Introduction

Country SA PHN applies a consumer focus of John and Jenny as a whole person living in country SA to support a holistic approach that considers multiple factors that may impact their ability to experience health optimisation and wellbeing as they go about their daily lives.

John and Jenny represent as individuals, families, all members of the community, across all age groups, cultural diversity and values, family groupings, ability or disability, advantage or disadvantage, sexual orientation.

This introduction is to provide a broad overview of the population within the Country SA PHN region: who we are, where we live and how we live.

Country SA PHN Region

The region covers all of South Australia, apart from the Adelaide metropolitan area. Covering the peri-urban, the Country SA PHN region covers 99.8% of the state geographically and approximately 30% of SA’s total population Country SA PHN boundaries align with the six regional Local Health Networks (LHNs).

Geography

The Country SA PHN region covers a region of over 980,000 square kilometres, which encompasses all of South Australia outside the core metropolitan area. The landscape ranges from fertile hills and intensive agriculture land of the Adelaide Hills, Barossa and Fleurieu Peninsula to vast broad acre farming regions, as well as Flinders Ranges and outback.

The data in this report is presented primarily by Statistical Area Level 3 (SA3); a census statistical geography that provides a framework for data analysis at a regional level; and/or by Local Government Area (LGA) or Statistical Area Level 2 (SA2) where data is available at a smaller geographical area. For a listing of country SA LGA and SA3 regions, refer to Appendix 1: Country SA PHN Region by SA3 and LGA

Population

The 2021 estimated resident population for the Country SA PHN region was 508,269 people, which represents almost 29% of the total South Australian population (2)

Male to female proportion is relatively even, with slightly more males than females, and the region has a noticeably lower proportion of young adults (aged 20 to 39 years) compared to the whole of South Australia (5).

The population is widely dispersed across the region, which impacts provision of health services, workforce distribution and patient access to services. 47% of the region’s population are found in following areas:

• Mount Gambier, Whyalla, Murray Bridge, Port Lincoln, Port Pirie and Port Augusta are collectively home to over 110,000 people and each serve as a hub for health and other services for the area and surrounding regions.

• Gawler, Mount Barker and Aldgate-Stirling are located nearer to the Adelaide metropolitan boundary, and account for 63,000 people. These areas have a relatively high access to local and metropolitan health services, as well as other services.

• Victor Harbor-Goolwa has over 25,000 people with a high proportion of their population over 65 years of age (1).

The remainder of the population live in small towns of up to 5,000 people, (many with less than 500 people), or are dispersed in the agricultural and outback regions of the state (6).

Remoteness

In 2021, approximately 46% of the Country SA PHN population lived in areas classified as Outer Regional, Remote and Very Remote; representing a reduction of approximately 4% since 2016 (see Table 1) (7)

Older Persons

Overall, 23% of people living in the Country SA PHN region are over 65 years The coastal city of Victor Harbor is a wellknown retirement destination, with more than 39% of their population aged 65 or over. Yorke Peninsula and Barunga West LGAs both have over 32% of their population aged over 65 years (2, 8).

Aboriginal Population

The term Aboriginal is used throughout this document to refer to people who identify as Aboriginal, Torres Strait Islander, or both Aboriginal and Torres Strait Islander. This has been done as the people indigenous to South Australia are Aboriginal and Country SA PHN respects that many Aboriginal people prefer the term ‘Aboriginal’. Country SA PHN also acknowledge and respect that many Aboriginal South Australians prefer to be known by their specific language group(s). The 2021 ABS Census reports an Aboriginal population of 20,128 in the Country SA PHN region, representing 4% of the region and almost half (47%) of South Australia’s Aboriginal population. This significantly exceeds the proportion of the total population who reside in Country SA PHN (29% of the SA population)(2, 8)

Concentrated in the regional towns and small Aboriginal communities, the Aboriginal population is a young population(9).

Port Augusta LGA has the highest proportion of the region’s Aboriginal population (14.9%). followed by Anangu Pitjantjatjara Yankunytjatjara Lands (APY Lands, 11.2%). Whyalla (6.1%) and Murray Bridge (5.7%)(1).

People from Culturally and Linguistically Diverse (CALD) backgrounds

The proportion of people born overseas in predominately nonEnglish speaking countries is highest in Coober Pedy followed by Renmark Paringa, Naracoorte, Lucindale and Tatiara LGAs (4).

The same areas experience the highest proportion of persons born overseas who speak English not well or not at all (4)

Disadvantage

Overall disadvantage measured by the Index of Relative Socio-Economic Disadvantage (IRSD) is a general index that summarises a collection of economic and social condition information for people and households within an area including employment, income, levels of education, disability, homes with internet and ability to speak English

In the Country SA PHN region, indexed disadvantage can be identified widely across the region.

Of note, two areas are identified by the index as experiencing the highest level of disadvantage are the APY Lands and Maralinga Tjarutja. These are followed by Peterborough, Coober Pedy and Port Pirie LGAs (1).

Health and Service Needs

The Country SA PHN region is large in geographical size, small in population with high spread of the population across the regions, each community has different population distributions and significant diversity, making each one unique in its focus and service requirements.

There are significant socio-economic disparities as the distance increases from metropolitan Adelaide. Infrastructure, education opportunities, economic participation, physical environment and access to basic needs, such as potable water, housing, and food supply is for different for each community, resulting in distinct health and service challenges.

Differing needs across dispersed communities, and lack of economies of scale is an ongoing challenge for service providers in establishing sustainable models. This is further heightened with significant health professional shortages and healthcare infrastructure making it difficult to match the level and type of services required to meet the need.

Disadvantage is further heightened with concentration of health care in metropolitan Adelaide. Participation in care away from home and family requiring time away from work, carer roles, access to transport and overall costs further increasing disadvantage experienced by these communities.

Country SA PHN works to identify specific and targeted opportunities for improving the health of communities across the region given the contextual environment and relative needs outlined in this Needs Assessment. For a summary of identified priorities from the health and service needs analysis, and options for how they may be addressed refer to the Opportunities, Priorities and Options section of this report.

List of Abbreviations

ABS Australian Bureau of Statistics

ACCHO Aboriginal Community Controlled Health Organisation

ADAC Aboriginal Drug and Alcohol Council (SA)

ADIS Alcohol Drug Information Service

AH After hours

AHS Australian Health Survey

AIHW Australian Institute of Health and Welfare

APHN Adelaide Primary Health Network

AOD Alcohol and Other Drugs

APY Lands Aņangu Pitjantjara Yankunytjatjara Lands

CALD Culturally and Linguistically Diverse

CKD Chronic Kidney Disease

COPD Chronic Obstructive Pulmonary Disease

CRM Customer Relationship Management System

CSAPHN Country SA Primary Health Network

CVD Cardiovascular Disease

ED Emergency Department

ERP Estimated Resident Population

ESKD End Stage Kidney Disease

FTE Full-time Equivalency

GP General Practice or General Practitioner

HPV Human Papillomavirus

IRSD Index of Relative Socio-Economic Disadvantage

LGA Local Government Area (local councils)

LHN Local Health Network

MBS Medicare Benefits Schedule

NCETA National Centre for Education and Training on Addiction

NCIS National Coronial Information Service

NDIS National Disability Insurance Scheme

NHSD National Health Service Directory

NHMRC National Health and Medical Research Council

MMM Modified Monash Model

PBS Pharmaceutical Benefits Scheme

PHIDU Public Health Information Development Unit

PHN Primary Health Network

PPH Potentially Preventable Hospitalisation

RACF Residential Aged Care Facility

RDWA Rural Doctors Workforce Agency

RFDS Royal Flying Doctor Service

RHD Rheumatic Heart Disease

SA South Australia

SA# Statistical Area, Level 1, 2, 3, etc.

SEIFA Socio-Economic Indexes for Areas

List of Figures

List of Tables

Aboriginal Health

Nationally, it has been well documented that Aboriginal and Torres Strait Islander people are significantly more likely to experience poorer health outcomes than non-Aboriginal people in almost every domain, and this is certainly true of the Country SA PHN region (10). Aboriginal and Torres Strait Islander people are also more likely to carry a greater burden of disease than non-Aboriginal people living in the same area and is commonly associated with increased rates of chronic disease (10) The term Aboriginal is used throughout this document to refer to people who identify as Aboriginal, Torres Strait Islander, or both Aboriginal and Torres Strait Islander. This reflects South Australian Aboriginal community preferences as specified by the Council of Aboriginal Elders of SA Country SA PHN also acknowledge and respect that many Aboriginal South Australians prefer to be known by their specific language group(s).

Key Points

• Complex interplay between the determinants of health and the health status of Aboriginal people in the region

• Access to primary health services is low, resulting in poorer health outcomes particularly in chronic conditions contributing to poor life expectancy and reduced quality of life across whole of life

• There are gaps in service area coverage of Aboriginal Community Controlled Health Organisations across the Country SA PHN region

Key areas

- Chronic Conditions - Eye and Ear Health

- Sexual Health - Early Detection and Treatment

- Mental Health

Identified Needs

1. Access to culturally appropriate health services

2. ACCHOs are supported to improve the individual and community health experience

3. Improve individual and community health outcomes

Mental health is an important part of the wholistic health and wellbeing of Aboriginal people in South Australia. Analysis of mental health and service needs have been incorporated in this Needs Assessment Report within sections: Mental Health and Alcohol and Other Drugs

Health Needs

Chronic Conditions

Chronic and preventable disease is a major factor behind the reduced life expectancy experienced by Aboriginal people.

• For Aboriginal people in South Australia chronic conditions are mostly preventable, however remain an issue across the region with high rates of potentially preventable hospitalisations (11, 12)

• Generally, diagnosis of conditions occurs late in the disease progression, leading to poor quality of life outcomes and/or mortality.

• Higher rates of chronic disease in general are found with greater distance from metropolitan areas.

• Cost impacts access and use of medication, resulting in poor medication management and adherence (11)

• One in three people experience comorbidities of chronic conditions (2 or more conditions simultaneously) (11)

• Management of chronic conditions is a growing problem with access to adequate services remaining limited particularly for rural and remote communities

Heart disease and Stroke

Circulatory diseases, commonly known as heart and stroke, are the leading cause of mortality for Aboriginal people in South Australia Aboriginal South Australian’s are three times more likely to be hospitalised for circulatory diseases than their non-Aboriginal counterparts and are at risk of developing issues at a much younger age (11) .

Cancer

Cancer is the second highest leading cause of mortality for Aboriginal people in country SA. Late-stage diagnosis and poorer access to health services are contributing factors to the high mortality rate, resulting in low rates of cancer survivorship (11)

Cancer types responsible for the most deaths in the SA Aboriginal population, include:

• Lung cancer

• Head and neck cancers

• Colon and Rectal Cancers

• Men’s Cancers

• Women’s Cancers

• Hepatocellular cancer and,

• Pancreatic cancer (11)

Diabetes

Type 2 diabetes accounts for 25% of the burden of disease for Aboriginal peoples across Australia and is a key priority within country South Australia , leading to further chronic conditions including vascular and kidney disease, Diabetes additionally increases an individual’s risk of disability in sight and physical movement (13). For these reasons prevention and appropriate management of Type 2 diabetes is a prime issue within Country SA PHN.

Approximately 1 in 5 Aboriginal people in Country SA PHN region will develop diabetes, compared to 1 in 8 nationally. This rate increases to 2 in 5 for Aboriginal people living in remote areas of South Australia (13).

Comparatively, 1 in 5 Aboriginal people in Country SA are hospitalised due to diabetes complications compared to 1 in 6 nationally, suggesting the issue is more prominent in South Australia (13)

Gestational diabetes is a highlighted concern for Aboriginal people in the Far West with 1 in 10 being diagnosed compared to 1 in 20 state-wide, with rates considerably higher than those observed in the non-Aboriginal population. The condition increases risk of complications during pregnancy and risk of mother and child developing type 2 diabetes later in life (13)

While prevention or delayed onset of type 2 diabetes can be controlled through modifiable lifestyle factors, population experiences of barriers across social determinants of health including access to preventative health services suggest access to support in management of diabetes is an ongoing issue for the region.

Acute Rheumatic Fever and Rheumatic Heart Disease

In Australia, the prevalence of Rheumatic Heart Disease (RHD) is highest among rural and remote Aboriginal people. Typically, these conditions are not found in developed countries due to the predominant risk factors being associated with poverty, overcrowding and limited access to health care services. Despite this, RHD is prevalent in SA, NT, WA and QLD (14, 15)

RHD is a potentially fatal disease, linked with reduced quality of life. Across Country SA PHN region, while incidence rates have remained stable (0.3 per 1000), prevalence rates are increasing (3.1 per 1000); this indicates that a growing portion of the population is living with and requiring long term care for RHD (11).

Rates of Acute Rheumatic Fever (ARF) and RHD are high in the Aņangu Pitjantjatjara Yankunytjatjara (APY) Lands, linked to housing conditions with significant overcrowding within the community(16)

Regular antibiotic prophylaxis for people confirmed or suspected to have ARF, and for those who are confirmed to have RHD, is one clinical intervention pathway that requires regular and consistent administration over extended periods for effectiveness. In 2020, on average patients in SA participating in regular antibiotic prophylaxis received 78% of scheduled doses However, there is variation in participation and adherence across the region with remote areas having higher rates of adherence, while populations in regional areas have the lowest adherence rates to ongoing scheduled secondary prophylaxis doses (17).

Chronic kidney disease

Chronic kidney disease in South Australia is high, with the incidence of end stage kidney disease occurring at 6.8 times that of non-Aboriginal people in the area (11).

Respiratory disease

Chronic Obstructive Pulmonary Disease (COPD) is one of the leading avoidable causes of mortality for Aboriginal people Chronic respiratory conditions affecting the airways can cause ill health, disability and death. Respiratory disease is responsible for 69% of the deaths in Aboriginal people, experienced at twice the rate of non-Aboriginal populations (11)

Sexual Health

In South Australia, the Aboriginal population commonly experience high rates of blood borne viruses and sexually transmitted infections (STIs) and lower levels of sexual health literacy.

Syphilis

Syphilis is highly infectious during the first two years of infection and can be transmitted in pregnancy to the foetus, resulting in perinatal death, premature delivery, and congenital abnormalities. Furthermore, syphilis increases the risk of HIV transmission (18).

An outbreak of infectious syphilis was declared in the Country SA regions of Far North and Western & Eyre from November 2016, affecting predominantly Aboriginal and Torres Strait Islander persons aged 15-34 years (18).

As of March 2022, 157 cases of infectious syphilis have been notified among Aboriginal and Torres Strait Islander people in SA, representing 93% of all cases in the state (19)

Gonorrhoea

The rate in the Aboriginal population was 813 per 100,000 population in 2018 compared to 55 per 100,000 population in the non-Indigenous population (20)

Chlamydia

Rates are consistently higher in Aboriginal and Torres Strait Islander populations with a rate of 10.4 per 1,000 in 2018. This was an increase on the previous year which was 8.3 per 1,000 (20).

Hiv

HIV notification rates in the Aboriginal population should be interpreted with caution as changes in the rates can appear larger due to small case numbers per year. The notification rate for SA reduced to 2.3 per 100,000 in 2018 from 11.8 in 2017 (20). Notification rates in the non-Indigenous population were similar to the Aboriginal population in 2018, 2.2 per 100,000 (20).

Eye and Ear Health

In Country SA PHN region, eye and ear health is of growing concern with rates of vision and hearing loss at higher rates than necessary. The high rates of vision and hearing loss are commonly preventable and/or treatable with early diagnosis. Delayed diagnosis leads to increased levels of disability (21) Good eye and ear health are key in contributing to positive outcomes in social determinants such as early childhood development, educational outcomes, employment, and income outcomes.

Vision Loss and Blindness

Preventable diseases and conditions of the eyes are a prominent issue within South Australia’s Aboriginal populations. Overall, one in four Aboriginal people will experience vision loss and blindness in remote areas of South Australia. Eye health is a particular priority for diabetic patients who have greater risk of cataract and diabetic retinopathy (22). These are the second and third leading causes of blindness and vision loss (21)

Hearing loss

Important to overall health and quality of life, poor ear health and hearing loss have long term impacts on overall wellbeing as well as participation in education and employment. Inflammation and infection of the middle ear (otitis media) is a significant cause of hearing loss in Aboriginal children, with the World Health Organisation identifying Aboriginal and Torres Strait Islander children experience some of the highest rates of ear disease and associated hearing loss in the world (21).

Hearing loss is experienced nationally for Aboriginal people at 1 in 8, and at 1 in 6 South Australia (11)

Service Needs Access to Services

There is a lack of access to services for Aboriginal people (11). Main barriers identified to accessing appropriate services are:

• Low access to services in the health system when care is required

• Increased distances to services for rural and remote living residents (23-25)

• Lack of tailored health services to Aboriginal holistic health perspectives (24-28).

• Transportation access - Mobility of Aboriginal peoples to and from communities, across state borders, and into metropolitan or regional centres, add to the challenges of accessing multi-disciplinary coordinated care, information sharing across the system, maintaining accurate health records and supporting self-management.

Higher rates of hospitalisations occur for Aboriginal people including potentially preventable hospitalisations (11, 29) This is indicative of services being accessed too late in the issue/disease progression and resulting in emergency assistance or further complications

Of those who are accessing services, chronic condition services are accessed through GP Management Plans and/or Team Care Arrangements at higher rate than non-Aboriginal people further indicating the issue of chronic disease for Aboriginal people in South Australia Adequate access to appropriate services to support both prevention and condition management (follow-up services, allied health and specialist care) continues to be an ongoing issue (11) Hospital stays tend to be briefer for Aboriginal people with many discharging themselves early, against medical advice (11).

Antenatal and Birthing

Antenatal and birthing services in the Far West have been affected by lack of required specialties. People in the Far West required to travel up to 900kms from the local community to Port Lincoln or Adelaide for birthing services. Lack of access for family members to state funded patient travel support (PATS) for accommodation when travelling with birthing mothers.

Aboriginal Health Service Providers

Regional coverage of tailored Aboriginal specific service providers such as Aboriginal Community Controlled Health Organisation (ACCHO) health services is limited. Riverland, Mid North, Lower North or Yorke Peninsula do not have an operational ACCHO despite sizeable Aboriginal populations in several LGAs for these regions including:

• Berri/Barmera, estimated at 605 residents or 5.8% of the total population

• Mount Remarkable, estimated at 113 residents or 4.1% of the total population

• Port Pirie, estimated at 655 residents or 3.7% of the total population

• Yorke Peninsula, estimated at 421 residents or 3.8% of the total population (30)

Capacity issues affecting ACCHO service and sustainability include:

• Workforce barriers and limitations:

- Lack of housing options for health staff in remote areas

- Lack of available Aboriginal health professionals in the workforce (refer to section: Health Workforce) (31)

- Low recruitment, development and retention of workforce, particularly in rural and remote areas, including general practitioners, nurses, allied health and Aboriginal health practitioners (25, 27)

• Limitations in establishing sustainable service models due to barriers in usage of primary and follow-up MBS items (27)

• Limitations in both currency and ongoing maintenance of clinic infrastructure and telecommunications are barriers to maintaining and implementing effective service delivery (32).

• Lack of social and emotional wellbeing programs are being raised as an issue within communities and has been a central point raised with ACCHO nationally (24, 33).

Culturally Appropriate Care

Nationally, 44.8% of Aboriginal and Torres Strait Islander people identified being treated unfairly over a 12 month period when accessing services, with 19.5% indicating specific unfair treatment by doctors, nurses or other staff in hospitals or doctors’ surgeries (11)

Lack of culturally competent and appropriate service provision impacts access of services by Aboriginal peoples. In South Australia, it was found that a third of Aboriginal people who needed to go to a health provider but did not, identified cultural appropriateness of the service as the reason for choosing not to engage in accessing care (11)

In 2012-13, there were 29.5% of Aboriginal people in South Australia who needed to go to a health provider but did not, where 33.3% provided cultural appropriateness of the service as the reason (11)

Early Detection and Treatment Cancer Screening

Cancer screening rates for breast, cervical, prostate and bowel for Aboriginal people in South Australia is low (11) There is a lack of screening programs for cancer types identified as issue of importance in the SA Aboriginal population: lung, head and neck, hepatocellular and pancreatic cancers.

715 Health Check

The 715 Preventive Health Assessment for Aboriginal and Torres Strait Islander people (715 Health Check) are a primary healthcare mechanism to identify risk factors for chronic disease and to identify a strategy to support good health with the person, including access to lifestyle support activities and preventative health care services

Uptake rates of 715 Health Checks are below national uptake rate (32%) and the targeted goal for 2023 (60%), across most country SA regions except for Outback – North and East

715 Health Check uptake rate is lower with areas where there are no ACCHO, and in areas that are closer to metropolitan Adelaide (28, 34, 35)

Workforce

Overall, the Country SA PHN region experiences issues with workforce, including difficulties in recruitment, development and retention of staff in rural and remote areas Regions with an especially high demand for general practitioners, nurses, allied health and Aboriginal health Practitioners include:

• Far West

• Riverland

• Eyre Peninsula

• Port Augusta and surrounds (24, 25, 27, 28)

Proportions of health professionals who identify as Aboriginal are low, well below population rates and in the cases of nurses and midwives is the third lowest rate in Australia. Low rates of Aboriginal and Torres Strait Islander health professionals affect access to health services.

Mainstream services including general practitioners, pharmacists, allied health and other services may require ongoing cultural competency training and facilitation to engage with Aboriginal specific providers (24).

Limited primary health care provider knowledge in application and use of 715 Health Assessment to support culturally appropriate care. This includes utilising the 715 Health Assessment to normalise sexual health assessment and annual testing for BBV and STIs, particularly in designated outbreak regions (28, 34, 35).

Lack of workforce and primary health services support with culturally appropriate care for Aboriginal sexual health issues, cultural communication and available Aboriginal specific resources (28, 34, 35)

COVID-19 has greatly impacted the number and availability of available workforce, particularly in remote locations. Service provider focus on COVID-19 activity reduces provider capacity to facilitate in care delivery other than COVID-19 management (including vaccinations).

• Far West loss of 49% of health professionals during COVID-19 while restrictions under the Biosecurity (Human Biosecurity Emergency) (Human Coronavirus with Pandemic Potential) Emergency Requirements for Remote Communities) Determination 2020 were in place (36)

• Port Augusta and surrounds continued reduction of health professionals including general practitioners, nursing staff, Aboriginal health practitioners and health workers (21).

• Australian state and territory boarder restrictions have resulted in:

- APY Lands loss of interstate health professionals providing outreach services (29)

- Southern Eyre loss of interstate health professionals (returning to home state) and inability to recruit (37)

Community Voice

Country SA PHN regularly engages with key stakeholders, service providers and community representation to ensure their thoughts and views are heard. While distinct key issues are identified here, they all reflect a core issue of lack of access to appropriate health care services in local regions that meet community needs to stay well in community.

• Dental health – There is a lack of dental services in remote areas. Getting dental care is difficult with people needing to travel to regional centres however getting there requires transport and state funded patient transport is not available for dental care. This issue is more prevalent in the Far West region.

• Giving birth - Having to travel away from home, family and community to access care to support giving birth and following pregnancy is a highlighted concern with communities, with options to support birthing on country as a key issue. In the Far West region there are high rates of fertility in the Aboriginal population, and low access to required health services. Access to key specialty services in remote areas are limited or not present, and state funded patient transport services limit access to funded transport and accommodation for fathers, or other family members.

• Cancer services - Regionally located cancer healing services are limited or not available requiring travel for care away from community.

Ageing Populations

People are living longer, and an increasing amount of older people are receiving care in the community for longer periods of time with the availability of home support and services packages enabling them to stay in their own homes. Ideally, quality and appropriate care in place supports reduced need for age-related hospitalisations.

Key Points

• Higher percentage of older people in country regions than metro Adelaide

• Projected increases in 65+ population

• Limited regional residential aged care facilities

• 96% of older people in country SA PHN region living at home (38)

Identified Needs

1. Older persons are supported to stay healthy and well in their place of residence.

2. Medication management

3. Access to specialist services to support ageing well

Health Needs

Ageing population

23% of Country SA’s population is over 65 years compared to 18% in metropolitan Adelaide. Population projections over the next decade show Country SA’s population over 65 increasing and remaining in greater proportions to that of Adelaide (5, 39)

Highest concentration of ageing population reside in outer regional locations, especially in the Fleurieu Peninsula, Yorke Peninsula and Barunga West LGAs (40)

Some regions in Country SA have over 30% of the population over 65 years such as Victor Harbor (40.3%) and Yorke Peninsula (34.1%). Over the next decade, Victor Harbor is predicted to have minimal growth in its population over 65 years (+2.5%), while other areas in Country SA will see very large growth in their ageing populations. Areas such as the Flinders Ranges, Lower Eyre Peninsula, and Robe are predicted to increase their over 65 population by over 10% within the next 10 years (1).

96% of older people in country SA PHN region are living at home(38). Just over 4,000 people aged over 65 years are living in residential aged care, with 116 residential aged care facilities (including multi-purpose services and National Aboriginal and Torres Strait Islander services) located across the Country SA PHN region (41)

Conditions of significance

As people age, there is increasing incidence of age-associated disability and disease, dementia and frailty with increased risk of falls and subsequent hospitalisation (42).

COPD/Asthma:

• Admissions to hospital for respiratory conditions are highest in LGA of Unincorporated SA and Port Augusta with over 7,000 admissions per 100,000 compared to 4,302 admissions for Country SA as a whole (39)

• Just under half of the LGAs in Country SA had admissions to hospital for respiratory conditions at a rate higher than Country SA PHN overall (39).

Country SA PHN Needs Assessment Report 2022-2025 (November 2021)

Dementia:

• Dementia is the second leading cause of death of Australians (43)

• In 2021, it was estimated that between 29,235 and 39,200 people (1.6% - 2.2% of the population) were living with dementia in South Australia. This figure is projected to double by 2058 (44, 45)

• Prevalence increases with age and is more common in females than males (45)

Disability:

• 12% of those over 65 years in Country SA are living in the community with a profound or severe disability (39)

• In Anangu Pitjantjatjara, 38% of the population over 65 are living in the community with a profound or severe disability (39)

• Orroroo/Carrieton, Karoonda East Murray, Southern Mallee, and Whyalla have the next highest proportion of older persons living in the community with a profound or severe disability (17%).

Falls

• The average length of stay in SA hospital for older people injured after a fall was 7.4 days (39, 46)

• 405 older people died in SA hospitals as a result of injury from a fall (46).

• 3,493 people in country SA over 65 were admitted to public hospitals for falls in 2018-19(39)

• The highest age standardised rate of falls was in Elliston, Renmark Paringa, and Naracoorte and Lucindale (39)

Medication management

Complexity with managing medications increases with polypharmacy, common in older populations as they often requiring multiple medicines to manage and prevent illness.

75% of all Pharmaceutical Benefit Scheme (PBS) medicines dispensed in 2016–17 were reported for people aged 50 and over, with the majority dispensed to those aged 65 and over (47). Within residential aged care facilities, systems and practices of prescribing, dispensing, administration and monitoring of medication involves multiple health professionals and carers, increasing complexity of medication management in this area (48).

Service Needs

Older people are high frequency users of primary health care services (42). The past 10 years has seen a dramatic shift in the delivery of services for older people including the diversity of types of home support and home care services and funding of these aged care services (38). Overall, the number of people using aged care services (residential care, home care, home support, transition care) has increased in the past 10 years across Australia (38).

2.6% of older Aboriginal and Torres Strait Islander people are using aged care services, with 40% of those using home support and 22% using permanent residential aged care aged under 65 years old (38) People from CALD backgrounds represented 12% of all people using aged care services, with the majority of people using aged care services speaking English as their preferred language (38).

In 2019-2020, Commonwealth funded aged care and support (at home or in place) available across the Country SA PHN region:

• Home care services – providing higher level care or support to meet increased needs of clients (49)

- 43 service providers

- 43.4 people in 1000 used this service

- This was below the national average

• Home support services – providing lower care or support to maintain health and wellness (49)

- 149 service providers

- 352.9 people in 1000 used this service

- This was above nation average

- Allied health and therapy services were the most common services accessed

Country SA PHN Needs Assessment Report 2022-2025 (November 2021)

Nationally, South Australia had the highest proportions of older people using permanent residential aged care (4.7%) and of older people using home support services (25%)(49)

In 2021, 116 public and private residential aged care facilities were sited across country SA PHN region (41). Access to residential aged care facilities is limited with lack of places available for current and projected population need. Areas of concern are Flinders & Far North, Hills, Mallee, & Southern, the Eyre Peninsula, and Riverland Aged Care Planning regions where aged care places are between 13 and 20 places less per 1,000 population compared to all of South Australia (38, 39).

From January 2023, CSAPHN will commission services to provide specialist and intensive aged care navigation support as part of the national Care Finder program. A supplementary Needs Assessment will be made available on the CSAPHN website.

Community Voice

Country SA PHN regularly engages with key stakeholders, service providers and community representation to ensure their thoughts and views are heard.

Service providers from the aged care sector have expressed how complex and challenging accessing support and services is for older people and their families, and how this complexity is challenging as well for service providers in supporting people in accessing the right care (50). The challenges of maintaining a skilled and consistent workforce in aged services is a fundamental issue for regional and remote service providers. Appropriate remuneration, training and education and value-based recruiting are identified as key for providers to respond to the recommendations from the Royal Aged Care Commission (50)

Country SA PHN Needs Assessment Report 2022-2025 (November 2021)

Child & Youth Health

Giving every child the best start in life is crucial to reducing health inequalities across the life course. What happens during these early years (starting in the womb) has lifelong effects on many aspects of health and wellbeing, from obesity, heart disease and mental health, to educational achievement and economic status (40)

Key Points

• Projected decline in youth population across most of country SA region

• Children report experiencing asthma at a higher rate than those living in metro Adelaide

• Childhood weight management is an area of concern

Identified needs

1. Access to health care services and preventative care.

2. Access to specialist services to support developmental health and wellbeing of children and youth

Health Needs Analysis

In 2019, 21% of South Australian population was aged 18 and under, with 2.7% of children in South Australia were under six years of age, 34.5% six to 11 years old, and 32.8% aged 12 to 17 years (51).

In 2018, 25.4% of South Australian children and young people were estimated to be living in the most disadvantaged socioeconomic circumstances, compared to 18.5% nationally (51)

The proportion of the youth population of country South Australia (0-14 years) will overall decline by 1% over the next decade (52, 53) Expected small growth in the youth population in the areas of Coober Pedy and Ceduna over the next decade with all other LGA areas declining

Perinatal Health

The perinatal period is broadly considered to encompass from one year before birth to 18 to 24 months after the birth of the child. The health of both mother and baby at birth can affect their wellbeing throughout the rest of their lives (54)

The APY Lands experience the highest infant mortality, followed by Port Augusta and Murray Bridge.

Higher proportions of both low birthweight babies and mothers who smoked during pregnancy exist in Port Augusta and the Outback regions. Pregnancy smoking rates were also high in Peterborough and Ceduna (55)

Developmental Vulnerability

The Australian Early Development Census (2018) defines developmental growth domains as: physical health and wellbeing, social competence, emotional maturity, language and cognitive skills (school-based), and communication skills and general knowledge. Children who experience vulnerability in key areas of developmental need are at risk of poor health outcomes over their lifespan (56)

1 in 4 South Australian children and young people are developmentally vulnerable in one of more of the domains under the Australian Early Development Census when they enter school (51).

Across country SA, areas of need:

• APY Lands - 71% of children were reported as experiencing vulnerability on two or more domains compared to 11% for the rest of Australia (57)

• Peterborough, Roxby Downs, Port Lincoln, Ceduna, and Unincorporated SA LGAs - had a proportion of children identified as experiencing vulnerability in two of more domains, these proportions are more than double the Australian average (57)

Country SA PHN Needs Assessment Report 2022-2025 (November 2021)

Child and Youth Health

Asthma

In 2018, Asthma was the leading cause of disease burden for children in Australia, and is one of the most common causes of hospital admission and visits to the doctor (58, 59)

• 17.9% of children in rural areas of South Australia report having asthma, compared to 13.8% in metropolitan Adelaide (60).

• Children living in lower socioeconomic areas are more likely to report having asthma than those living in higher socioeconomic areas (60).

• Nationally, prevalence for asthma is twice as high for children with disability than with those with no reported disability (61)

Disability

Children and youth with disability may experience limitations or barriers to participating in a range of activities that support developmental growth.

• Estimated 7.4% of children aged 0-14 across Australia having a level of disability (62).

• 1 in 4 suspensions from SA government schools have been identified as students with disability (51)

Weight management

Overweight and obesity in children and youth is associated with poorer health and wellbeing and higher health-care costs. Nationally obesity and being overweight affects 25% of Australian children and youth (63).

In rural South Australia 17.5% of children aged 5 to 17 were overweight and 19% were obese meaning almost 40% of children were an unhealthy weight (60)

Child and Youth Mental Wellbeing

Youth are experiencing increased prevalence of psychological distress(64) Refer to Alcohol and Other Drugs and Mental Health sections of this report.

Service Needs

General practice is the most accessed health care provider for children and youth with 86% of rural South Australian children visiting a general practitioner in 2018-2019 period (60). In 2019, 24.4% of rural South Australian children travelled over 75km to use a health service in 2019, compared to 1.8% in metropolitan Adelaide. The majority of those who travelled did so due to lack of services in the local community (65).

Community Voice

In 2020, young people across regional South Australia identified a need for more GPs with expertise in working with and providing care for youth. In addition to young people wanting greater choice in primary care providers to enable seeking care from a GP that does not provide care to immediate family members or carers (51)

Limitations in access to specialist care locally required regionally based young people to worry about issues of affordability with transport and the distance with travelling to Adelaide for care (51). Privacy and confidentiality were also highlighted concerns by young people in accessing care in a small community.