Populations of Special Interest

While many Australians experience poor health outcomes, concentrated inequalities in health exist in some population groups. Populations experiencing inequity due to cultural, ethnic or health characteristics, and social disadvantage are at risk of disparate access to health care and outcomes. For detail regarding Aboriginal and Torres Strait Islander health and wellbeing refer to Aboriginal Health section of this report.

Key Points

• Culturally and Linguistically Diverse (CALD) communities

• LGBTQI+ communities

• People experiencing disability

• People providing informal care

• Rural and remote communities

Identified Needs

1. Access to culturally appropriate health services.

2. Access to health care services and preventative care

Health Needs

Culturally and Linguistically Diverse (CALD) communities

Country SA PHN region population is diverse and includes people who were born overseas, have family members who were born overseas or speak a variety of languages. While these groups are distinct and unique, they are identified here as CALD populations.

English proficiency can impact health by hindering an individual’s access to health services (107) Coober Pedy, Naracoorte and Lucindale, Renmark Paringa, and Murray Bridge have higher proportions of persons born overseas who report speaking English not well or not at all (53).

Just under half of country SA surveyed respondents from General Practice and Allied Health reported seeing clients who are not proficient in English occasionally or (very) frequently, with allied health providers indicating a higher frequency.

Refugee and Special Humanitarian Visa migrants entering Australia under the Offshore Humanitarian Program between 2000 and 2016 are settling more frequently in the south east of SA (53) Specific health needs for individual new arrivals, and those from refugee background communities will vary depending on their refugee experience, region and country of origin. Common health concerns across communities can include trauma from violence and injury, communicable and non-communicable diseases have been poorly managed in the past, and limited or disrupted access to preventative care and mental health support (108).

LGBTQI+ communities

There is complexity and severe limitations in identifying national, state and regional level data and reporting for people identifying as being LGBTQI+. This is due to both lack of data sources including information on diverse sex, gender and sexual orientation, and the complexity of how individuals identify themselves (109). It is acknowledged that grouping people identifying as lesbian, gay, bisexual, transgender, intersex or other gender or sexual orientation into a single group (LGBTQI+) is limited in effective representation.

While reporting is identified as limited, national findings indicate a disproportionate number of people identifying as LGBTIQ+ experience have poorer mental health outcomes and have higher risk of suicidal behaviours than their peers (109, 110). It is surmised experiences of stigma, prejudice, discrimination and abuse by those who identify as being LGBQI+ have a direct impact on health behaviours including risk and help seeking (110). Only 34% of people who identify as LGBTI reported hiding their sexuality or gender identity when accessing services (111)

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

Mental health is a highlighted issue with older Australians who identify as lesbian, gay, bisexual, transgender or intersex have lived experience of discrimination, criminalisation, family rejection and social isolation, resulting in anxiety (111, 112).

People experiencing disability

Nationally, 18% of the population have disability, with prevalence increasing with age. Around 1 in 8 people aged under 65 have some level of disability, rising to 1 in 2 for those aged 65 and over (113)

In 2019, 20.3% of South Australian adults reported having a disability with a higher proportion of females (22.1%) than males (18.2%). In the same year, a total of 9.7% of South Australian adults reported providing long term care at home for a parent, partner, child, relative or friend (60).

Higher proportion of people with a disability are living in country SA than metropolitan Adelaide (53).

Health risk factors and behaviours (such as poor diet, physical inactivity, and smoking) can have a detrimental effect on a person’s health (113):

• 72% of people with a disability are overweight or obese, compared to 55% of people without a disability.

• 72% do not do enough physical activity for their age compared to 52% of people without a disability.

• 54% had hypertension compared to 27% of people without a disability

• Those with a disability were less likely to exceed the guidelines for single occasion risk for alcohol consumption

People providing informal care

In 2018, 3.5% of all Australians aged 15 years and over were the primary carers (informal) to a person with disability, with those aged 55-64 the highest proportion of providers, followed by 65–74-year-olds (114).

Just over 12% of country South Australians spend time providing unpaid care, help or assistance to family members or others because of a disability, a long-term illness (lasting six months or more), and/or problems related to older age (8).

Carer SA consultation with SA based carers in 2020 found carers experienced a lack of inclusion and consideration by GPs and hospitals in regards to care planning Carers who are unpaid and are most often caring for a family member at home reported NDIS services as not easy to organise and that their own needs are not considered, asked for or met. 91% of those consulted reported caring role resulted in a negative impact to self, and 86% reported their caring role resulted in a negative impact on important relationships (partner, family, friends) external to the person they were caring for (115)

Remote communities

Approximately 54% of the Country SA PHN population live in areas classified as Outer Regional, Remote, and Very Remote Australia. Just over 42% of the Country SA PHN ’s population reside in Outer Regional areas, and 35% in Inner Regional areas (40)

With increasing remoteness, access to GP and specialist care becomes increasingly difficult and reduces participation in care. 3 in 5 people residing in Remote/Very Remote areas identify a lack of healthcare providers nearby stopped them from accessing care (80, 98). People living in Outer Regional and Remote/Very Remote areas are unlikely to have a usual GP with populations living in these areas being the most likely to access emergency care due to lack of access to a GP (80, 98, 116)

Service Needs

Culturally appropriate care

Surveyed respondents in a 2019 state-wide health survey identified the most common reasons they experienced discrimination was because of race (11.7%), age (11.2%), gender (10.3%), disability (5.4%), and religion (5.0%)(60)

Persons identifying as LGBTQI+ are likely to feel their sexual orientation or gender identify is not respected in mainstream services, and are more likely to access services that are accredited or identified as LGBTQI+ inclusive (117)

Joint consultation (2021) with South Australian people of lived experience and service providers, identified key needs for provider education in LGBTQI+ health needs, improved access to and choice of providers for LGBTQI+ people (118)

For people from culturally and linguistically diverse communities, there is an overall reliance on healthcare provider multilingual capabilities and use of family members as interpreters to support language assistance for persons to efficiently participate in health and wellbeing activity, including discussions with GPs, specialists, allied health and other professionals (108, 119). Time intensive consults involving interpretation services and associated costs find GP access and use of government subsidised interpretation services in consultation is historically low (108, 119).

Access

Carers experience exclusion by GPs and hospitals regarding care planning for those they care for. In addition, carers experience a lack of consideration for their own needs in the delivery of the care. 63.7% of SA carers surveyed in 2020 reported hospitals did not ask about their needs as carers, with 57% experiencing the same with GPs (115). Difficulty in organisation of services for those they care for through National Disability Scheme (NDIS) is a highlighted issue for SA based carers (115)

Services are concentrated in Metro and Inner Regional areas, resulting in barriers for Regional, Outer Regional and Remote communities in access with travel, expense, and time away from the community required in order to participate in health care(80, 98). In 2019, 13.6% of South Australians were required to travel over 75kms from their homes to use a health service. While 15% chose to access a service further away, 74% were required to do so as the required services were not located or accessible locally.