the life expectancy gap between people living with mental illness and the rest of the population.

Equally Well aligns with the values and principles identified in the Adelaide PHN Access and Equity Framework.

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Appendix C: Policy context in Adelaide (cont.)

Policy, framework or plan

Purpose

Towards Wellness Plan

The Towards Wellness Plan: Adelaide Metropolitan Integrated Mental Health and Suicide Prevention Plan formalises the commitment of key local service providers to work together towards system improvement and ensure people who experience mental health challenges or are at risk of suicide across the metropolitan region can access the right support, at the right time and in the right place.

The Towards Wellness Plan aligns with the values and principles identified in the Adelaide PHN Access and Equity Framework

Innovate Reconciliation Action Plan

Aboriginal and Torres Strait Islander health continues to be a key priority for Adelaide PHN. We actively work with our partners to address health inequities and increase access to culturally appropriate services in our region.

The Adelaide PHN Access and Equity Framework aligns to the Innovate Reconciliation Plan values, principles and actions to ensure improved equity of access.

Adelaide PHN Strategic Plan

Adelaide PHN has approached the development of our Strategic Plan 2023-2026 through an equity lens as we recognise that health inequities are complex and diverse affecting many of our local communities. In response to addressing the health inequities, Adelaide PHN recognises our responsibility in shaping the market through partnerships, co-creating integrated care pathways and commissioning services that are person-centred.

Adelaide PHN Access and Equity Framework aligns with the equity strategies and objectives identified in the Adelaide PHN Strategic Plan.

Gayaa Dhuwi (Proud Spirit) Declaration

The Declaration aims to improve health outcomes by supporting Aboriginal and Torres Strait Islander people and communities to access the ‘best of both worlds’ of clinical and culturally capable care, including access to cultural healers.

The principles of co-design and self-determination align with the Adelaide PHN Access and Equity Framework.

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