Population Health and Other Factors (GEN 5, 11, 15, 16

There are a wide range of indicators that describe the health of a community and individual including where you live, what culture you were born into, your socioeconomic status across life, health status and risks, and ability to access required services that are close to where you live. Other factors include living in a healthy community with access to clean water and sanitation, where government supports health preventative measures such as immunisation against common communicable diseases and promotion of a healthy lifestyle. The following topic areas span from life to death in public and population health.

Identified Need Key Issue Description of Evidence

Immunisation - outcomes Childhood immunisation for 2015-2016 varied depending on ∙ NHPA analysis of ACIR data by SA3 of health needs analysis age cohort and location, with few SA3 areas achieving 95% ∙ SA Health reporting of ACIR data coverage. ∙ NHPA analysis of National HPV Vaccination Program Register by SA Barossa, Yorke Peninsula and Limestone Coast all achieved the national target of 95% for 1 year of age. ∙ Issue of importance in priority matrix No SA3 area achieved 95% coverage for 2 years of age, and ∙ Concerns raised by immunisation nurses throughout the region only two SA3s achieved 95% coverage for 5 years of age which were Eyre Peninsula South and South West and Limestone Coast. Lack of coordination between different providers (e.g. GP, local council, ACCHO clinic). Uncertainty around the validity of ACIR data.

Priority

Immunisation (GEN 11) opportunities, priorities and options

Possible Options

1. Continue to support the Immunisation Hub for SA in partnership with APHN including: ∙ Explore ways to gather and maintain accurate ACIR data for CSAPHN ∙ Identify and support immunisation ‘champions’ in local practices and communities ∙ Commission and distribute immunisation resources to providers and communities. 2. Explore alternative opportunities for hard to reach populations to increase uptake of childhood immunisation. ∙ Childhood immunisation rates reach national target (95%). ∙ Older children – especially CALD – to have immunisation status accurately recorded and updated. ∙ Increased community awareness of the benefits and availability of immunisations and the recommended schedule. ∙ Improvements in childhood immunisation rates for Aboriginal and Torres Strait Islander children ∙ CSAPHN working primarily with DATIS (SA Health) and the APHN ∙ Aboriginal Health Council of

South Australia

∙ ACCHOs

Expected Outcome Potential Lead

Identified Need

Oral Health - outcomes of health needs analysis

Priority

Oral Health (GEN – 16) opportunities, priorities and options

Identified Need Other Population Health

Factors - outcomes of health needs analysis

Key Issue

“Oral health is essential to general health and wellbeing and greatly influences quality of life. It is defined as a state of being free from mouth and facial pain, oral diseases and disorders that limit an individual’s capacity in biting, chewing, smiling, speaking and psychosocial wellbeing.” Anecdotally, there are increasing rates of poor oral health across the CSAPHN region particularly where low sociogenic disadvantage has added tyranny to accessible service. Low rates of accessible dental practitioners in country SA. ∙ http://www.euro.who.int/en/health-topics/disease-prevention/oralhealth Accessed 04 May 2018 ∙ Identified area for investigation including sourcing evidence and data ∙ Issue of concern in priority matrix ∙ HWA rates of health practitioners

Possible Options 1. Undertake an inventory of oral health providers across the

CSAPHN region. ∙ Improved understanding of needs and service availability. ∙ Primary Health Care

Committees (PHCC) ∙ SA State Government

∙ IPHCS Providers

2. Work with local communities to understand issues of access and needs.

3. Work with state and Commonwealth governments to address access issues particularly for rural and remote disadvantaged populations.

Key Issue Socio-demographic disadvantage

∙ High rate of single parent families in the Mid North, Yorke

Peninsula and Riverland ∙ Homelessness is not well recognised or documented throughout the region ∙ Affordability of health care for disadvantaged people ∙ Health literacy is perceived to be an issue across the entirety of the CSAPHN catchment. Of particular concern are those areas identified as being of low English ∙ PHIDU analysis of ABS Census 2011 ∙ PHIDU analysis of births and deaths registry data ∙ PHIDU analysis of DSS data ∙ The Kirby Institute, 2015 ∙ Stakeholder consultation and feedback ∙ STI and Blood Born Virus Advisory Committee (SABSAC)

Description of Evidence

Expected Outcome

∙ Ability to work with partners on oral health from a position of knowledge.

∙ Development of partnerships to undertake low cost local activities to improve oral health.

Potential Lead

∙ RFDS

∙ Local Dentists and oral health professionals ∙ Dental and Oral Health

Associations

Description of Evidence

Identified Need Other Population Health

Factors - outcomes of health needs analysis continued

Key Issue

proficiency and where there are high rates of disadvantage ∙ Concentration of disadvantage in Peterborough, Coober

Pedy, Port Pirie, the APY lands and other remote South

Australian Aboriginal communities.

Perinatal health

∙ Infant mortality highest in the APY lands, followed by Port

Augusta and Murray Bridge ∙ Child mortality rates are generally below metropolitan rates, but not reported for many areas due to low numbers ∙ Higher proportions of both low birthweight babies and mothers who smoked during pregnancy exist in Port

Augusta and the Outback regions. Pregnancy smoking rates also high in Peterborough and Ceduna.

Disability and carers

∙ Higher proportion of people with a disability living in country SA than metropolitan Adelaide.

Sexual Health

∙ Aboriginal and Torres Strait Islander populations have higher rates of blood borne virus and sexually transmissible infections, including HIV, Hepatitis C,

Hepatitis B, gonorrhoea, chlamydia and syphilis.

Remoteness

∙ Financial and time costs borne by patients to attend regular/recommended appointment ∙ Increasing rates of morbidity and mortality with increasing remoteness ∙ Access to appropriate transport to attend appointments ∙ No public transport throughout most of the region. Some local bus services operate with varying regularity. ∙ Issues of concern in priority matrix ∙ AIHW report on rural, regional and remote health system performance indicators (AIHW 2008) ∙ Proportion of region classified as outer regional, remote or very remote by ABS classification of remoteness ∙ CSAPHN analysis of SA Health inpatient admissions database by LGA and

SA3 ∙ Issue of importance in priority matrix ∙ Extensive community engagement done within PHNs ∙ Report on transport options within the former Country South SA

Medicare Local region

Description of Evidence

Identified Need Other Population Health

Factors - outcomes of health needs analysis continued

Priority Other Population Health

Factors (GEN – 5) opportunities, priorities and options

Key Issue

∙ Residents of areas with no or limited public transport options face significant barriers to accessing timely primary health care and can have difficulty coordinating appointments. ∙ Services provided from centralised locations create a burden of cost, time and loss of income on clients and client support or carers. ∙ The great majority of specialist services are accessed from Adelaide and, to a lesser extent, regional centres which are remote from populations in need. ∙ Significant travel cost (time and financial) is often required to facilitate follow up appointments of short duration. The issue is felt across the region but accentuated the further the travel demand from

Adelaide.

Possible Options

1. Engage with local providers of services that enable equitable access to health services

2. Commissioning to respond to the identified needs of particular population demographics (eg. Aboriginal and

Torres Strait Islander people, CALD communities and identified localities)

3. Support for local evidence-based programming around lifestyle-related chronic disease risk factors that responds to an unmet health and/or service need. see above…

Description of Evidence

Expected Outcome

∙ Mitigation of socio-demographic disadvantage with regard to health care access.

∙ Improved risk behaviour in participants of targeted communities, activities or improved environmental context (e.g. food security, use of space).

∙ Improved knowledge of the impact of health risk behaviours on individuals and communities. Better prevention and management strategies around population health issues.

Potential Lead

∙ CSAPHN and selected community partners

Priority Other Population Health

Factors (GEN – 5) opportunities, priorities and options - continued

Possible Options

4. Review the need for education, awareness and targeted services to be incorporated into the overall health service delivery picture for at-risk communities including: ∙ perinatal care ∙ sexual health ∙ people living with a disability and their carers. ∙ Improved organisational knowledge of the overall picture of local communities.

Expected Outcome

Transport (GEN – 15) This is an area that does not necessarily fit the purview of the PHN but is a widely identified issue for country regions in SA. As such the following potential option for work has been identified. The CSAPHN can work toward this option as an underlying area of need in conjunction with local government public health planning. 1. Identification of communities in need and their prevalence of service support need ongoing monitoring. Additional mapping of impact for access to services occasioned by cost of travel to obtain services arising through reduction or withdrawal of services from rural and remote areas. Data use to advocate for continuation of activities in a local setting or replacement with technological solutions where best. ∙ CSAPHN leading these activities in consultation with SA Health, Local

Government, the six regional

Local Health Networks and metropolitan LHNs with support provided from the

APHN as the PHN with primary and first engagement with the Metro

LHN’s.

Potential Lead

See above…