Ddswqml health atlas 2013 by DDSWQ Medicare Local

Acknowledgements and Disclaimers The Darling Downs South West Queensland Regional Health Atlas 2013 Published by the Darling Downs South West Queensland Medicare Local, September 2013 ISSN: 2201-8816

The Darling Downs South West Queensland Regional Health Atlas 2013 is licensed under a Creative Commons Attribution-Non Commercial 3.0 License. © Darling Downs South West Queensland Medicare Local 2013 You are free to copy, communicate and adapt this work, as long as you attribute the Darling Downs South West Queensland Medicare Local. For copyright information contact: info@ddswqmedicarelocal.com.au. This report is also available on the Darling Downs South West Queensland Medicare Local website at www.ddswqmedicarelocal.com.au. There is the potential for revisions of data in this report. Please access the online version for the latest version.

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DISCLAIMER

The Darling Downs South West Queensland Regional Health Atlas 2013, Toowoomba, 2013

The Darling Downs South West Queensland Medicare Local acknowledges that some data, including service capacity and workforce data, may not be accurate or complete, and welcomes the provision of additional data that will improve the quality and value of the report.

TRADITIONAL OWNERS The Darling Downs South West Queensland Medicare Local acknowledges the traditional owners of the land we live and work on across our region and respects their continuing culture and the contribution they make to the life of the region.

NEEDS ASSESSMENT ADVISORY GROUP The Darling Downs South West Queensland Medicare Local has established a Research, Population Health and Epidemiology SubCommittee. This committee has acted as an advisory group in the preparation of this report. The current members of the Research, Population Health and Epidemiology Sub-Committee are: MS JENNY FLYNN | South West Hospital & Health Service

All data and information in this report is believed to be accurate and has come from sources believed to be reliable. However, the Darling Downs South West Queensland Medicare Local does not guarantee or represent that the data and information is accurate, up to date or complete, and disclaims liability for all claims, losses, damages or costs of whatever nature and howsoever occurring, arising as a result of relying on the data and information. The health data incorporated into this Health Atlas has been sourced from other States and projected onto the DDSWQML population. The Medicare Local acknowledges the support and assistance of our strategic partners in the development of this report and takes sole responsibility for the content of this report.

DR PENNY HUTCHINSON | Darling Downs Public Health Unit DR JULIA LEEDS | South West Hospital & Health Service

ACKNOWLEDGEMENT

DR SCOTT KITCHENER | Queensland Rural Medical Education

A special acknowledgement to Dr Geetha Ranmuthugala, Epidemiologist from the University of Queensland’s Rural Clinical School who reviewed the content and provided comment to enhance the Atlas.

DR MAREE TOOMBS | University of QLD - Rural Clinical School MR MICHAEL BISHOP | Darling Downs Hospital & Health Service DR SRINIVAS KONDALSAMY-CHENNAKESAVAN | University of QLD - Rural Clinical School The Darling Downs South West Queensland Regional Health Atlas 2013 was prepared by the Data and Planning team, Darling Downs South West Queensland Medicare Local, with advice and assistance from others at the Medicare Local, the Darling Downs Hospital and Health Service, the South West Hospital and Health Service, Health Workforce Queensland and other strategic partner stakeholder organisations. EDITOR: Garry Hansford DATA AND PLANNING TEAM: Liz Grummitt, Elise Grills PUBLICATION: Red Comb Designs www.redcomb.com.au

FOR FURTHER INFORMATION: Data and Planning Manager Darling Downs South West Queensland Medicare Local PO Box 1510, Toowoomba QLD 4350 Email: info@ddswqmedicarelocal.com.au

Table of contents SECTION 1.0 - Introduction. . . . . . . . . . . . . . . . . . . . . . . 5

3.11 Baby and young children population change 2010-2025. . . . . . . . . . . . . . . . . . . . . . . . . . 24

3.12 Teenager population change 2010-2025. . . . . . . . . . 25

3.13 Aged population change 2010-2025. . . . . . . . . . . . . 26

1.1 About this report. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

1.2 Why we need a Health Atlas? . . . . . . . . . . . . . . . . . . . 5

1.3 Understanding needs . . . . . . . . . . . . . . . . . . . . . . . . . 5

1.4 Statistical areas explained. . . . . . . . . . . . . . . . . . . . . . 5

SECTION 4 - Environmental factors. . . . . . . . . . . . . . 27

1.5 What data is included? . . . . . . . . . . . . . . . . . . . . . . . . 6

4.1 Terrain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

1.6 What data isnâ&#x20AC;&#x2DC;t available? . . . . . . . . . . . . . . . . . . . . . . 6

4.2 Rurality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

SECTION 2.0 - At a glance . . . . . . . . . . . . . . . . . . . . . . . 8 SECTION 3.0 - Characteristics of the population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

3.1 Estimated resident population 2011. . . . . . . . . . . . . . 12

3.2 Estimated non-resident population 2011-2012. . . . . 13

3.3 Population distribution by age group and gender. . . . 14

3.4 Births, birth rate and fertility rate 2011. . . . . . . . . . . . 15

3.5 Gender profiles 2011. . . . . . . . . . . . . . . . . . . . . . . . . 16

3.6 Aboriginal and Torres Strait Islander population profiles 2011 . . . . . . . . . . . . . . . . . . . . . . 17

4.3 Land use. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

4.4 Transport. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

4.5 Major industry employers. . . . . . . . . . . . . . . . . . . . . . 31

4.6 Climate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 4.7 Temperature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 4.8 Rainfall . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

4.9 UV Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

4.10 Climate change . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

4.11 Resource development in the Surat Basin . . . . . . . . . 37

SECTION 5 - Social factors. . . . . . . . . . . . . . . . . . . . . . 38

3.7 Culturally and linguistically diverse population profiles 2011 . . . . . . . . . . . . . . . . . . . . . . 18

5.1 Relative Socio-economic advantage and disadvantage 2011. . . . . . . . . . . . . . . . . . . . . . . . . . 39

3.8 People with a disability 201. . . . . . . . . . . . . . . . . . . . 19

5.2 Low income 2011. . . . . . . . . . . . . . . . . . . . . . . . . . . 40

3.9 Expected population growth regionally 2011-2031. . . 20

5.3 High unemployment September 2012. . . . . . . . . . . . 41

3.9 Expected population growth within the region 2011-2031. . . . . . . . . . . . . . . . . . . . . . . . 21-22

5.4 Low education level 2011 . . . . . . . . . . . . . . . . . . . . . 42

5.5 People receiving government support 2010. . . . . . . . 43

3.10 Median age profiles 2011-2031. . . . . . . . . . . . . . . . . 23

5.6 People living in rented accommodation 2011. . . . . . . 44

Table of contents

5.7 Single parent families 2011 . . . . . . . . . . . . . . . . . . . . 45

SECTION 8 - BIOMEDICAL FACTORS. . . . . . . . . . . . . 68

5.8 Dwellings with no vehicles 2011 . . . . . . . . . . . . . . . . 46

8.1 Type 2 Diabetes 2011. . . . . . . . . . . . . . . . . . . . . . . . 69

5.9 Volunteer profiles 2011 . . . . . . . . . . . . . . . . . . . . . . . 47

8.2 High blood pressure 2007-2008 . . . . . . . . . . . . . . . . 70

SECTION 6 - Access factors. . . . . . . . . . . . . . . . . . . . . 48

8.3 High Serum Cholesterol 2007-2008. . . . . . . . . . . . . . 71

6.1 Self-reported difficulty accessing health services 2010 . . . . . . . . . . . . . . . . . . . . . . . . . 49

8.4 Psychological Distress 2007-2008. . . . . . . . . . . . . . . 72

8.5 Heart Disease 2007-2008. . . . . . . . . . . . . . . . . . . . . 73

6.2 Our experience with primary health care 2010-2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

8.6 Chronic Obstructive Pulmonary Disease 2007-2008. . . . . . . . . . . . . . . . . . . . . . . . . . 74

6.3 Health concession cards 2009. . . . . . . . . . . . . . . . . . 51

8.7 Asthma 2007-2008 . . . . . . . . . . . . . . . . . . . . . . . . . 75

6.4 Private health insurance 2007-2008 . . . . . . . . . . . . . 52

8.8 Arthritis 2007-2008. . . . . . . . . . . . . . . . . . . . . . . . . . 76

6.5 No internet access 2011. . . . . . . . . . . . . . . . . . . . . . 53

8.9 Avoidable death rates 2003-2007 . . . . . . . . . . . . . . . 77

6.6 Calls to 13 HEALTH 4th Quarter, 2012. . . . . . . . . . . . 54

8.10 Deaths from all Cancers 2003-2007 . . . . . . . . . . . . . 78

6.7 Number of local primary health services 2012 . . . . . . 55

8.11 Dementia 2011-2021. . . . . . . . . . . . . . . . . . . . . . . . 79

6.8 Number of local hospitals and hospital beds 2012. . . 56

8.12 Australia Early Development Index (AEDI) 2012 . . . . . 80

6.9 Number of home and community care services 2010-2011. . . . . . . . . . . . . . . . . . . . . . 57

8.13 Childhood development â&#x20AC;&#x201C; Immunisation 2011-2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81

6.10 Number of residential aged care places 2011 . . . . . . 58

Section 9 Appendices. . . . . . . . . . . . . . . . . . . . . . . . . . . 82

Section 7 - Health behaviours . . . . . . . . . . . . . . . . . . . 59

7.1 Self-assessed health status 2007-2008. . . . . . . . . . . 61

9.2 Acronyms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83

7.2 Males Overweight and Obese 2007-2008 . . . . . . . . . 62

7.3 Females Overweight and Obese 2007-2008 . . . . . . . 63

7.4 Smoking 2007-2008. . . . . . . . . . . . . . . . . . . . . . . . . 64

7.5 Harmful alcohol consumption 2007-2008 . . . . . . . . . 65

7.6 Physical inactivity 2007-2008 . . . . . . . . . . . . . . . . . . 66

7.7 Fruit and vegetable consumption 2007-2008. . . . . . . 67

9.1 Technical appendices . . . . . . . . . . . . . . . . . . . . . . . . 82

9.3 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84-85

Section 1

Introduction This Regional Health Atlas includes a comprehensive range of datasets that together paint a picture of the population health profile of the Darling Downs South West Queensland region. The atlas also highlights variations in health status across 22 statistical areas or communities within the region.

1.1 About this report This Regional Health Atlas includes a comprehensive range of datasets that together paint a picture of the population health profile of the Darling Downs South West Queensland region. The atlas also highlights variations in health status across 22 statistical areas or communities within the region. The purpose of this report is two-fold: to provide the data that will support the primary health care planning process undertaken by the DDSWQ Medicare Local on an ongoing basis; and to provide stakeholders, health service managers and the community with the first or baseline health atlas for the region as a whole and for smaller regions as well.

1.2 Why we need a Health Atlas? A recent government report highlights the fact that people living outside of major cities in Australia still have worse outcomes on the leading indicators of health and access to health care. They have higher rates of obesity, smoking and risky alcohol consumption. Their rates of potentially preventable hospitalisations are also higher and they are less likely to gain timely access to aged care.1 All of the Darling Downs and South West Queensland region is classified as regional, rural, remote or very remote.2 The DDSWQ Medicare Local is committed to resolving these health issues in our communities and providing the best primary health care and service delivery models that we can. That‘s because strong primary health care systems are associated with better health outcomes and lower costs.3 The role of Medicare Locals is to help achieve these goals. They have responsibility for identifying and assessing the health care needs of their populations, improving the responsiveness, coordination and integration of primary health care in local communities, addressing service gaps and making it easier for individuals, carers and service providers to navigate their local health system.4 And that‘s why we need a health atlas. Before we, as a community of health service providers, can improve the primary health care in our region we need to identify and assess the health care needs of our region.

1.3 Understanding needs Need, in the context of health, is a challenging concept with no one universal definition. For example, the need for health is not the same as the need for healthcare. The need for healthcare can be defined as the need that exists when someone has an illness and healthcare is provided to address that need; while the need for health is much broader and can include issues and problems with no known treatment or even issues and problems outside the “healthcare” system, such as environmental, socio-economic and social issues. These non-traditional health issues are also called the Social Determinants of Health.5 The difference between health (defined as the absence of illness) and wellbeing (defined as something much broader again) is also a distinction made by health experts. Health experts also make a distinction between supply and demand. Supply is defined as what is provided or available; demand is defined as what is asked for. However, what is asked for is influenced by factors included in the social determinants of health, location and the available resources; while supply is often influenced by historical patterns, political pressures and economic realities.6 Finally, planning health services is influenced not only by the need to get people well where they live, but by the practical necessity to provide services in central or hub locations rather than in small local communities (adding transport and access needs). There is also the issue of how best to address the different needs of different people, the distribution of people with different needs across a region, and the fair and equitable distribution of available resources to meet needs.

1.4 Statistical areas explained In preparing the framework for this health atlas, a decision as to the number of statistical areas to be used for data collection and reporting purposes was required. The Darling Downs South West Queensland region, as defined by the Federal government as the Darling Downs South West Queensland Medicare Local, includes two Hospital and Health Services (HHSs), (Map 1.4a); 12 local government areas (LGAs), (Map 1.4b); and over 60 communities or towns, each with a strong history, an identifiable culture, viable population numbers and demonstrated sustainability as communities over time. While it would be good to report at the 60 plus town or community level, this is impractical due to a number of factors, principally the current unavailability of comparable population health data at this level. On the other hand, reporting at a whole of region level is equally impractical, not because of the lack of data, but because of the lack of detail leading to the inability to identify which areas within the region have the greatest need.

Local government areas (LGAs) provide a possible geographical framework for data collection and reporting. LGAs are well defined political entities with well established service provision models. LGAs are classed as Cities, Towns, Shires and Regional Councils. Within the region there are six Shire Councils (including one Aboriginal Shire Council) and 6 Regional Councils and no City or Town local government areas. Australian Bureau of Statistics (ABS) data is readily available at the LGA level. A number of the more populated LGAs in the eastern third of the region have well defined sub-regions that better reflect communities of need. ABS data is also available at this sub-region level, using Statistical Area Level 2 datasets. However, in the west of the region, the opposite is the case. Three LGAs, Paroo (Cunnamulla), Bulloo (Thargomindah) and Quilpie Shire Councils, are in one ABS defined SA2. Therefore the decision has been made to use a combination of six LGAs and 16 SA2s as the statistical areas for the purposes of this health atlas (Map 1.4c).

1.5 What data is included? The datasets included in the health atlas are grouped into six sections, based on a model developed by the Australian Institute of Health and Welfare.7 Section 3: C haracteristics of the population datasets including current population, age and gender profiles, special needs group demographics and expected population growth into the future; Section 4: E nvironmental factors including the geography, climate and industry base for the region; Section 5: Social factor datasets including socio-economic status, employment, and education; Section 6: A ccess factor datasets including self-reported difficulty accessing health services, health assistance and insurance and the distribution of health services; Section 7: L ifestyle factor datasets including self-assessed health status, obesity, physical activity, smoking and alcohol consumption; and Section 8: B iomedical factor datasets including the prevalence of selected chronic diseases, avoidable depths and childhood development indicators. Datasets from national organisations including the Australian Bureau of Statistics (ABS), Medicare Australia, the Department of Health and Ageing (DoHA), the Australian Institute of Health and Welfare (AIHW) and the Public Health Information Development Unit (PHIDU) as well as state and local datasets has been used to generate the tables and maps in this atlas. Data sources for each dataset are detailed in footnotes. For a full list of references, see section 9.3. The data in this health atlas represents the first comprehensive baseline dataset for identifying the health needs of the region, and, where possible, the health needs of each of the 22 statistical areas within the region. Each dataset includes, where possible, state (Queensland) and national data for comparison, ranks the 22 statistical areas within the region and maps the rankings.

1.6 What data isnâ&#x20AC;&#x2DC;t available? Many of the datasets used in this Health Atlas rely on a small statistical area dataset provided to Medicare Locals by the PHIDU that used synthetic or modelled data estimates that were based on National Health Survey data collected in 2007-2008. The survey excluded persons residing in collection districts in Very Remote areas under the ABS remoteness classification and estimates were not produced for SLAs with more than 50% of their populations residing in Very Remote regions, SLAs with populations under 1,000, and SLAs in which Aboriginal people comprise 75% or more of the population (see Technical Appendix Note 5.5 for more detail). These estimates are therefore to be used with caution, and treated only as indicative of the prevalence of health indicators in the region and especially in the smaller statistical areas. In particular, readers and users of this health atlas need to be aware that data for the Cherbourg Aboriginal Shire Council, located within the ABS defined Kingaroy North statistical area, have been included in the North Kingaroy data and are not available separately at this time. Workforce and service capacity data is available separately in the Health Workforce Queensland Report, DDSWQ Whole of Region Service and Workforce Mapping Project Report, 2013. This report is available from the Darling Downs South West Queensland Medicare Local and from the Medicare Local website www.ddswqmedicarelocal.com.au.

MAP 1.4A: HOSPITAL AND HEALTH SERVICE BOUNDARIES IN THE DDSWQ REGION

MAP 1.4B: LOCAL GOVERNMENT AREAS IN THE DDSWQ REGION

MAP 1.4C: STATISTICAL AREAS USED IN THE HEALTH ATLAS

Section 2 At a glance

The DDSWQ Regional Health Atlas 2013 provides a systematic approach to identifying key elements of the health and wellbeing of the population living and working in the region. It provides a baseline dataset for identifying the needs of the region, and, where possible the needs of each of the 22 statistical areas within the region.

Section 3: Characteristics of the population This section focuses on the people living and working in the region by describing the distribution of residents and nonresidents; their age and gender; and the profile of the Aboriginal and Torres Strait Islander, culturally and linguistically diverse, and people with a disability populations. This section highlights the fact that of the 292,312 estimated resident population in 2011, over 90% live in the eastern third of the region, predominantly in or around the regional centre of Toowoomba. It is an ageing population. The proportion of Indigenous persons is higher than the state and national averages, the proportion from culturally and linguistically diverse communities is less than the state and national averages, and the proportion of people with a disability is higher than the state and national averages. Within the DDSWQ region, communities to the east of the region have more females than males while communities to the west of the region have more males than females. The statistical areas with higher proportions of the population identified as Aboriginal and Torres strait Islander included Cunnamulla, Kingaroy North and St George; areas with higher proportions of culturally and linguistically diverse communities included Stanthorpe, Millmerran and Toowoomba; and areas with higher proportions of people with a disability included Kingaroy South, Tara, Crows Nest, Oakey and Kingaroy North. This section also addresses projected population growth to 2031 and profiles the expected distribution of babies and children, teenagers and the aged throughout the region up to 2025. Population growth for the next 20 years is estimated to be around 2% a year, which is almost twice the annual growth rate experienced over the last 15 years. The increase in non-resident population far exceeds projected increases, possibly as a result of increasing resource exploration and mining activity. The population will continue to age, with the proportion of the population aged 65 and over increasing from 15% to almost 20% by 2025. Within the DDSWQ region, most of the growth will occur in the eastern one third of the region, with the far western region expected to experience a small population decline. The statistical areas with higher proportions of the population projected to be babies and young children included St George, Dalby and Roma; the growth areas for teenagers are projected to be Oakey, Crows Nest and Pittsworth; and for people aged over 65, Kingaroy South, Stanthorpe, Clifton and Kingaroy North.

Section 4: Environmental factors This section provides an overview of the geography, climate and the industry of the region. Including this information in the Health Atlas provides the reader with an understanding of the environment within which the communities live. This section highlights the fact that the geographical area is exclusively regional, rural or remote; and experiences a temperate climate; land use is traditionally for grazing, cropping and dairy farming, although the region has seen a rapid expansion of mining activity resulting in significant environmental, social and economic impact; and that Health and Social Care is the largest employment group in the region, followed by retail trade, agriculture, and education & training.

Section 5: Social determinants of health This section profiles the social determinants of health of the region as a whole and, where data is available, at the community level (based on the 22 statistical areas identified for this report). Data in this section focuses on the Index of Relative Socio-economic Advantage and Disadvantage (IRSAD), communities with low income, high unemployment, low education level, high levels of government support, and low access to traditional social support mechanisms. Findings are that the region is below the state average in socio-economic status and education attainment, has a higher than state and national average of the proportion of 18 + year old individuals on low incomes, sits below the state average in rate of unemployment, and has higher proportions of the population receiving government support than the state and national averages. Within the DDSWQ region, the statistical areas with the lowest IRSAD scores included Kingaroy North, Tara and Kingaroy South. These areas also appear at the higher end of the proportion of the population on low incomes, unemployment and receiving government assistance along with Cunnamulla and Stanthorpe. The statistical areas with higher proportions of the population with low education included Crows Nest, Cunnamulla and Kingaroy North; for rented accommodation - Thargomindah, Quilpie and St George; for single parent families - Cunnamulla, Quilpie and Kingaroy; and for dwellings without a vehicle - Quilpie, Cunnamulla and Kingaroy North. The statistical areas with higher proportions of the population who volunteer included Miles, Chinchilla and Quilpie.

Section 6: Access factors This section addresses access to health services and profiles the region as a whole and, where data is available, at the community level (based on the 22 statistical areas identified for this report). Data in this section focuses on difficulty accessing health services, the patient experience, financial assistance to meet the cost of health needs and access to health information via a variety of communication channels. Findings are that the proportion of persons who reported difficulty accessing health service is higher than the state and national averages; the patientâ&#x20AC;&#x2DC;s experience of primary health care is generally equal to the average for similar nonmetropolitan urban and regional areas with middle socio-economic status; and the proportion of the population with health concession cards and/or private health insurance is below the state and national averages.

Section 6: Access factors cont. Within the DDSWQ region, the statistical areas with higher proportions of the population reported as having difficulty accessing health services included Miles, Chinchilla and Quilpie. The statistical areas with higher proportions of people with health concession cards included Tara, Kingaroy North and Kingaroy South, while the areas with lower proportions of people with private health insurance included Tara, Kingaroy North and Stanthorpe. The statistical areas with higher proportions of households with no internet connection included Cunnamulla, Kingaroy North and Tara; and the statistical areas making the most use of the Queensland 13HEALTH telephone triage service included Kingaroy, Kingaroy South and Dalby. This section also reports on some basic measures of service capacity in the region. Findings are that the number of health services per 1,000 population varies throughout the region significantly while the number of home and community care services and the number of residential aged care places per 1,000 population are comparable to both the state and national number of places per 1,000 population. Within the DDSWQ region, the statistical areas with higher numbers of local health service organisations per head of population included Charleville, Quilpie and Kingaroy; areas with higher numbers of home and community care services per head of population included Millmerran, Oakey and Charleville; and areas with higher numbers of residential aged care places per head of population included Quilpie, Millmerran, Pittsworth and St George.

Section 7: Health behaviours This section reports on the self-reported health status of the region as a whole and, where data is available, at the community level (based on the 22 statistical areas identified for this report). Data in this section focuses on health risk factors. Findings are that between 6 and 7 out of 10 adult males and 6 out of 10 adult females living in the region were overweight or obese in 2011-12 (latest available data) while five years ago only 6 out of 10 males and 4 out of 10 females were overweight or obese. Half of the adults in the region were not engaged in sufficient physical activity to meet the National Physical Activity Guidelines, compared to four of 10 five years ago. The report also concludes that nine out of 10 adults did not consume the recommended amounts of fruit and vegetables; two out of 10 adults drank in excess of the recommended limits that would avoid long term health problems; and the smoking rate continued to decline with less than 2 out of 10 adults smoking daily. Within the DDSWQ region, the statistical areas with higher proportions of the population reported to have poor to only fair health included Tara, Kingaroy South and Kingaroy. The statistical areas with higher proportions of the population reported as overweight or obese included Stanthorpe, Kingaroy South and Tara. For smokers the high risk statistical areas included Kingaroy North, Charleville and Kingaroy South; for alcohol consumption - Chinchilla, Kingaroy North and Goondiwindi; for physical inactivity - Tara, Kingaroy North and Charleville; and for inadequate fruit intake - Kingaroy South, Kingaroy North and Tara.

Section 8: Health and wellbeing (Biomedical Fators) This section reports on the health and wellbeing status of the region as a whole and, where data is available, at the community level (based on the 22 statistical areas identified for this report). Data in this section focuses on the prevalence of some key chronic diseases and avoidable death rates. Findings are that in 2007-8 (latest available data) the prevalence rate for Type 2 diabetes, high blood pressure, high cholesterol and psychological distress were not significantly different from the state and national rates while the prevalence rate for heart disease, chronic obstructive pulmonary disease, asthma and arthritis were higher than the state and national rates. The annual avoidable premature death rate was higher than both the state and national rates. Within the DDSWQ region, the statistical areas with higher prevalence rates for the reported chronic diseases included Kingaroy North, Kingaroy South and Tara. The statistical areas with higher annual avoidable premature death rates included Kingaroy North, Cunnamulla and Quilpie. This section also reports on the health and wellbeing status of children in the region as a whole and, where data is available, at the community level (based on the 22 statistical areas identified for this report). Data in this section focuses on the Australian Early Development Index (AEDI) and childhood immunisation rates. Findings are that the proportion of children who were developmentally vulnerable on one or more of the five AEDI domains was higher than the state and national averages and that the childhood immunisation rates were at the high end of the national range. Immunisation rates for Aboriginal and Torres Strait Islander children, while lower than the overall rates, were also at the high end of the national range. Within the DDSWQ region, the statistical areas with higher proportions of children identified as developmentally vulnerable on one or more AEDI domains included Cunnamulla, Clifton and Kingaroy North. The statistical areas with lower childhood immunisation rates included Cunnamulla, Kingaroy North and Kingaroy South.

Section 3

Characteristics of the population The DDSWQ region is expected to experience significant population growth in the future Understanding the current characteristics and distribution of the population, and the expected change in these characteristics over time, will assist in the planning and funding of current and future health services. This section focuses on factors critical to understanding the population dynamics now and in the future in the region as a whole and, where data is available, at the community level.

3.1 Estimated resident population 2011 As at June 30, 2011, the estimated resident population (ERP â&#x20AC;&#x201C; see Technical Appendix Note 3.1) of the DDSWQ region was 292,312 persons, compared with 4,611,491 persons in Queensland. The region population represents 6.3% of the Queensland population, while the region represents 23.4% of the land area of the state.

Over 90% of the population live in the eastern one third of the region, with 53% of the population living in the communities immediately in and surrounding Toowoomba, the socio-economic focus for the region. The remaining 9.1% of the population live in the western two thirds of the region. The average density of the region is 0.72 people per km2, compared to a Queensland density of 2.66 people per km2. The most densely populated area is Toowoomba, at 172.85 people per km2. The rest of the region is much less densely populated. Within the region, two thirds of the population live in the 13 major towns identified on Map 3.1.

ESTIMATED RESIDENT POPULATION

MAP 3.1: ESTIMATED RESIDENT POPULATION 2011

SOURCE: Australian Bureau of Statistics, 2011, Regional Population Growth, Australia, 2011, cat no 3218.0.

3.2 Estimated non-resident population 2011-2012 The resource development area known as the Surat Basin currently straddles the statistical areas of Toowoomba, Oakey, Dalby, Chinchilla, Miles Roma and Millmerran (see Map 3.2 below). These areas have experienced the influx of significant number of non-residents, also called fly-in, fly-out and drive-in, drive-out workers. These workers are reported to be impacting on service provision (including health service provision) in the affected communities. This non-resident workforce not accounted for in the ABS Estimated Resident Population (ERP) data (Section 3.1). To estimate the non-resident workforce the Queensland Government Office of Economic and Statistical Research initiated an annual survey of the non-resident workforce in the Surat Basin in July 2011. The primary data sources were three surveys – the Survey of Accommodation Providers, the Resource Operations Employment Survey, and the Resource Projects Employment Survey. The survey was repeated in late June 2012.

ESTIMATED NON-RESIDENT POPULATION GROWTH 2011-2018 While only two years data are available, the data is significant. The Surat Basin’s non-resident workforce population nearly doubled over the year to June 2012, growing by 97 per cent. The growth in the Miles area was 126.8%, in the Chinchilla area 108.7%, in the Dalby area 92% and in the Roma area 80.1%. In addition, the non-residential workforce population, as a percentage of the Statistical area population, doubled in the 12 months from June 30, 2011 to June 30, 2012 in all areas.

ESTIMATED NON-RESIDENT POPULATION 2011-2012 The DDSWQ region had a total non-resident Surat Basin workforce of 6,450 as at June 30, 2012. The Western Downs LGA area (Chinchilla, Miles and Dalby) had the largest nonresident workforce population, with two-thirds (65%) of the regional total. The Maranoa LGA (Roma) region accounted for 32% with the remaining 3% in Toowoomba Local Government area. While the Surat Basin’s 2012 non-resident work force population represented only 2.2% of the total population, in these four statistical areas the non-resident work force population represented a significantly higher percentage of the population, ranging from 8.3% in Dalby, to 15.4% in Roma, 22.9% in Chinchilla and 27.2% in Miles.

MAP 3.2: SURAT BASIN RESOURCE DEVELOPMENT ZONE

SOURCES: Surat Basin Population Report, 2011, Office of Economic and Statistical Research, Queensland Treasury and Trade Surat Basin Population Report, 2012, Office of Economic and Statistical Research, Queensland Treasury and Trade

3.3 Population distribution by age group and gender The population pyramid for the DDSWQ region based on the 2011 Census data (Table 3.3a) can be described as a stationary, or near stationary pyramid, displaying somewhat equal percentages (range for almost all age groups, with smaller percentages at the oldest age groups (see Technical Appendix Note 3.3 for more information on the interpretation of age pyramids).

INDIGENOUS AND NONINDIGENOUS POPULATION DISTRIBUTION BY AGE GROUP AND GENDER 2011

Symmetry: The region pyramid is generally symmetrical, with more females at age ranges above 75 which indicates that women are living to older ages than males. There are also slightly more males than females in the 20-24 and 60-64 age groups.

In this region, at the time of the 2011 Census, 40.8% of the Indigenous population were aged 14 years or younger, compared with 20.8% of the non-Indigenous population. Of the total Indigenous population, 3.5% were aged 65 years or over, compared with 16.3% for the non-Indigenous population.

Bumps: The bump in the sides of the region pyramid for the 35-64 age groups reflects the post World War 2 baby boom. This â&#x20AC;&#x2DC;bumpâ&#x20AC;&#x2122; will travel upwards as this cohort ages.

POPULATION DISTRIBUTION

The population pyramid for the DDSWQ region based on the 2011 Census data and Indigenous/non-Indigenous status (Table 3.3b) highlights a significant skew in the Indigenous demographics when compared to the non-Indigenous data.

Base width: The width of the base of the region pyramid reflects the current fertility rate for the region, which at 2.27 is above the current replacement rate of 2.1.

GRAPH 3.3a: POPULATION DISTRIBUTION BY AGE GROUP AND GENDER (2011) SOURCES: Table 3.3a: ABS, Population by Age and Sex, Regions of Australia, 2011, cat. no. 3235.0. Table 3.3b: Australian Bureau of Statistics, Census of Population and Housing, 2011 Indigenous Profiles. Table 3.3c: Compiled by PHIDU from ABS Population Projections, 2010, 2015, 2020 and 2025; Customised Population Projections for Statistical Local Areas prepared for the Australian Government Department of Health and Ageing by the Australian Bureau of Statistics.

POPULATION DISTRIBUTION BY AGE GROUP 2010 AND 2025 The population pyramid for the DDSWQ region based on the estimated 2010 population and the expected 2025 population (Table 3.3c) highlights a significant skew in the age profile, with lower percentages in the 2025 younger age groups and higher percentages in older age groups compared to 2010.

3.4 Births, birth rate and fertility rate 2011 A countryâ&#x20AC;&#x2122;s birth and fertility rates (See Technical Appendix Note 3.4) are a measure of the ability of a nation to reproduce itself and sustain population growth. A regionâ&#x20AC;&#x2122;s birth and fertility rates also inform the planning of perinatal, birthing and post natal services, as well as primary health care services related to pregnancy and birthing, in that region.

BIRTH RATE In 2011, 4,371 babies were born in the DDSWQ region. This represents a birth rate of 15.0 births per 1,000 population. By comparison, the Queensland birth rate for 2011 was 14.4 births per 1,000 population and the national birth rate was 13.5 births per 1,000 population. Within the region, the birth rate ranged from 20.0 births per 1,000 population in the St George statistical area to 11.3 births per 1,000 population in the Kingaroy statistical area. It should be noted that the number of births recorded for each statistical area is based on the place of birth as recorded on birth registration records.

FERTILITY RATE In 2011, the regionâ&#x20AC;&#x2122;s total fertility rate (TFR) was 2.27 babies per woman, higher than both the national TFR of 1.88 babies per woman and the Queensland TFR of 2.08 babies per woman. Within the region, the fertility rate ranged from 3.66 in the Oakey statistical area to 1.76 in the Thargomindah statistical area.

MAP 3.4: BIRTH RATE. The statistical areas in the map with higher birth rates have darker shading than areas with lower rates.

SOURCE: Australian Bureau of Statistics, Births, Australia, 2011, cat no 3301.0.

3.5 Gender profiles 2011 In the DDSWQ region males represented 49.4% of the population and females represented 50.6% as at June 30, 2011. Generally, communities to the east of the region have more females than males while communities to the west of the region have more males than females.

3.5 Gender profiles

MALE FEMALE

49.8%

49.6%

49.4%

50.2%

50.4%

50.6%

AUST

QLD

DDSWQ

The proportion of the population that was males was lower in the region than in both QLD and Australia.

MAP 3.5: GENDER PROFILES. The statistical areas in the map with higher percentages of male population have darker blue shading than areas with lower percentages, while the statistical areas with higher percentages of female population have darker pink shading than areas with lower percentages. Statistical areas where the male/female distribution is equal are shard white.

SOURCE: ABS Population by Age and Sex, Regions of Australia, 2011, unpublished data.

3.6 Aboriginal and Torres Strait Islander population profiles 2011 As at June 30, 2011, the DDSWQ region had 13,865 persons who stated they were of Aboriginal and/or Torres Strait Islander origin. Indigenous persons made up 4.7% of the total population (compared with 3.6% in Queensland). Nine of the 22 statistical areas in the region have an identified Aboriginal and/ or Torres Strait Islander population above

the Medicare Local average. Cherbourg, an Aboriginal Shire Council located in the Kingaroy North statistical area, has the highest identified population percentage at 93.7% of the population, which contributes to the overall high ranking of the Kingaroy North statistical area in the graph and map. The population figures in the table and graph do not include 600 Aboriginal and/ or Torres Strait Islander people living over the border in Boggabilla, Toomelah and Mungindi NSW, who regularly access health and other services in the Goondiwindi and St George/Roma areas. If these numbers are added to the relevant statistical area numbers the Goondiwindi area ranking rises three places to 9.4% of the statistical area population, the ranking for St George and Roma do not change.

3.6 Aboriginal and Torres Strait Islander population profiles

2.5% AUST

3.6% QLD

4.7%

DDSWQ

More people in the region identified as Aboriginal and/or Torres Strait Islanders than in both QLD and Australia.

MAP 3.6: ABORIGINAL AND TORRES STRAIT ISLANDER POPULATION PROFILES. The statistical areas in the map with higher percentages of the population who identified as Aboriginal and/or Torres Strait Islander have darker shading than areas with lower percentages.

SOURCES: Queensland Regional Profiles, Office of Economic and Statistical Research, Queensland Treasury and Trade, 2011. Centre for Epidemiology and Evidence, Health Statistics New South Wales, Sydney, NSW Ministry of Health, 2011.

3.7 Culturally and linguistically diverse population profiles 2011 The ABS provides a number of datasets relating to cultural and linguistic diversity. Two of these indicators, the number of people born in a non-English country and the number of people who state they speak a language other than English at home and not very well or at all are used in this report, on the assumption that people so identified may experience challenges

when accessing health care services due to a language barrier. As at June 30, 2011, the DDSWQ region had 12,360 persons who stated that they were born in a non-English speaking country (4.2% of the total population). Of these people, 8,644 persons (70% of the overseas-born population) stated that they spoke a language other than English at home and not well or at all, and therefore may experience challenges when accessing health care. In Queensland, 9.8% of the population stated they spoke a language other than English at home and not very well or at all. Four of the 22 statistical areas in the region have an identified non-English speaking population above the regional average.

3.7 Culturally and linguistically diverse popultion profiles

14.7%

9.8%

MAP 3.7: CALD POPULATION PROFILES. The statistical areas in the map with higher percentages of the population who stated that they spoke a language other than English at home have darker shading than areas with lower rates percentages.

SOURCE: ABS: Census of Population and Housing, 2011, Basic Community Profiles - B09 and B11.

AUST

QLD

3.0% DDSWQ

Less people in the region use English as a 2nd lanhuage than in both QLD and Australia.

3.8 People with a disability 2011 The number of people living in a community and identified as having a disability is measured in this report by the ‘Core Activity Need for Assistance’ variable developed by the Australian Bureau of Statistics (ABS) for use in the five-yearly population Census (see Technical Appendix Note 3.8 for more details). The ABS figures used in this report include people of all ages living care (“Number in Care” - in long-term residential accommodation in nursing homes,

accommodation for the retired or aged, hostels for the disabled and psychiatric hospitals) and in the community (“Number in Comm”). Details of the number of people with a moderate or mild disability are not included. As at June 30, 2011, the number of people identified as in need of assistance in the DDSWQ region was 27,889, representing 9.5% of the population. In comparison, the percentage of the Queensland population identified as in need of assistance was 8.4% while the Australian percentage was 8.5%. Within the region, the statistical areas with the higher percentage of the population identified as in need of assistance were Kingaroy South (18.9%), Tara (16.1%), Crows Nest (14.1%) and Oakey (14%). Nine statistical areas had a percentage of the population identified as in need of assistance that was above the Medicare Local average of 9.5%, and 13 were above the Queensland and Australian averages of 8.4% and 8.5% respectively.

3.8 People with a disability

8.5%

8.4%

9.5%

AUST

QLD

DDSWQ

More people were identified as having a disability in the region than in both QLD and Australia.

MAP 3.8: PEOPLE WITH A DISABILITY. The statistical areas in the map with higher percentages of the population who identified as in need of assistance have darker shading than areas with lower percentages

3.9 Expected population growth within the region 2011-2031 Projecting the future population of a community is a key dataset for planning purposes, and the Queensland Government (OESR) published in 2011 population projections for the state for the 2011-2031 period based on the best available information at the time of publication.

ERP data for regions for the 2016-2031 period.

3.9 Expected population growth 2011-2031

In this report, the DDSWQ Medicare Local uses the revised June 30, 2011 ERP data for the estimated 2011 QLD DDSWQ population and the originally published ERP data for The report includes three projection series 2016-2031 projections. The – a low series (resulting from assuming low projections will be updated 1996 2001 2006 2011 2016 2021 2026 2031 rates of natural increase and migration), a (slightly downwards) when The region is projected to be on the cusp of a significant medium series and a high series (resulting the ABS releases revised period of population growth, at an annual rate of around 2%, twice the annual growth rate for the region. from higher growth assumptions). The low data, and therefore should and high series projections form upper and be treated as indicative only lower limits of likely population futures, until the revision has been years and a 10.4% growth over the next however this report uses the medium published. five years. series data only. Also, the projects do not Population growth projections regionally Traditionally, regional, rural and remote include non-resident workforce numbers regions experience less growth when With this proviso, the population of the from Surat Basin resource development compared to larger urban and coastal region is projected to be 418,379 at June activity. 2031, representing 43.1% growth over the regions. For example the estimated growth The ABS has since revised the baseline for the region from 1996 to 2011 was 15.4% next 20 years. The growth over the next 2011 Estimated Resident Population (ERP) five years (2011-2016) is projected to be compared to a state growth of 38.1% for the data used in the state report, resulting in same 15 year period. 9.8%, with a population of 329,896 by not insignificant population reductions for June 2016. However, over the next five years, the the 2011 ERP for all statistical areas in the This compares to a projected Queensland projected growth for the region (9.8%) will DDSWQ region. However, to date, neither almost match the projected growth for population of 6.6 million in June 2031, OESR or the ABS have released revised representing 43% growth over the next 20 the state (10.4%) and over the next 20 years the projected growth for the region (43.1%) will match the projected growth for the state (43.0%).

WHAT THIS MEANS REGIONALLY The region is projected to be on the cusp of a significant period of population growth, with the regional population growing at an annual rate of almost 2% per annum over the next five years and an annual growth rate of over 2% over the next 20 years. Previously the region has experienced annual growth of around 1%. There is evidence that strong population growth of around 2% a year can lead to a decline in the quality of life. Health issues cited include increases in the prevalence of mental health and lifestyle related chronic diseases diagnoses.

SOURCE: Queensland Government population projections to 2031: local government areas, 2011 edition, Office of Economic and Statistical Research, Queensland Treasury. This report makes the following statement that is equally applicable to this population projections used in this report: “The population projections have been prepared using the best methodology, expert advice and much care; nevertheless, actual outcomes cannot be predicted with precise accuracy. Projected population figures are not forecasts. If migration patterns, life expectancy or fertility differ from what has been assumed, the future population will vary from these projected figures. Projections should be used with caution, but are an essential input when planning for infrastructure and services at a range of geographical levels.”

Within the DDSWQ region, the projected population growth over the next 20 years is not evenly distributed. Generally, the further west one goes, the lower the projected population growth, with three of the four most western statistical areas projected to experience a population decline over the next 20 years. As at June 30, 2011, 53.0% of the population lived in the Toowoomba Regional Council area, 37.9% lived in the surrounding local government areas of South Burnett, Western Downs, Goondiwindi and Southern Downs, and 9.1% lived in the six most western local government areas. By June 2031, the population will be even more concentrated towards the east, with 58.4% of the population living in the

POPULATION DISTRIBUTION JUNE 2011

POPULATION DISTRIBUTION JUNE 2031

Toowoomba Regional Council area, 34.2% living in the surrounding local government areas and 7.4% living in the most western local government areas. The statistical areas projected to experience the most growth over the next 20 years in terms of both the number of people and the rate of growth are Crows Nest (with a projected growth of almost 80% over the next 20 years), Toowoomba (50%), Pittsworth (49%) and Miles (45%). The statistical areas projected to experience the most growth over the next five years in terms of both the number of people and the rate of growth are Crows Nest (with a projected growth of almost 25% over the next 5 years), Miles (20%), Millmerran (17.5%) and Pittsworth (17.3%). The statistical areas projected to experience a population decline over the next 20 years are Thargomindah (-13%), Cunnamulla (-7%) and Quilpie (-3%). These communities are also projected to experience a decline in population over the next five years, with Thargomindah projected to

experience a population decline of almost 15%.

MAP 3.9: EXPECTED POPULATION GROWTH 2011-2031. The statistical areas in the map with higher percentages of population growth have darker shading than areas with lower percentages.

SOURCE: Queensland Government population projections to 2031: local government areas, 2011 edition, Office of Economic and Statistical Research, Queensland Treasury.

3.10 Median age profiles 2011-2031 The population of the DDSWQ region, like that of the rest of Australia and the world, is ageing due to declining fertility rates and increasing life expectancy. The World Health Organisation recommends all health systems be prepared to address the needs of older people at the community level. It is paramount that primary health care workers are well versed in the diagnosis and management of the so called “four giants” of geriatrics (memory loss, urinary incontinence, depression and falls/ immobility) as well as the chronic diseases that are common in later life and that can often be prevented or delayed. As people age, they become more vulnerable to ill-health and become more dependent on government benefits. As the population aged 65 years and over increases in size and proportion, associated social expenditures on income support, care and health services can be expected to increase. One of the most significant changes to the demograhic profile of the region over time is the estimated change in the population’s median age, defined as the age which divides the population into two equal parts, half falling below the value and half exceeding it.

MEDIAN AGE 2011 As at June 30, 2011, the median age of the population in the statistical areas within the region ranged from 35.1 in Kingaroy to 47.1 in Kingaroy South. In comparison the median age of the Queensland population as at June 30, 2011 was 36.6. The median age in 14 statistical areas in the region was above the state median age. At the time of the last census (2006), the median age of the population in the statistical areas within the region ranged from 33.8 in St George to 44.3 in Kingaroy South. In comparison, the median age of the Queensland population as at June 30, 2006 was 36.0.

MEDIAN AGE CHANGE 2006-2011 Seventeen of the 22 statistical areas in the region recorded an increase in the median age from 2006 to 2011. The range of this change was from an increase in the median age of almost four years in Stanthorpe to a decrease of three years in the median age for Chinchilla.

MEDIAN AGE CHANGE 2011-2031 While no data is currently available on the projected change in median age for statistical areas within the region or the region as a whole, the Queensland median age is expected to increase from 36.6 years to 38 years by 2021, reaching 40 years by 2031. All but one local government area in Queensland can expect an increase in their population’s median age, and the median age for the Darling Downs South West Regionalisation Strategy Area (not the same region as the Medicare Local region) has been projected to be 41.0 in 2031.

In total, the median age of all Queensland Indigenous communities was 24 years in 2006 (12 years younger than the total Queensland population median age of 36 years). The median age of the population in the Indigenous communities is projected to increase slightly to 25 years in 2031. The median age for the Cherbourge Aboriginal Shire Counmcil community in June 2006 was 20.2, and in June 2011, it was 21.9, a 1.7 years increase.

INDIGENOUS MEDIAN AGE Indigenous populations have young age profiles, with a high proportion of children and low proportion of elderly compared with the Queensland average. This age structure reflects the higher fertility and lower life expectancy of the Indigenous population.

SOURCES: Queensland Government population projections to 2031: local government areas, 2011 edition, Office of Economic and Statistical Research, Queensland Treasury. Queensland Regional Profile for DDSWQLM LGA Overview Region, Government Statistician, Queensland Treasury and Trade.

3.11 Baby and young children population change 2010-2025 One sector of the changing population profile is the percentage of the population aged between 0 and 4 years old and the expected distribution of this demographic within the DDSWQ region.

In 2015, the percentage of the population aged between 0 and 4 years old is expected to be 6.7%. This compares to a Queensland percentage of 6.6% and a national percentage of 6.3%.

In June 2010 the percentage of the regionâ&#x20AC;&#x2122;s population aged between 0 and 4 years old was estimated to be 7.0%. Over the next 15 years the percentage is projected to drop steadily to 6.2% in 2025.

Within the region, the statistical areas with the highest percentage of the population aged between 0 and 4 years old in 2015 are projected to be St George, Dalby, Roma, Goondiwindi and Cunnamulla. The statistical areas with the lowest percentage of the population aged between 0 and 4 years old in 2015 are projected to be Stanthorpe, Kingaroy South, Thargomindah and Quilpie.

3.11 Population change 2010-25 Babies and young children

MAP 3.11: BABIES AND YOUR CHILDREN POPULATION CHANGE 2010-2025. The statistical areas in the map with higher percentages of population aged between 0 and 4 years old in 2015 have darker shading than areas with lower percentages.

6.3%

6.6%

6.7%

AUST

QLD

DDSWQ

The proportion of the population aged between 0-4 in 2015 is projected to be higher in the region than in both QLD and Australia.

SOURCE: Compiled by PHIDU from ABS Population Projections, 2010, 2015, 2020 and 2025; Customised Population Projections for Statistical Local Areas prepared for the Australian Government Department of Health and Ageing by the Australian Bureau of Statistics.

3.12 Teenager population change 2010-2025 One sector of the changing population profile is the percentage of the population aged between 10 and 19, and the expected distribution of this demographic within the DDSWQ region.

In 2015, the percentage of the population aged between 10 and 19 years old is expected to be 13.8%. This compares to a Queensland percentage of 12.9% and a national percentage of 12.3%.

In June 2010 the percentage of the regionâ&#x20AC;&#x2122;s population aged between 10 and 19 years old was estimated to be 14.6%. Over the next 15 years the percentage is projected to drop steadily to 13.4% in 2025.

Within the region, the statistical areas with the highest percentage of the population aged between 10 and 19 years old in 2015 are projected to be Oakey, Crows Nest, Pittsworth and Dalby. The statistical areas with the lowest percentage of the population aged between 10 and 19 years old in 2015 are projected to be Cunnamulla, Thargomindah and Quilpie.

3.12 Population change 2010-25 Teenagers

MAP 3.12: TEENAGER POPULATION CHANGE 2010-2025. The statistical areas in the map with higher percentages of population aged between 10 and 19 years old in 2015 have darker shading than areas with lower percentages.

12.3%

12.9%

AUST

QLD

13.8% DDSWQ

The proportion of the population aged between 10-19 in 2015 is projected to be higher in the region than in both QLD and Australia.

3.13 Aged population change 2010-2025 One sector of the changing population profile is the percentage of the population aged over 65, and the expected distribution of this demographic within the DDSWQ region.

the population aged 15 and under in 2010 was 21.5% and by 2025 the percentage is expected to be only 19.7%.

In 2015, the percentage of the population aged 65 and over is expected to be 16.4%. As at June 30, 2010, the percentage of the This compares to a Queensland percentage population aged 65 and over was 15%. The of 14.3% and a national percentage of percentage of the population aged 65 and 15.1%. over is expected to increase to 19.6% in Within the Medicare Local, the statistical 2025. At the same time, the percentage of areas with the higher percentage of the population aged 65 and over in 2015 is expected to be Kingaroy South, Stanthorpe, Clifton and Kingaroy North. Ten statistical areas are expected to have a percentage of the population aged 65 and over above the Regionl average of 16.4%, and 17 are expected to be above the Queensland average.

3.13 Population change 2010-25 Aged 65 and over

MAP 3.13: AGED POPULATION CHANGE 2010-2025. The statistical areas in the map with higher percentages of the population expected to be aged 65 and over in 2015 have darker shading than areas with lower percentages.

15.1%

14.3%

AUST

QLD

16.4%

DDSWQ

The proportion of the population aged 65 and over in 2015 is projected to be higher in the region than in both QLD and Australia.

Section 4

Environmental Factors Geography is the study of the physical characteristics of an area, itâ&#x20AC;&#x2122;s significant features and the effects of those features on human activity. Typically, geographic data include profiles on the terrain, climate, land use and industry of a region. Geography data provides a holistic view of a region, allowing us to make sense of complex issues such as climate change, drought, ageing populations, urban growth, ethnic conflicts and globalisation.

Geography is the study of the physical characteristics of an area, it’s significant features and the effects of those features on human activity. Typically, geographic data include profiles on the terrain, climate, land use and industry of a region. Geography data provides a holistic view of a region, allowing us to make sense of complex issues such as climate change, drought, ageing populations, urban growth, ethnic conflicts and globalisation. A number of national and state government departments are responsible for collecting, analysing and publishing geographic datasets and in this regional health atlas data has been sourced from: • the Australian Bureau of Meteorology (BOM); • the Australian Department of Sustainability, Environment, Water, Population and Communities (DSEWPC),; • the Queensland Department of Natural Resources & Mines (DNR); • the Australian Bureau of Statistics(ABS); and • the Queensland Office of Economic and Statistical Research (OESR).

4.1 Terrain The DDSWQ region lies west of the Great Dividing Range and the narrow coastal strip which contains most of the state population. The typography of the region can be described as broad relatively lowrelief grassland plains built on quite fertile, though generally heavy in texture soil with a strong tendency to crack due to the erratic rainfall. The region is bounded on the eastern boundary by the more lush vegetation of the Great Dividing Range and by the dry inland desert and channel country to the west. The region is transversed in the generally north to south direction by a number of significant waterways and many smaller rivers and creeks that form part of the

MAP 4.1: DDSWQ TERRAIN MAP

Murray Darling River and Lake Eyre Basin systems. The northern tributaries of the Murray River in the region include the Maranoa River, Warrego River and Condamine River. Rivers of the Lake Eyre Basin include Coopers Creek. There is an absence of any large natural lakes in the region, and urban water supplies are generated by river weirs, or in the case of Toowoomba, the Southern Downs and the South Burnett, a number of small to medium sized dams. The flow of the rivers and creeks in the far western region depends on monsoonal rains falling months earlier and many hundreds of kilometres away in northern and eastern Queensland. This combination

of low, highly variable rates of rainfall together with very high evaporation rates means the waterways in this region are reduced to a series of drying ponds during droughts. Many of the regions towns are located on relatively flat land on the banks of rivers. During severe floods numerous towns are inundated as flood waters rise. Levees have alleviated some minor flooding but after prolonged periods of heavy rainfall the sheer volume of flood waters cannot be held back. Disruptions from flooding have become accepted in inland towns like Charleville, Mitchell, Roma, St George and even Goondiwindi, Chinchilla and Dalby (see Section 3.6 Climate change).

4.2 Rurality All of the DDSWQ region is within Remoteness Classifications RA2 (Inner Regional), to RA5 (Very Remote). No part of the region is within the Remoteness Classification RA1 (Major Cities). Generally speaking, the further west one travels, the more remote the classification. Geographically, more than half of the region

is classified as RA5, Very Remote, with all but parts of 8 out of the 22 statistical areas classified as RA5, RA4 or RA3 .From a population perspective 71.2% of the population resides in the RA2 classification, 20.7% in RA3 with the remaining 8.1% in classifications RA4 and RA5.

MAP 4.2: DDSWQ RURALITY MAP

SOURCE: ASGC Remoteness Structure, ABS 2006, 2nd Edition. The population based percentage split of RA for each ML was sourced from the Department of Health and Ageing and derived from the overlay with ABS Estimated Resident Population (ERP 2010) by ABS ASGC Statistical Local Areas (SLA 2010).

4.3 Land use The DDSWQ region land use pattern ranges from intense cropping and dairy farming in the east, to sheep and wheat farming on the Darling Downs and to cattle farming on natural grasslands in the south west. In the â&#x20AC;&#x2DC;haydayâ&#x20AC;&#x2122; of the sheep, cattle and wheat industries the region was considered to be a major contributor to the national economy, More recently the introduction of irrigation has changed the land use of the Darling Downs to include cotton production, particularly in the Goondiwindi and Dalby regions.

MAP 4.3: DDSWQ LAND USE MAP

SOURCE: Department of Sustainability, Environment, Water, Population and Communities, 2012

Agriculture is still a major industry in the region (see Section 4.5: Major Industries). The exploration for mineral and energy resources, the establishment of extraction, processing and transporting infrastructure, and the relative long term plans for the resource industry in the region have had significant impact on liveability and workforce sustainability across most of the region (see Section 4:11: Resource Development).

4.4 Transport Road travel: The DDSWQ region is well serviced by national highways that transverse the region in both east-west and northsouth directions, however significantly increased traffic flows on the region’s roads, due to resource development, are impacting both travel times and accidents. Toowoomba acts as the major transport hub which restricts the region interconnecting and currently acts as a ‘choke point’ for

the region. A second Range Crossing is desperately needed to bring efficiencies to the transport network. Roma, St George, Goondiwindi, Warwick, Stanthorpe, Miles and Charleville are secondary transport hubs within the region which are important for the region in relation to tourism, freight and produce movement, transport movements and service delivery.

MAP 4.4a: DDSWQ ROAD TRAVEL MAP

Rail travel: Passenger rail services between Brisbane and Charleville run twice weekly. Freight, cattle, grain and coal are also hauled by rail, with coal now the major commodity carried by rail

throughout the region. This is impacting on the agricultural and livestock transport systems, putting pressure on road transport as mentioned above.

MAP 4.4b: DDSWQ RAIL TRAVEL MAP

Local bus travel: Toowoomba is the only urban centre with a regular week day public bus service. In the South Burnett and on the Southern Downs limited public transport is available, but not every day. Across the region school bus services also operate, but legislation and operating guidelines prevent school bus services

being used for general or patient transport purposes. Attempts to gain transport synergies by using school bus infrastructure and resources in non-peak times have proven to be logistically impossible.

Regional bus travel: Interstate and regional bus services operate throughout the major towns in the region. Toowoomba is a major transit point for most of these services. However travel

times are generally during the unsociable hours and unsuitable for patient transport.

MAP 4.4c: DDSWQ BUS TRAVEL MAP

Air travel: Toowoomba airport has been recently upgraded but is only suitable for smaller aircraft. Passenger flights service some communities, although daily return flights are limited and can make air travel inconvenient and require an overnight stay.

Toowoomba and Sydney was commences in 2012 and in 2013 it is expected that Toowoomba and Roma will be linked by a daily return service, reducing the travel time between these two major regional centres from 4-5 hours to less than an hour.

Multiple daily flights between Brisbane and Roma are well patronised by non-resident workers, a regular service between

Other smaller airstrips in the region provide access for the Royal Flying Doctor Service and charter services.

MAP 4.4d: DDSWQ AIR TRAVEL MAP

Transport Subsidies and Assistance: A limited range of transport subsidies and assistance with the cost of transport for disadvantaged people is available in the region. Options include the Taxi Subsidy Scheme (TSS) which subsidises taxi travel for people with severe disabilities; the Patient Travel Subsidy Scheme (PTSS) which subsidises transport and accommodation costs for specialist medical services not available locally; Community Transport, available to help people with

a disability travel for shopping, social activities, and medical appointments; and non-emergency medical transport through Queensland Ambulance. All of these options have eligibility criteria and processes to be followed before accessing. Patient transport has been identified as a need is all communities in the region and the DDSWQ Medicare Local has initiated the Regional Patient Transport Network to develop community collaboration on addressing the issue.

4.5 Major industry employers As at June 30, 2011, just over 120,000 people worked in the DDSWQ region, including 6,445 non-resident workers. This represents 39.5% of the total population (not including nonresident workers). The region is home to some of the best farming country in Australia and traditionally farming and its related industries (manufacturing and transport) have been the major employers. However the 2011 census data show that health and social care and retail workers now represent the largest employment groups, followed by farming, education and training, manufacturing and mining and exploration. These six major industries in the region account for 59.2% of the workers in the region.

SOURCE: REMPLAN data incorporating Australia Bureau of Statisticsâ&#x20AC;&#x2122; (ABS) June 2011 data. ABS data does not include non-residential workforce data (FIFO/DIDO), however the table does include this data, from the Queensland Treasury & Trade Surat Basin Population Report, 2012. The data represents the number of people registered at the 2011 census as residents employed by businesses / organisations in each of the industry sectors in each LGA and the region as a whole, and represents total numbers of employees without any conversions to full-time equivalence.

4.6 Climate The Australian Bureau of Meteorology classifies the climate of a region using three different schemes - temperature/humidity, vegetation (Köppen) and seasonal rainfall. Almost all of the DDSWQ region is classified as “hot dry summer and cold winter” under the temperature/humidity scheme or “wet summer & low winter rainfall” under the seasonal rainfall scheme.

The Köppen classification scheme is based on the concept that native vegetation is the best expression of climate in an area. Based on this scheme, the climate of the region can be described as temperate with no dry season in the east of the region, subtropical with no dry season or a dry winter on the Darling Downs, hot persistently dry grassland in the south west and hot persistently dry desert in the far south west.

MAP 4.6: DDSWQ CLIMATE MAP

4.7 Temperature The average monthly indoor apparent temperature over the period 1976 to 2005 was 90C-180C in winter and 240C-330C in summer. (Indoor apparent temperature describes the combined

MAP 4.7a: DDSWQ MAXIMUM TEMPERATURE MAP

effect of temperature and humidity and is an estimation of what the temperature “feels like” to an appropriately dressed adult.)

MAP 4.7b: DDSWQ MINIMUM TEMPERATURE MAP

4.8 Rainfall The 30 year average rainfall, over the period 1976 to 2005, ranged from 600ml in the east of the region to 0ml in the far west. The average number of days with rainfall in excess of 25ml, over the

MAP 4.8: DDSWQ RAINFALL MAP

period 1971 to 2000 ranged from 2 days per annum in the far south west to 10 days per annum in the east.

4.9 UV Index The average UV Index for the region, for the period 1979-2007, in summer was extreme (12-13) and in winter, moderate (4-5). The UV Index provides a simple measure of the potential for skin

MAP 4.9a: DDSWQ SUMMER U V INDEX MAP

MAP 4.9b: DDSWQ WINTER UV INDEX MAP

damage. Values range from 0 to 14. Protective measures need to be taken for UV Index values of 3 or above.

4.10 Climate change Like the rest of Australia, the DDSWQ region has been experiencing significant â&#x20AC;&#x153;extreme weather eventsâ&#x20AC;? over recent years. Extreme weather events resulting from climate change include cycles of intense drought and flooding (change in rainfall patterns), unpredictable weather, increased temperatures (in particular the daily minimum temperatures), heat waves, more frequent storm activity and increased carbon dioxide and ozone concentration at ground level (less significant in regional and rural regions when compared to urban areas). Health effects associated with climate change include heat related morbidity and mortality (particularly in the elderly and people with existing chronic disease); exacerbation of asthma, allergies or respiratory disease; vector borne disease (such as malaria and Ross River virus); climate sensitive infectious disease (such as salmonella related infections); loss of life due to flooding or storm activities and an escalation of mental health issues. The most devastating extreme weather events in the region in recent years have been drought and flooding. Communities and statistical areas in the following LGAs were flood affected in the 2011 floods: Balonne, Cherbourg, Goondiwindi, Maranoa, Murweh, South Burnett, Southern Downs, Toowoomba and the Western Downs. Communities in Balonne, Maranoa, Murweh, Paroo, Toowoomba and the Western Downs and were also flooded in 2012. In Australia, floods are the most expensive type of extreme weather event. Until recently, the most costly year for floods in Australia was 1974, when floods affecting New South Wales, Victoria and Queensland resulted in a total cost of $2.9 billion. The Queensland Government estimates costs for the 2011 floods will exceed this figure for Queensland alone. From a primary health care perspective, the short term impacts of flooding in the region include potential deterioration of health conditions owing to waterborne diseases and sanitation infrastructure disruption and medicines supply issues due to transport infrastructure disruption. Longer term impacts include psychological distress leading to an escalation of mental health issues and significant delays in people (including residents of residential aged care facilities) returning to their communities after evacuation. In some cases, aged care residents have

been displaced for more than 12 months, relocated to a distant community facility, leading to complications with the coordination of primary health care treatment. The increasing frequency and severity of these events means it is vital the community develop strategies to ensure health services can be rapidly mobilised and effectively targeted during extreme weather events.

THE ROLE OF THE DDSWQ MEDICARE LOCAL DURING AND AFTER FLOODS 1. While local emergency services attend to the immediate and urgent health and safety needs of the community, the DDSWQ Medicare Locals has a role to ensure that residents needing non-urgent care can access local GPs and pharmacies and avoid unnecessary emergency department presentations at local hospitals. 2. Keeping the community informed on which local health services, specifically GP practices and pharmacies, are still functioning, utilising existing stakeholder networks, liaising with newspapers, radio, the internet and social media. 3. Supporting the evacuation of aged care residents, who may be moved to facilities outside of the Medicare Local region, by ensuring their medication needs are met through liaison with GPs and pharmacists. Experience shows that often residents are evacuated hastily without their medication lists. 4. Supporting GPs whose practices are inundated to establish triage and medical checks service at evacuation centres, giving emergency paramedic staff much needed support. 5. Supporting practices with Cold Chain management issues that might arise due to power outages and practice inundation. 6. Activating the Aboriginal and Torres Strait Islander health team to assess the health and wellbeing of indigenous clients at evacuation centres across town. 7. Deploying community-based psychologists to help residents, service providers and volunteers cope with the emotional toll of this crisis, both during and after the event.

MAP 4.10: FLOOD AFFECTED COMMUNITIES 2011-2012. The map shows that over the last two years flooding has been widespread across the region, with many communities being disrupted.

4.11 Resource development in the Surat Basin Experience in the Bowen Basin and other exploration and mining • decrease in land availability, and conflicts between different land regions of Australia show that rapid expansion of mining operations uses; results in significant environmental, social and economic impacts, • appropriate provision for and location of industrial lands to meet including cumulative impacts on local communities. These impacts regional industrial development needs; can include: • road safety impacts from increase in heavy and over• significant pressure on social infrastructure including housing; dimensional road traffic, and fatigued drive-in drive-out workers; education; social support services such as child care, health and care including mental health, domestic violence and youth • skills and labour shortages, for mining and agri-food operations, justice services; and community facilities including sport and as well as other businesses. recreation; There is compelling anecdotal evidence that all of these impacts • significant increased pressure on community members that are are already affecting communities in the Surat Basin, however, no socially excluded or at risk of social exclusion; research study has been published on the effect of the resource • changes in community dynamics due to dominance of single development in the Surat Basin on the health and community men and shift workers; service sector. • significant pressure on economic infrastructure such as roads, rail, power, water, and waste treatment;

MAP 4.11: SURAT BASIN OPERATIONS & DEVELOPMENT SEPTEMBER 2012. This map shows current and approved future coal, coal seam gas and mineral resource developments in the Surat Basin as at September 2012. The map shows that over 60 major projects are either in operation or scheduled for commissioning by 2020, valued at $180 billion, and creating an estimated 12,500 jobs.

SOURCES: Surat Basin Operations & Development September 2012 Map, QLD Govt, Department of Natural Resources & Mines, Sept 2012, MAP11 006 and Advance Western Downs, http://www.advancewesterndowns.com.au/major-projects.html

Section 5

Social Determinants of Health Health is not the same as an absense of illness. The houses we live in, the transport we are able to access, the level of stress in our lives, the job we have or donâ&#x20AC;&#x2122;t have, the social support we have around us and how much money weâ&#x20AC;&#x2122;ve got, have as much impact on our health and wellbeing as our genes and biomedical condition.

Health begins where we live, learn, work and play

5.1 Relative Socio-economic advantage and disadvantage 2011 The Australian Bureau of Statistics Census-based Socio-Economic Index of Relative Socio-economic Advantage and Disadvantage (IRSAD) is the most widely used general measure of socio-economic status in Australia (see Technical Appendix Note 5.1 for more details).

The IRSAD ranks areas in terms of relative socio-economic advantage and disadvantage. All SEIFA Indexes are standardised against a mean of 1000 which represents the Australian average, the lower the index for a region, the more disadvantaged the region. As at June 30, 2011, the Index of Relative Socio-economic Advantage and Disadvantage score (IRSAD) for the DDSWQ region was 961, compared to a Queensland score of 999. All statistical areas in the region have an IRSAD Index score below 1000, ranging from 862 (Kingaroy North) to 993 (Chinchilla). Thirteen statistical areas had a SEIFA IRSAD index score below the regional average.

5.1 Socio-economic index of advantage & disadvantage

1000

999

AUST

QLD

961 DDSWQ

The region was more socio-economically disadvantaged than both QLD and Australia.

MAP 5.1: RELATIVE SOCIO-ECONOMIC ADVANTAGE AND DISADVANTAGE 2011. The statistical areas in the map with higher SEIFA IRSAD scores have darker shading than areas with lower scores.

SOURCE: ABS Census: Socio-Economic Indexes for Areas (SEIFA), Australia, 2011, Statistical Area Level 2, Indexes and Local Government Area, Indexes. The index scores are based on an arbitrary numerical scale and do not represent a quantity of advantage or disadvantage. For example, we cannot say that Kingaroy North, with an index score of 862 is about 10% less advantaged than Charleville (with an index score of 947) even though the Kingaroy North index score is about 10% less than the Charleville index score.

5.2 Low income 2011 Low income is a well recognised determinant of social disadvantage, and low income has been strongly correlated to poor health outcomes. As healthy food becomes increasingly expensive families on low incomes struggle, often

compromising by buying less healthy, cheaper food to cut costs.

a low income population above the regional average.

As at June 30, 2011, the number of people living in the DDSWQ region who stated that their total personal weekly income was less than $400 was 83,844. This represents 36.6% of all persons aged 15 years and over living in the region. In comparison, the number of people in Queensland who stated that their total personal weekly income was less than $400 was 1,195,059, representing 34.6% of all persons aged 15 years and over living in the state. The equivalent national figure was 35.9%. Within the region, the percentage of the population aged 15 years and over on low incomes is higher than both the national and the state percentages. The statistical areas with the highest number of low income persons were Kingaroy South, Kingaroy North, Tara and Crows Nest,income with ten statistical areas with 5.2 Low

35.9%

AUST

34.6% QLD

36.6%

DDSWQ

More people in the region lived on a low income than in both QLD and Australia.

MAP 5.2: LOW INCOME 2011. The statistical areas in the map with higher percentage of low income persons have darker shading than areas with lower percentages.

SOURCE: Australian Bureau of Statistics, Census of Population and Housing, 2011, Basic Community Profile - B17.

5.3 High unemployment September 2012 The health effects of unemployment and the mechanisms by which unemployment causes adverse health outcomes are well researched, however the relationship between unemployment and health outcomes is complex: ill-health also causes unemployment, and confounding factors include socioeconomic status and lifestyle.

increasing mortality rates, causing physical and mental ill-health and greater use of health services.

A study undertaken by Queensland Health in 2002 found that people who were unemployed were 70% less likely to report good or very good quality of life or rate their health status as good, very good or Longitudinal studies with a range of designs excellent. People who were unemployed provide reasonably good evidence that were also 30% less likely to exhibit good unemployment itself is detrimental to health health behaviours in relation to nutrition, and has an impact on health outcomes physical activity levels and smoking. The number of unemployed persons aged 15 years and over (based on a smoothed series) in the DDSWQ region in the September 2012 quarter was 8,318. This represents an unemployment rate of 5.1% of the labour force in the region. In comparison, Queenslandâ&#x20AC;&#x2122;s unemployment rate (percentage of the labour force) for the same period was 5.6% and Australia had a rate of 5.4%. Within the region the statistical areas with the higher unemployment rate were Cunnamulla, Tara, Kingaroy North and Stanthorpe, all with rates of 8% or higher. Ten statistical areas in the region had an unemployment rate above the regional average.

5.3 Unemployment

5.7%

AUST

5.6%

QLD

5.1% DDSWQ

The unemployment rate in the region was lower than in QLD and Australia.

MAP 5.3: HIGH UNEMPLOYMENT 2011. The statistical areas in the map with higher percentage of low income persons have darker shading than areas with lower percentages.

SOURCE: DEEWR Australian Government, Small Area Labour Markets Australia, various editions and ABS Census 2011. Labour Force data represents the number of people working or registered with Centrelink as looking for work and has been derived from Census 2011 Small Area Labour Market data and Centrelink data. ABS advises that quarterly Labour Force data (especially for small populations) should be treated with extreme caution

5.4 Low education level 2011 The ability to access and use health information is a fundamental skill which allows people to make informed decisions and helps them to maintain their basic health. On a broader level, adequate levels of health literacy may help to reduce some

of the costs in the health system, prevent illness and chronic disease, and reduce the rates of accident and death. Health literacy affects not only a personâ&#x20AC;&#x2122;s involvement in the formal health care system, but also decisions they make in the home, workplace and community. The level of a personâ&#x20AC;&#x2122;s health literacy impacts on tasks such as reading dosage instructions on a package of medicine and also affects whether people seek screening or diagnostic tests. As at June 30, 2011, the number of people living in the DDSWQ region who stated that their highest level of schooling or education was Grade 8 or less was 22,578. This represents 9.9% of all persons aged 15 years and over living in the region. By comparison, the number of people in Queensland who stated that their highest level of schooling or education was Grade 8 or less was 219,102, representing 6.6% of all persons aged 15 years and over living in the state. National data is not available. Within the region all statistical areas have more persons with a low level of education than the QLD average. The statistical areas with the highest low education rates were Crows Nest, Cunnamulla, Kingaroy North and Tara. The regional average is 50% higher than the state average, and six of the statistical areas in the region have a rate that is more than twice the state average.

5.4 Education level

5.7% AUST

6.6% QLD

9.9%

DDSWQ

More people in the region left school at grade 8 or earlier than in both QLD and Australia.

MAP 5.4: LOW EDUCATION LEVELS 2011. The statistical areas in the map with higher percentage of adults who stated that their highest level of schooling or education was Grade 8 or less have darker shading than areas with higher percentages.

SOURCE: Australian Bureau of Statistics, Census of Population and Housing, 2011, Basic Community Profile - B16

5.5 People receiving government support 2010 This dataset measures the percentage of the population aged 18 years and over who had government support as their main source of income, for 12 months or more, within the past 24 months. The dataset is based on 2009-2010 data and is the latest available at the SA2 statistical area level for

the DDSWQ region, and is modelled data (see Technical Appendix Note 5.5 for more details). The percentage of the region population aged 18 years and over who had government support as their main source of income, for 12 months or more, within the past 24 months as at June 30, 2010 was estimated to be 24.3%. By comparison, the percentage of the Queensland population was estimated to be 22.4% and the percentage of the national population was estimated to be 21.8%. Within the region the percentage ranged from a high of 35.5% in Kingaroy South to a low of 19.2% in Crows Nest. Ten statistical areas within the region had a percentage above the regional average and only four statistical areas had a percentage below the national average.

5.5 Government support

24.3% 21.8% 22.4% AUST

QLD

DDSWQ

More people in the region received government support than in both QLD and Australia.

MAP 5.5: PEOPLE RECEIVING GOVERNMENT SUPPORT 2010. The statistical areas in the map with higher percentage of people in receipt of government support have darker shading than areas with lower percentages.

SOURCE: Social Health Atlas of Australia, Data by Medicare Locals (incl. Statistical Local Areas (SLAs - or part SLA), Metropolitan/ Country areas & States/ Territories), January 2013, Public Health Information Development Unit (PHIDU). Users of these modelled estimates should note that they do not represent data collected in administrative or other data sets. As such, they should be used with caution, and treated as indicative of the likely social dimensions present in an area with these demographic and socioeconomic characteristics.

5.7 Single parent families 2011 This dataset measures the percentage of households in the DDSWQ region that were single parent families as at the 2011 census.

By comparison, the percentage of Queensland single parent families was estimated to be 16.1% while the national average was 15.0%.

The percentage of single parent households Within the region the percentage ranged in the region was estimated to be 14.7%. from a high of 17.8% in Cunnamulla to a low of 7.0% in Thargomindah. Statistical areas with higher percentages included Cunnamulla, Quilpie, Kingaroy, Toowoomba, Kingaroy South and Kingaroy North. Statistical areas with low percentages included Thargomindah, Miles, Chinchilla, Crows Nest and Warwick. Seven statistical areas within the region had a percentage above the regional average.

5.7 Single parent families

15.0% AUST

16.1%

QLD

14.7% DDSWQ

There were less single parent families in the region than in both QLD and Australia.

MAP 5.7: SINGLE PARENT FAMILIES 2011. The statistical areas in the map with higher percentage of households that are single parent families have darker shading than areas with lower percentages.

SOURCE: Australian Bureau of Statistics, Census of Population and Housing, 2011, Basic Community Profile â&#x20AC;&#x201C; B25.

5.8 Dwellings with no vehicles 2011 This dataset measures the percentage of dwellings in the DDSWQ region with no motor vehicle as at the 2011 census. The percentage of dwellings with no vehicle in the region was estimated to be 16.6%.

By comparison, the percentage of Queensland dwellings with no vehicle was estimated to be 7.2% while the national average was 8.6%. Within the region the percentage ranged from a high of 10.0% in Quilpie to a low of 3.2% in Clifton. Statistical areas with higher percentages included Quilpie, Cunnamulla, Kingaroy North, Charleville and Toowoomba. Statistical areas with low percentages included Clifton Thargomindah, Oakey, Millmerran and Pittsworth. Seven statistical areas within the region had a percentage above the regional average.

5.8 Dwellings with no vehicle

8.6%

AUST

7.2%

6.6%

QLD

DDSWQ

There were less dwellings with no vehicle in the region than in both QLD and Australia.

MAP 5.8: DWELLINGS WITH NO VEHICLE 2011. The statistical areas in the map with higher percentage of dwellings with no motor vehicle have darker shading than areas with lower percentages.

SOURCE: Australian Bureau of Statistics, Census of Population and Housing, 2011, Basic Community Profile â&#x20AC;&#x201C; B29.

5.9 Volunteer profiles 2011 This dataset measures the percentage of people aged 15 years old and over in the DDSWQ region who volunteer as at the 2011 census. The percentage of people who volunteer in

the region was estimated to be 22.2%. By comparison, the percentage of Queenslanders who volunteer was estimated to be 18.7% while the national average was 15.8%. Within the region the percentage ranged from a high of 31.50% in Miles to a low of 18% in Kingaroy South. Statistical areas with higher percentages included Miles, Chinchilla, Quilpie, St George and Roma. Statistical areas with low percentages included Kingaroy South, Toowoomba, Oakey, Thargomindah and Kingaroy All 22 statistical areas within the region had a percentage above the national average and all but one statistical area has a percentage above the Queensland average.

5.9 People who volunteer

15.8% AUST

18.7% QLD

22.2%

DDSWQ

More people volunteer in the region than in QLD and Australia.

MAP 5.9: VOLUNTEER PROFILES 2011. The statistical areas in the map with higher percentage of people aged 15 and over who volunteer have darker shading than areas with lower percentages.

SOURCE: Australian Bureau of Statistics, Census of Population and Housing, 2011, Basic Community Profile â&#x20AC;&#x201C; B19.

Section 6

Access Factors Health services provision in regional areas is a challenge. Equity in health care service delivery implies that peopleâ&#x20AC;&#x2122;s access to or use of services is based on the need for those services. This is distinct from equality in service provision, where all individuals receive the same services regardless of their level of need. This section focuses on factors critical to accessing health services in the region as a whole and, where data is available, at the community level.

6.1 Self-reported difficulty accessing health services 2010 This dataset measures the percentage of the population aged 18 years and over who self reported difficulty accessing health services for one or more of three reasons: • d elayed medical consultation because they could not afford it;

• d elayed purchasing prescribed medication because they could not afford it; • o ften has difficulty getting to places because of a lack of transport. The dataset is based on 2009-2010 data and is the latest available at the SA2 statistical area level for the DDSWQ region, and is modelled data (see Technical Appendix Note 6.1 for more details). The percentage of people who self reported difficulty accessing health services in the region was estimated to be 37.3%. By comparison, the percentage of Queenslanders was estimated to be 31.6% while the national average was 29.7%. Within the region the percentage ranged from a high of 44.7% in Charleville to a low of 35.3% in Oakey. Statistical areas with higher percentages included Charleville, St George, Miles, Roma and Tara. Statistical areas with low percentages included Oakey, Crows Nest, Pittsworth, Clifton and Toowoomba. All 22 statistical areas within the region had a percentage above the national and Queensland averages.

MAP 6.1: SELF REPORTED DIFFICULTY ACCESSING HEALTH SERVICES 2010. The statistical areas in the map with higher percentage of people who reported difficulty accessing health services have darker shading than areas with lower rates.

SOURCE: Social Health Atlas of Australia, Data by Medicare Locals (incl. Statistical Local Areas (SLAs - or part SLA), Metropolitan/ Country areas & States/ Territories), January 2013, Public Health Information Development Unit (PHIDU). Users of these modelled estimates should note that they do not represent data collected in administrative or other data sets. As such, they should be used with caution, and treated as indicative of the likely social dimensions present in an area with these demographic and socioeconomic characteristics.

6.2 Our experience with primary health care 2010-2011 As a component of the national health reforms, the National Health Performance Authority (NPHA) was established in 2012 as an independent body to provide locally relevant and nationally consistent information on the performance of hospitals and other health care organisations. The NHPA second report Healthy Communities: Australians’ experience with primary health care in 2010–11 focused on indicators that relate to the experiences people have in accessing and receiving primary health care, with the results broken down into the 61 geographic areas that are covered by Medicare Locals.

NATIONAL COMPARISON The key findings from this report for the DDSWQ region tell us that the percentage of adults who visited a GP at least once in the preceding year varied across Medicare Local catchments nationally, from 88% to 71%. For the DDSWQ region the percentage was 78%. There was large variation in the annual number of visits to GPs per person. Annual visits were three times higher in some Medicare Local catchments than in others, ranging from 7.4 to 2.4 visits. For the DDSWQ region the average number of visits was 5.1.

There was also a large variation in the affordability of care between different Medicare Local populations, ranging from 15% to 3% across Medicare Local catchments nationally. For the DDSWQ region the percentage was 7%.

For most patients, experiences with GPs Nationally, the number of after-hours GP are positive, and most patients feel their attendances ranged from 0.79 attendances GP listened to them. The percentage of to 0.05. For the DDSWQ region the average patients who thought their GP always number of after-hours visits was0.18. or often listened carefully varied across Medicare Local catchments nationally, from The percentage of patients who had seen 96% to 83%. For the DDSWQ region the a GP in the preceding 12 months and who percentage was 88%. felt they waited longer than acceptable to get an appointment varied across Medicare PEER GROUP COMPARISON Local catchments nationally, from 28% to 8%. For the DDSWQ region the percentage As part of its work, the Authority used statistical methods to allow, for the first was 21%. time, Australians to make fair comparisons Most adults in Australia said they had between the populations for which access to a preferred GP, but again this Medicare Locals are responsible. varied across Medicare Local catchments, from 95% to 78%. For the DDSWQ region the percentage was 82%.

6.2 Adults who saw a GP

88% 71% AUST RANGE

81% REGIONAL PEER GROUP

78% DDSWQ

Less adults in the region visited a GP than in the regional peer group average.

To this end, each Medicare Local has been allocated to one of seven peer groups: three in metropolitan areas, two in regional areas, and two in rural areas. Medicare Locals in the same peer group are more similar to each other than to Medicare Locals in other peer groups in terms of socioeconomic status, remoteness and distance to hospitals. The DDSWQ Medicare Local has been allocate to the Regional 2 peer group, which is defined as mostly non-metro

6.2 Number of visits to a GP

7.4 2.4

AUST RANGE

5.2

5.1

REGIONAL PEER GROUP

DDSWQ

The number of GP visits per year in the region was

just below the regional peer group average. 6.2 GP waiting times

28% 8%

AUST RANGE

19%

21%

REGIONAL PEER GROUP

DDSWQ

One in five people believed they waited too long to see a GP in the region.

urban and regional areas, with middle socioeconomic status. When the DDSWQ region results are measured against the Regional 2 averages, the region scores are generally equal to or better than the peer group averages with the exception of the percentage of adults who say a GP in the previous year, which was 78% compared to 81% and the percentage who reported waiting too long for a GP appointment (21% versus 19%).

SOURCE: Healthy Communities: Australians’ experience with primary health care in 2010–11. The data in this report principally rely on experiences with primary health care as reported by 26,423 adults in the Australian Bureau of Statistics Patient Experience Survey 2010–11. In the survey, Australians were asked to recall their experiences with health services that occurred over the preceding year. It is important to note that these data were collected before Medicare Locals were set up.

6.3 Health concession cards 2009 This dataset measures the percentage of the population with either a Health Concession Card or a Pensioner Concession Card. The data is Centrelink card holdersâ&#x20AC;&#x2122; data provided at the Statistical Local Area (SLA) as at June 30, 2009. The percentage of people with health concession cards in the DDSWQ region was estimated to be 25.0%. By comparison, the percentage of Queenslanders was estimated to be 41.3% while the national average was 46.9%. Within the region the percentage ranged from a high of 41.1% in Tara to a low of 18.2% in Crows Nest. Statistical areas with higher percentages included Tara, Kingaroy South, Kingaroy North, Stanthorpe and Warwick. Statistical areas with low percentages included Crows Nest, Roma, Pittsworth, Goondiwindi and Dalby. All 22 statistical areas within the region had a percentage below the national and Queensland averages.

6.3 Health concession cards

46.9% 41.3% 25.0% MAP 6.3: HEALTH CONCESSIONS CARDS 2009. The statistical areas in the map with higher percentage of people with a health concession card have darker shading than areas with lower percentages.

AUST

QLD

DDSWQ

Less people in the region had a health concession card than in QLD and Australia.

SOURCE: Social Health Atlas of Australia, Data by Medicare Locals (incl. Statistical Local Areas (SLAs - or part SLA), Metropolitan/ Country areas & States/ Territories), January 2013, Public Health Information Development Unit (PHIDU). Compiled by PHIDU using data from Centrelink, as agent for the Department of Families, Housing, Community Services and Indigenous Affairs, June 2009; and ABS Estimated Resident Population, 30 June 2009.

6.4 Private health insurance 2007-2008 This dataset measures the percentage of the population aged 15 years and over who self reported having private health insurance. The dataset is based on 20072008 data and is the latest available at the SA2 statistical area level for the DDSWQ region, and is modelled data (see Technical Appendix Note 6.4 for more details). The percentage of people with health insurance in the region was estimated to be 39.2%. By comparison, the percentage of Queenslanders with health insurance was estimated to be 41.3% while the national average was 46.9%. Within the region the percentage ranged from a high of 60.4% in Crows Nest to a low of 20.4% in Tara. Statistical areas with higher percentages included Crows Nest, Oakey, Toowoomba, Pittsworth and Kingaroy. Statistical areas with low percentages included Tara, Kingaroy North, Stanthorpe, Charleville and St George. Only three statistical areas within the region had a percentage above the national and Queensland averages.

6.4 Private health insurance

46.9% 41.3%

MAP 6.4: PRIVATE HEALTH INSURANCE 2007-2008. The statistical areas in the map with lower percentage of people with private health insurance have darker shading than areas with higher percentages.

AUST

QLD

39.2% DDSWQ

Less people in the region have private health insurance than in both QLD and Australia.

SOURCE: Social Health Atlas of Australia, Data by Medicare Locals (incl. Statistical Local Areas (SLAs - or part SLA), Metropolitan/ Country areas & States/ Territories), January 2013, Public Health Information Development Unit (PHIDU). Compiled by PHIDU using data estimated from the 2007â&#x20AC;&#x201C;08 National Health Survey (NHS), ABS (unpublished); and ABS Estimated Resident Population, average of 30 June 2007 and 30 June 2008. Users of these modelled estimates should note that they do not represent data collected in administrative or other data sets. As such, they should be used with caution, and treated as indicative of the likely social dimensions present in an area with these demographic and socioeconomic characteristics.

6.5 No internet access 2011 While health professionals are the major source of health information, recent studies suggest that people seek health information from other sources as well. The National Health Call Centre Network reported that 62% of Australians have used the internet to search for health information and that 50% have used that information to diagnose themselves.

The Australian Government hosts over 30 separate websites containing health information and service directories, and promotes them as a way of accessing reliable, quality, evidence-based information from trusted sources. Based on this evidence, it seems reasonable to map the percentage of dwellings in the DDSWQ region that do not have access to the internet. This information can be used by health care providers to make informed decisions about suitable information dissemination methods. As at June 30, 2011, the number of dwellings in the region that did not have access to the internet was 26,888, or 25.9% of the total number of dwellings in the region. By comparison, the percentage of Queensland dwellings that did not have access to the internet was 18.2%, and nationally, the percentage was 21.0%. Within the region, the percentage of dwellings without access to the internet ranged from 21.8% in Toowoomba to 39.4% in Cunnamulla. Sixteen of the 22 statistical areas reported a higher percentage of dwellings without internet access than the regional average, and all statistical areas reported a higher percentage of dwellings without internet access than both the state and national averages.

6.5 No internet access

21.0%

AUST

25.9% 18.2% QLD

DDSWQ

More people in the region did not have internet access at home than in both QLD and Australia.

MAP 6.5: NO INTERNET ACCESS. The statistical areas in the map with higher percentages of dwelling without internet access have darker shading than areas with lower percentages.

SOURCE: Australian Bureau of Statistics, Census of Population and Housing, 2011, Basic Community Profile - B35

6.6 Calls to 13 HEALTH 4th Quarter, 2012 In April 2006 the Queensland Government established a 24 hour, 7 day-a-week, state-wide Health Contact Centre to give easy access to health advice, information, referral and triage services to all Queenslanders, for the cost of a local call. This service is also known as 13 HEALTH.

13 HEALTH triage services are provided by Registered Nurses using a clinical decision support system which uses clinically proven protocols to assist the nurses in determining the appropriate recommendation of care. Since October 2012, the Health Contact Centre has made de-identified 13 HEALTH call centre data available to Medicare Locals in Queensland. The data includes the postcode of the caller, and has been analysed to map the number of calls made from each statistical area within the DDSWQ region. The number of calls made from postcodes within the region to the 13 HEALTH service in the three months from October to December 2012 was 2,050, representing 7.0 calls per 1,000 population (based on the estimated resident population in the region as at June 30, 2011) By comparison, the number of calls from all Queensland postcodes 13 HEALTH in the same period was 9.8 calls per 1,000 population (based on the estimated resident population for the state as at June 30, 2011). Within the region, the calls to

6.6 Health call centre usage

9.7

9.8

AUST

QLD

7.0

13 HEALTH ranged from 0.7 calls per 1,000 population in Clifton to 14.2 calls per 1,000 population in Kingaroy.

DDSWQ

The number of calls to 13Health was lower in the region than in both QLD and Australia.

MAP 6.6: CALLS TO 13 HEALTH 2012. The statistical areas in the map with low 13 HEALTH call rates have darker shading than areas with higher call rates.

SOURCE: Health Contact Centre, Queensland Government, unpublished data made available to Medicare Locals and Australian Bureau of Statistics, Regional Population Growth, Australia, 2011, cat no 3218.0.

6.7 Number of local Primary health services 2012 Rural and regional residents are recognised as one of the specific subpopulation groups in Australia facing the greatest health inequalities.24 Access to appropriate local health services is also reported to impact greatly on the experience of health and wellbeing and

access to appropriate primary health care facilities is considered vital in offering preventative health care services.25 A total of 842 primary health care organisations were identified within the DDSWQ region in 2012. These organisations include general practices and aboriginal medical services, offering primary health care services, residential aged care facilities, home and community care providers, allied health practitioners, dentists, pharmacies and a range of other primary health care service providers. Public and private hospitals, even if they provide some primary health care, are not included (see section 6.8). The number of primary health care service organisations varied across the region, ranging from one services in Thargomindah (the most remote area within the region and with the lowest population) to over 350 services in Toowoomba (the area with the highest population). The average number of services in the region was 2.88 services per 1,000 population. National and state averages were not available. There was significant variation across the 22 statistical areas, ranging from less than one service per 1,000 population in Clifton to almost seven services per 1,000 population in Charleville.

MAP 6.7: NUMBER OF LOCAL HEALTH SERVICES 2012. The statistical areas in the map with higher numbers of health care service organisations per 1,000 population have darker shading than areas with lower rates.

SOURCE: The primary health services mapping exercise was initially conducted by the DDSWQ Medicare Local, independently audited by Health Workforce Queensland, and finally augmented with additional categories of primary health care providers by the Medicare Local. There are complexities associated with any health workforce mapping exercise, and results can only represent a snapshot in time and should be treated with caution. The data only records the number of organisations providing a local service, and data on the number of clinicians delivering services or the frequency of service delivery is not currently available.

6.8 Number of local hospitals and hospital beds 2012 Hospitals are an important part of the DDSWQ region health landscape, providing services to many residents each year. There are 38 hospitals located in the DDSWQ region, including 35 public and three private hospitals.

include emergency department services and outpatient clinics. For admitted patients, they include emergency and planned (elective) care, maternity services, and medical and surgical services.

These hospitals provide a range of services for both non-admitted and admitted patients. Services for non-admitted patients

As hospital sizes vary considerably, the number of beds is a better indicator of the availability of hospital services than is the number of hospitals. A total of 1,200 hospital beds were identified within the DDSWQ region in 2012 (see Technical Appendix 6.8 for details on how bed numbers were calculated). The average number of hospital beds in the region was 4.11 beds per 1,000 population in 2012. By comparison, the average number of hospital beds per 1,000 population in the state was 3.9 and nationally, 3.83 9latest available figures, 2009-10). There was significant variation across the 22 statistical areas, ranging from just over one bed per 1,000 population in Oakey to over ten beds per 1,000 population in St George.

MAP 6.8: NUMBER OF HOSPITAL BEDS 2012. The statistical areas in the map with higher numbers of hospital beds per 1,000 population have darker shading than areas with lower rates.

SOURCES: The hospital mapping exercise was initially conducted by the DDSWQ Medicare Local, independently audited by Health Workforce Queensland. Other sources included unpublished data provided by the Darling Downs Health and Hospital Service, data available on the www.myhospitals.gov.au website, previously available on the Queensland Health website and from various AIHW reports including Australiaâ&#x20AC;&#x2DC;s hospitals 2010â&#x20AC;&#x201C;11, at a glance Health services series no. 44. Cat. no. HSE 118. Canberra: AIHW

6.9 Number of home and community care services 2010-2011 The Commonwealth Home and Community Care (HACC) Program provides services that support older people to stay at home and be more independent in the community. These services are delivered by a range of government and nongovernment organisations in the DDSWQ region. HACC services are available to people aged 65 years and over (or 50 and over

for Aboriginal and Torres Strait Islander people), who are at risk of premature or inappropriate admission to long term residential care, and to carers of older Australians eligible for services under the program. In 2010-2011 the number of HACC clients in the region was almost 13,000 and the number of services delivered to these clients exceeded 30,000. The number of services per 1,000 population aged 65 years and over in the region was 288, compared to a state rate of 764 and a national rate of 683. Within the region the services per 1,000 population aged 65 years and over ranged from a high of 1,320 in Millmerran to a low of 374 in Kingaroy South. Statistical areas with higher rates included Millmerran, Oakey, Charleville, Quilpie and Stanthorpe. Statistical areas with low rates included Kingaroy South, Clifton, Thargomindah, Kingaroy and Toowoomba. Fourteen statistical areas within the region had a rate above the regional average.

6.9 Home and community care

764 683

MAP 6.9: HACC SERVICES 2010-2011. The statistical areas in the map with higher rates of HACC service per 1,000 population aged 65 years and over have darker shading than areas with lower rates.

AUST

676 QLD

DDSWQ

The number of HACC services per 1000 pop. in the region was lower than in both QLD and Australia.

SOURCE: Social Health Atlas of Australia, Data by Medicare Locals (incl. Statistical Local Areas (SLAs - or part SLA), Metropolitan/ Country areas & States/ Territories), January 2013, Public Health Information Development Unit (PHIDU). Compiled by PHIDU using data from the Department of Health and Ageing, 2010/11; and ABS Estimated Resident Population, 30 June 2010.

6.10 Number of residential aged care places 2011 As the population of Australia grows older, the demand for care services that assist older people increases. To address this demand there are three main service streams in Australiaâ&#x20AC;&#x2122;s aged care system: home and community care, flexible care services (see Section 6.8)and residential aged care services.

representing an increase of 2,553 places (1.4%) over the previous year. There were 2,760 facilities providing care.28 In 2011 the number of RACF places in the DDSWQ region was 2,755 divided almost equally between high care and low care places (see Technical Appendix 6.9 for definitions of high and low care places).

The number of residential aged care places The total number of places per 1,000 (RACF) in Australia has grown steadily since population aged 70 years and over in the 1995 to reach 185,482 at 30 June 2011, region was 89, compared to a state rate of 86 and a national rate of 87. Within the region the number of places per 1,000 population aged 70 years and over ranged from a high of 147 in Quilpie to a low of 33 in Kingaroy South. Thirteen statistical areas had rates higher than the regional average and five statistical areas, Kingaroy South, Crows Nest, Cunnamulla, Warwick and Goondiwindi, had rates well below the regional average.

6.10 Residential age care places

87 MAP 6.10: RACF PLACES 2011. The statistical areas in the map with higher rates of RACF places per 1,000 population aged 70 years and over have darker shading than areas with lower rates.

AUST

86 QLD

DDSWQ

There were more residentiual ageed care beds in the region than in QLD and Australia

SOURCE: Social Health Atlas of Australia, Data by Medicare Locals (incl. Statistical Local Areas (SLAs - or part SLA), Metropolitan/ Country areas & States/ Territories), January 2013, Public Health Information Development Unit (PHIDU). Compiled by PHIDU using data from the Department of Health and Ageing, June 2011; and ABS Estimated Resident Population, 30 June 2011. This data includes: Multi-Purpose Services; National Aboriginal and Torres Strait Islander Aged Care Program; and Consumer Directed Care.

Section 7

Health Behaviours Encouraging healthier lifestyle choices is an important goal Lifestyle choices can influence how healthy people are in the short and long term. Exercise, a well-balanced diet and maintaining a healthy body weight may reduce the risk of poor health. Risky behaviours, such as smoking tobacco and misusing alcohol, may increase the likelihood of poor health. This section focuses on behavioural risk factors in the region as a whole and, where data is available, at the community level.

Lifestyle factors reported in this section 7.1 Self-assessed Fair to poor health

7.2 Overweight and obese males

7.3 Overweight and obese females

Males 2011-12: 66.5%

Females 2011-12: 62%

Males 2007-08: 60.1%

Females 2007-08: 40.8%

In 2011-12 almost 7 out of 10 adult males were overweight or obese while five years ago only 6 in 10 were overweight or obese.

In 2011-12 more than 6 our of 10 adult females were overweight or obese while five years ago only 4 in 10 were overweight or obese.

14.9% 16.5% 16.4%

AUST

QLD

DDSWQ

The number of people in the region who self-assessed their health as fair to poor was more than in Australia and about the same as in QLD.

7.5 Alcohol consumption

7.4 Smoking

17.0%

100%

2007-08: 22.4%

19.7% 100%

In 2011-12 the percentage of the population who smoke continued to decline, down from over two out of 10 in 2007-08 to less than two in 10.

7.6 Physical inactivity

2011-12: 48.1%

0% In 2011-12 less than one in two adults drank in excess of the recommended limits that would avoid long term health problems.

7.7 Fruit and vegetable consumption 100%

91.7%

2007-08: 39.1% 0% In 2011-12 almost half of the adults were not involved in sufficient physical activity while five years ago only 4 in 10 were not active enough.

In 2011-12 more than nine our of 10 adults did not eat the recommended amounts of fruit and vegetables.

About the data: The data in this section has been sourced from a variety of reliable sources including the Australian Health Surveys 2007-8 and 2011-12, produced by the Australian Bureau of Statistics (ABS) and the Queensland Health Survey 2011-12, produced by Queensland Health. Both the Australian anddata the Queensland Health are based self reported data sources collectedincluding via telephone interviews Health and/or Surveys surveys, 2007-8 and About the data: The in this section has Surveys been sourced fromon a variety of reliable the Australian represent the only available datasets on the health and wellbeing status of people. and 2011-12, produced by the Australian Bureau of Statistics (ABS) and the Queensland Health Survey 2011-12, produced by Queensland Lifestyle health risk data at the national and state level comes from the Australian Health Survey 2011-12; health risk data at the regional level Health. Both the Australian and the Queensland Health Surveys are based on self reported data collected via telephone interviews and/or comes from the Queensland Health Survey 2011-12 and statistical level data comes from the Australian Health Survey 2007-8. If, and when, the surveys, and represent only available datasets onAustralian the healthHealth and wellbeing status ABS releases statisticalthe area datasets for the 2011-12 Survey the data of willpeople. be included in an update to this report. The datasets thisatsection of the report are estimates thatfrom havethe been synthetically predicted the Statistical Area at (SLA) level fromlevel Lifestyle healthused risk in data the national and state level comes Australian Health Survey at 2011-12; healthLocal risk data the regional the 2007-08 National Health Survey the ABSand (see Technicallevel Appendix Note 5.5 for the more details). Users these modelled estimates comes from the Queensland Health (NHS), Survey by 2011-12 statistical data comes from Australian HealthofSurvey 2007-8. If, and when, should note that they do not represent data collected in administrative or other datasets. As such, they should be used with caution, and treated the ABS releases statistical area datasets for the 2011-12 Australian Health Survey the data will be included in an update to this report. as indicative of the likely social dimensions present in an area with these demographic and socioeconomic characteristics.

The datasets used in this section of the report are estimates that have been synthetically predicted at the Statistical Local Area (SLA) level from the 2007-08 National Health Survey (NHS), by the ABS (see Technical Appendix Note 5.5 for more details). Users of these modelled estimates should note that they do not represent data collected in administrative or other datasets. As such, they should be used with caution, and treated as indicative of the likely social dimensions present in an area with these demographic and socioeconomic characteristics.

7.1 Self-assessed health status 2007-2008 Self-assessed health status is commonly used as a proxy measure of actual health status and may provide insights into how people perceive their own health in relation

to lifestyle behaviours or disease. Research suggests that self-assessments are valid health status indicators in middle-aged populations, and they can be used in cohort studies and population health monitoring. In 2007-2008 the percentage of the population aged 15 years and over in the DDSWQ region that reported their self-assessed health as fair to poor was 16.4%, compared to a state average of 16.5% and a national average of 14.9%. Within the region, the rate ranged from a high of 21.3% in Tara to a low of 14.1% in Crows Nest. Data was not available for five statistical areas (see Technical Appendix Note 7.1 for details). Two statistical areas, Tara and Kingaroy South, had rates well above the regional, state and national averages. All but one statistical area had rates above the national average.

MAP 7.1: SELF-ASSESSED HEALTH STATUS 2007-2008. The statistical areas in the map with higher proportion of the population aged 15 years and over self reporting their health as fair to poor have darker shading than areas with lower rates.

SOURCE: Social Health Atlas of Australia, Data by Medicare Locals (incl. Statistical Local Areas (SLAs - or part SLA), Metropolitan/ Country areas & States/ Territories), January 2013, Public Health Information Development Unit (PHIDU). Respondents aged 15 years and over in the 2007–08 NHS were asked to rate their health on a scale from ‘excellent’, through ‘very good’, ‘good’ and ‘fair’, to ‘poor’ health. The data includes those respondents who rated their health as fair or poor in the “fair to poor” group and excellent, very good or good in the “good to excellent” group.

7.2 Males Overweight and Obese 2007-2008 The health problems as a consequence of being overweight and obese are many and varied, including cardiovascular disease, hypertension, type 2 diabetes, some cancers, sleep apnoea and musculoskeletal problems.

and morbidity are also associated with the amount of weight gained in adult life. For example, a weight gain of 10kg or more since young adulthood is associated with increased mortality, coronary heart disease, hypertension, stroke and type 2 diabetes.

There are several new large well conducted studies that have shown a clear relationship between excessive body weight and increased mortality and morbidity. Mortality

In 2007-2008 the percentage of the adult male population aged 18 years and over in the DDSWQ region that self-assessed their condition as overweight or obese was 60.1%, compared to a state average of 57.1% and a national average of 55.6%. Within the region, the percentage of the adult male population that self-assessed their condition as overweight or obese ranged from 58.7% in Crows Nest to 64.1% in Stanthorpe. The variation between statistical areas is not considered to be significant, suggesting that interventions to address male overweight and obesity levels could be delivered across all statistical areas.

MAP 7.2: MALES OVERWEIGHT AND OBESE 2007-2008. The statistical areas in the map with higher proportion of the adult male population self reporting as overweight or obese have darker shading than areas with lower rates.

SOURCE: Social Health Atlas of Australia, Data by Medicare Locals (incl. Statistical Local Areas (SLAs - or part SLA), Metropolitan/ Country areas & States/ Territories), January 2013, Public Health Information Development Unit (PHIDU). The data is self-reported data, reported to interviewers in the 2007â&#x20AC;&#x201C;08 National Health Survey. Overweight and obesity were measured using the Body Mass Index (BMI) which is calculated by dividing weight in kilograms by height in metres squared. Overweight is measured at a BMI of 25 or more with obesity determined at a BMI of 30 or more. These cut-off points are based on associations between and chronic disease and mortality and have been adopted for use internationally by the World Health Organisation. Definition sourced from Promoting Healthy Weight Department of Health and Ageing, www.health.gov.au, accessed 23/04/2013.

7.3 Females Overweight and Obese 2007-2008 The health problems as a consequence of being overweight and obese are many and varied, including cardiovascular disease, hypertension, type 2 diabetes, some cancers, sleep apnoea and musculoskeletal problems. There are several new large well conducted studies that have shown a clear relationship

between excessive body weight and increased mortality and morbidity. Mortality and morbidity are also associated with the amount of weight gained in adult life. For example, a weight gain of 10kg or more since young adulthood is associated with increased mortality, coronary heart disease, hypertension, stroke and type 2 diabetes. In 2007-2008 the percentage of the adult female population aged 18 years and over in the DDSWQ region that self-assessed their condition as overweight or obese was 40.8%, compared to a state average of 40.2% and a national average of 39.1%. Within the region, the percentage of the adult female population that selfassessed their condition as overweight or obese ranged from 39.4% in Crows Nest to 43.8% in Tara. The variation between statistical areas is not considered to be significant, suggesting that interventions to address female overweight and obesity levels could be delivered across all statistical areas.

MAP 7.3: FEMALES OVERWEIGHT AND OBESE 2007-2008. The statistical areas in the map with higher proportion of the adult female population self reporting as overweight or obese have darker shading than areas with lower rates.

SOURCE: Social Health Atlas of Australia, Data by Medicare Locals (incl. Statistical Local Areas (SLAs - or part SLA), Metropolitan/ Country areas & States/ Territories), January 2013, Public Health Information Development Unit (PHIDU). The data is self-reported data, reported to interviewers in the 2007â&#x20AC;&#x201C;08 National Health Survey. Overweight and obesity were measured using the Body Mass Index (BMI) which is calculated by dividing weight in kilograms by height in metres squared. Overweight is measured at a BMI of 25 or more with obesity determined at a BMI of 30 or more. These cut-off points are based on associations between and chronic disease and mortality and have been adopted for use internationally by the World Health Organisation. Definition sourced from Promoting Healthy Weight Department of Health and Ageing, www.health.gov.au, accessed 23/04/2013

7.4 Smoking 2007-2008 There is good reason for smokers to quit and non-smokers to avoid other peopleâ&#x20AC;&#x2122;s smoke: smoking increases the risk of lung cancer, cardiovascular disease, chronic lung disease, and several other conditions. Research indicates that about 80% of lung cancer is caused by smoking, and smoking

also causes death, with about one-half to two-thirds of long term smokers eventually killed by their addiction. The Australian Government has invested heavily in anti-smoking campaigns, and has increased restrictions on smoking in public places such as workplaces, restaurants and pubs. As a result, overall rates of smoking in Australia have been decreasing since 2001. In 2007-2008 the percentage of people aged 15 years and over in the DDSWQ region that self-reported that they smoked was 22.4%, compared to a state percentage of 21.8% and a national percentage of 20.3%. Within the region, there was considerable variation in the percentage of the population aged over 15 who reported that they smoked, ranging from 18.3% in Crows Nest to 27.5% in Kingaroy North. In more than half of the 22 statistical areas in the Medicare Local, the percentage of people aged 15 and over who reported that they smoked exceeded the region average of 22.4%, and in only one statistical area (Crows Nest) the rate was below the Queensland and national rate in 2007-8.

MAP 7.3: SMOKING 2007-2008. The statistical areas in the map with higher proportion of people aged 15 and over who smoke have darker shading than areas with lower rates.

7.5 Harmful alcohol consumption 2007-2008 Alcohol is widely used in Australian society. It is a source of pleasure and is associated with celebration and relaxation, but also with a range of problems that affect individuals, families and society.

Drinking at risky levels over a lifetime can result in cardiovascular disease, diabetes and cancers, while risky consumption on a single occasion can lead to road traffic injuries, violence, falls and drowning. In 2007-2008 the percentage of people aged 18 years and over in the DDSWQ region that self-reported consuming alcohol at levels considered to be a high risk to health was 5.5%, compared to a state and national percentage of 5.4%. Within the region, the percentage of the adult population who reported consuming alcohol at levels considered to be a high risk to health ranged from a high of 7.2% in Chinchilla to a low of 4.8% in Crows Nest. In ten of the 22 statistical areas the percentage of people aged 18 and over who reported consuming alcohol at levels considered to be a high risk to health exceeded the regional average.

MAP 7.5: HARMFUL ALCOHOL CONSUMPTION 2007-2008. The statistical areas in the map with higher proportion of people aged 18 and over whoâ&#x20AC;&#x2122;s alcohol consumption is high risk have darker shading than areas with lower rates.

7.6 Physical inactivity 2007-2008 The health benefits of physical activity are reported to be numerous: markedly reduced mortality from coronary heart disease, reduced risk of developing hypertension, diabetes and colon cancer, enhanced mental health, stronger muscles

and bones, and helping to preserve independence and maintain function in older people. The National Physical Activity Guidelines for Australians outline the minimum levels of physical activity required for health benefits and ways to incorporate physical activity into everyday life. In 2007-2008 the percentage of people aged 15 years and over in the DDSWQ region that self-reported that they did not engage in sufficient physical activity to meet the National Physical Activity Guidelines was 39.1%, compared to a state percentage of 36.9% and national percentage of 34.3%. Within the region, there was considerable variation in the percentage of the population aged over 15 not engaged in sufficient physical activity to meet the National Physical Activity Guidelines, ranging from 34.2% in Crows Nest to 44.1% in Tara. In half of the 22 statistical areas in the region the percentage of people aged 15 and over who did not meet the guidelines exceeded the region average.

MAP 7.6: PHYSICAL INACTIVITY 2007-2008. The statistical areas in the map with higher proportion of people aged 15 and over who were insufficiently physically active have darker shading than areas with lower rates.

7.7 Fruit and vegetable consumption 2007-2008 The Australian government has invested in the promotion of healthy eating for many years and in 2005 the Go for 2&5 campaign was implemented by state and territory health departments across Australia (www. gofor2and5.com.au). As a consequence the idea that healthy

eating includes the daily consumption of two serves of fruit and five serves of vegetables has received considerable exposure over a long period of time, and the ABS has, since 2007, included questions on fruit and vegetable consumption in National Health Surveys. While data on fruit and vegetable consumption is available at the national and state level from both the 2007-8 and 2011-12 National Health Surveys, data at the DDSWQ region level and for statistical areas within the region is not yet available for 2011-12, and only available for fruit consumption for 2007-8. In 2007-2008 the percentage of adults aged 18 years and over in the region that self-reported that they did not consume less than the daily recommended two serves of fruit was 50.8%, compared to a state percentage of 51.0% and national percentage of 49.8%. Within the region, there was some variation in the percentage of the adult population that reported consuming less than the daily recommended two serves of fruit, ranging from a high of 53.0% for Kingaroy South to a low of 49.4% for Crows Nest. Nine statistical areas within the region including Kingaroy South, Kingaroy North, Tara, Charleville Oakey and Warwick reported consuming less than the daily recommended two serves of fruit.

MAP 7.5: FRUIT CONSUMPTION 2007-2008. The statistical areas in the map with higher proportion of adults whoâ&#x20AC;&#x2122;s fruit consumption was inadequate have darker shading than areas with lower rates.

Section 8

Biomedical Factors Chronic diseases are the leading cause of death and disability Many illnesses and health conditions are classified as chronic diseases. For various reasons, including the fact that more people are living to older age, chronic diseases have increased in prevalence and are now considered to be a significant burden on health care costs in Australia. This section focuses on the prevalence of key chronic diseases in the region as a whole and, where data is available, at the community level.

8.1 Type 2 Diabetes 2011 Diabetes is a complex and chronic disease. Diabetes mellitus (diabetes) is used to describe a group of different disorders with common elements, including high blood glucose (sugar) levels and glucose

intolerance, that are due to insulin deficiency, impaired effectiveness of insulin or both. Type 2 is the most common form of diabetes, affecting 85-90% of all people with diabetes. While it usually affects older adults, more and more younger people, even children, are getting type 2 diabetes. Type 2 diabetes results from a combination of genetic and environmental factors. Although there is a strong genetic predisposition, the risk is greatly increased when associated with lifestyle factors such as high blood pressure, overweight or obesity, insufficient physical activity, poor diet and the classic â&#x20AC;&#x2DC;apple shapeâ&#x20AC;&#x2122; body where extra weight is carried around the waist. There is currently no cure for Type 2 diabetes , however the disease is highly preventable. In 2011 the percentage of the population in the DDSWQ region that were registered with the National Diabetes Services Scheme (NDSS) with type 2 diabetes was 5.0%, the same as the state percentage and below the national percentage of 5.4%. Within the region, the percentage of the population registered with the NDSS with type 2 diabetes ranged from a high of 7.2% in Cunnamulla to a low of 4.1% in Miles. In nine of the 22 statistical areas in the region the percentage of people who were registered with the NDSS with type 2 diabetes exceeded the region average of 5.0%.

Statistical areas with high rates included Cunnamulla, Kingaroy North, Clifton, Millmerran and Chinchilla. Statistical areas with low rates included Miles, Roma, 8.1 Type 2 Diabetes Quilpie, St George and Stanthorpe.

5.4%

5.0%

QLD

DDSWQ

MAP 8.1: TYPE 2 DIABETES 2011. The statistical areas in the map with higher proportion of the population who were registered with the NDSS with type 2 diabetes have darker shading than areas with lower rates.

AUST

The number of people in the region with type 2 diabetes was the same as in QLD and lower than in Australia.

SOURCE: Australian Diabetes Map, National Diabetes Services Scheme (NDSS), www.ndss.com.au/en/Australian-Diabetes-Map/Map/, accessed 10/7/2013. The data contained in the Australian Diabetes Map is derived from the National Diabetes Services Scheme (NDSS) Registrant database from September 2011 and shows people diagnosed with diabetes who are registered on the Scheme. The NDSS is an initiative of the Australian Government administered by Diabetes Australia.

8.2 High blood pressure 2007-2008 High blood pressure (called hypertension) is a medical condition where blood is pumping at a higher pressure than normal

through the arteries. This can contribute to a number of diseases including heart attack, kidney failure or stroke. High blood pressure usually produces no symptoms. Research shows that lifestyle is very important in helping manage high blood pressure and its associated risks. Recommended strategies include being smoke-free, reducing salt intake, achieving and maintaining a healthy body weight, limiting alcohol intake to no more than two drinks per day, or one drink per day for women and undertaking regular physical activity. In 2007-2008 the percentage of the population in the DDSWQ region that selfreported that they had been diagnosed with high blood pressure was 9.1%, compared to the state percentage of 8.5% and the national percentage of 9.2%. Within the region, the percentage of the population who reported that they had been diagnosed with high blood pressure ranged from a high of 9.8% in Chinchilla to a low of 7.7% in Crows Nest. In eleven of the 22 statistical areas in the and Millmerran. Statistical areas with region, the percentage of people who low rates included Crows Nest, Oakey, reported that they had been diagnosed with Pittsworth, 8.2 High bloodand pressure Stanthorpe Kingaroy South. high blood pressure exceeded the region average of 9.1%. Statistical areas with high rates included Chinchilla, Kingaroy, Clifton, Tara, Dalby

9.2%

8.5%

9.1%

MAP 8.2: HIGH BLOOD PRESSURE 2007-2008. The statistical areas in the map with higher proportion of the population who self reported being diagnosed with high blood pressure have darker shading than areas with lower rates.

AUST

QLD

DDSWQ

The number of people with high blood pressure in the region was higher than in QLD and about the same as in Australia.

SOURCE: Social Health Atlas of Australia, Data by Medicare Locals (incl. Statistical Local Areas (SLAs - or part SLA), Metropolitan/ Country areas & States/ Territories), January 2013, Public Health Information Development Unit (PHIDU). The data is self-reported data, reported to interviewers in the 2007â&#x20AC;&#x201C;08 National Health Survey. Respondents to the NHS were asked whether they had been diagnosed with any long term health condition (a condition which has lasted or is expected to last for 6 months or more), and were also asked whether they had been told by a doctor or nurse that they had high blood pressure.

8.3 High serum Cholesterol 2007-2008 Cholesterol is a fatty substance produced naturally by the body and found in blood. It is also present in some foods. It is used for many different things in the body, but

causes health problems when there is too much of it in the blood. Too much cholesterol in the blood causes fatty deposits to gradually build up in blood vessels. This makes it harder for blood to flow through, which can cause a heart attack or stroke. Factors that are well recognised as increasing the risks of serious problems associated with high cholesterol include smoking, having high blood pressure, being overweight and having diabetes. In 2007-2008 the percentage of the population in the DDSWQ region that selfreported that they had been diagnosed with high blood cholesterol was 5.6%, compared to the state percentage of 5.5% and the national percentage of 5.6%. Within the region, the percentage of the population who reported that they had been diagnosed with high cholesterol ranged from a high of 5.9% in Kingaroy North to a low of 5.3% in Pittsworth. In nine of the 22 statistical areas in the region the percentage of people who reported that they had been diagnosed with high cholesterol exceeded the region average of 5.6%. In almost all of the 22 statistical areas in the region the percentage of people who reported that they been diagnosed with high cholesterol equalled or exceeded the state and national averages, although the difference between the rates is not considered to be significant.

Statistical areas with high rates included Kingaroy North, St George, Kingaroy South, Tara and Chinchilla, Statistical areas with low rates included Pittsworth, Crows High serum cholesterol Nest,8.3 Miles, Oakey and Goondiwindi.

5.6%

5.3%

5.6%

MAP 8.3: HIGH SERUM CHOLESTEROL 2007-2008. The statistical areas in the map with higher proportion of the population who reported that they been diagnosed with high cholesterol have darker shading than areas with lower rates.

AUST

QLD

DDSWQ

The number of people with high cholesterol was higher in the region than in QLD.

SOURCE: Social Health Atlas of Australia, Data by Medicare Locals (incl. Statistical Local Areas (SLAs - or part SLA), Metropolitan/ Country areas & States/ Territories), January 2013, Public Health Information Development Unit (PHIDU). The data is self-reported data, reported to interviewers in the 2007â&#x20AC;&#x201C;08 National Health Survey. Respondents to the NHS were asked whether they had been diagnosed with any long term health condition (a condition which has lasted or is expected to last for 6 months or more), and were also asked whether they had been told by a doctor or nurse that they had a circulatory condition including high blood cholesterol.

8.4 Psychological Distress 2007-2008 Many rural and remote communities have very limited access to mental health services, especially psychology services. There are a multiplicity of reasons for this limited access including the obvious geographical isolation, mental health professional workforce issues and a higher level of stigma attached to mental health

issues in the rural areas when compared to urban areas. Adopting the principles of primary health care, in particular the concepts of community self-determination and an understanding of the social, economic, cultural and political determinants of health, and working as part of genuine multidisciplinary primary health care teams that operate from a commitment to maximise community and individual selfreliance are reported to be the keys to more effective delivery of mental health services in rural and remote communities. In 2007-2008 the percentage of the population in the DDSWQ region that self-diagnosed that they had psychological distress was 11.3%, compared to the state percentage of 11.2% and the national percentage of 11.0%. Within the region, the percentage of the population who selfdiagnosed that they had psychological distress ranged from a high of 14.4% in Kingaroy South to a low of 10.0% in Miles. In eight of the 22 statistical areas in the region the percentage of people who self-diagnosed that they had psychological distress exceeded the region average of 11.3%.

Statistical areas with high rates included Kingaroy South, Tara, Kingaroy North, and Stanthorpe, Statistical areas with low rates 8.4 Psychological included Miles, Pittsworth,distress Roma, Oakey and Crows Nest.

11.0%

11.2% 11.3%

MAP 8.4: PSYCHOLOGICAL DISTRESS 2007-2008. The statistical areas in the map with higher proportion of the population that self-diagnosed that they had psychological distress have darker shading than areas with lower rates.

AUST

QLD

DDSWQ

The number of people with psychological distress was higher in the region than in both QLD and Australia.

SOURCE: Social Health Atlas of Australia, Data by Medicare Locals (incl. Statistical Local Areas (SLAs - or part SLA), Metropolitan/ Country areas & States/ Territories), January 2013, Public Health Information Development Unit (PHIDU). The data is self-reported data, reported to interviewers in the 2007â&#x20AC;&#x201C;08 National Health Survey. However, unlike the approach used for conditions such as heart and circulatory conditions, and/or diabetes, respondents in the survey were not specifically asked whether they had been diagnosed with any mental disorders. The information provided by respondents could therefore be based on self-diagnosis rather than diagnosis by a health professional. Mental or behavioural problems Includes alcohol and drug problems, mood disorders and anxiety problems.

8.5 Heart Disease 2007-2008 Heart diseases include a number of conditions affecting the circulatory system, which consists of the heart, arteries and veins. These diseases include all heart,

stroke, vascular and hypertensive diseases as well as tachycardia. According to the Chief Health Officer, Queensland, about 70% of all circulatory disease deaths are due to the joint effect of modifiable physiological and lifestyle factors. In 2007-2008 the percentage of the population in the DDSWQ region that reported that they had been diagnosed with a heart disease was 16.4%, compared to the state and national percentage of 16.0%. Within the region, the percentage of the population that reported that they had been diagnosed with a heart disease ranged from a high of 17.4% in Kingaroy South to a low of 15.3% in Crows Nest. In ten of the 22 statistical areas in the region the percentage of people who reported that they had been diagnosed with a heart disease exceeded the region average of 16.4%. In all of the 22 statistical areas in the region the percentage of people who reported that they had a circulatory disease exceeded the state and national average of 16.0%. Statistical areas with high rates included Kingaroy South, Tara, Chinchilla, Clifton, Kingaroy North, Kingaroy, Stanthorpe and Warwick. Statistical areas with low rates included Crows Nest, Goondiwindi, Oakey, Toowoomba and St George.

MAP 8.5: HEART DISEASE 2007-2008. The statistical areas in the map with higher proportion of the population that reported that they had been diagnosed with a heart disease have darker shading than areas with lower rates.

8.5 Heart disease

16.0% 16.0% AUST

QLD

16.4%

DDSWQ

The number of people with heart disease was higher in the region than in both QLD and Australia.

SOURCE: Social Health Atlas of Australia, Data by Medicare Locals (incl. Statistical Local Areas (SLAs - or part SLA), Metropolitan/ Country areas & States/ Territories), January 2013, Public Health Information Development Unit (PHIDU). The data is self-reported data, reported to interviewers in the 2007â&#x20AC;&#x201C;08 National Health Survey. Circulatory Diseases includes all heart, stroke, vascular and hypertensive diseases. Respondents to the NHS were asked whether they had been diagnosed with any long term health condition (a condition which has lasted or is expected to last for 6 months or more), and were also asked whether they had been told by a doctor or nurse that they had heart disaease.

8.6 Chronic Obstructive Pulmonary Disease 2007-2008 Chronic Obstructive Pulmonary Disease (COPD) is a term used to describe a number of lung conditions that are long-term, gradually worsen, and cause

shortness of breath by reducing the normal flow of air through the airways. The most common are emphysema, chronic bronchitis and chronic asthma. Each of these conditions can occur on its own, although many people have a combination of conditions. Smoking is the main cause of COPD. Around half of all smokers will develop some form of airflow limitation, and 1520% of smokers will develop severe lung problems. In 2007-2008 the percentage of the population in the DDSWQ region that reported that they had been diagnosed with COPD was 2.6%, compared to the state percentage of 2.4% and the national percentage of 2.3%. Within the region, the percentage of the population who reported that they had been diagnosed with COPD ranged from a high of 3.1% in Kingaroy South to a low of 2.3% in Crows Nest. In five of the 22 statistical areas in the region the percentage of people who reported that they had been diagnosed with COPD exceeded the region average of 2.6%. In all of the 22 statistical areas in the region the percentage of people who reported that they had been diagnosed with COPD was equal to or above the national average of 2.3%.

Statistical areas with high rates included Kingaroy South, Tara, Kingaroy North, Clifton and Millmerran. Statistical areas with low rates included Crows Nest, Goondiwindi, Miles, St George, Roma and Charleville.

MAP 8.6: COPD 2007-2008. The statistical areas in the map with higher proportion of the population that reported that they had been diagnosed with COPD have darker shading than areas with lower rates.

SOURCE: Social Health Atlas of Australia, Data by Medicare Locals (incl. Statistical Local Areas (SLAs - or part SLA), Metropolitan/ Country areas & States/ Territories), January 2013, Public Health Information Development Unit (PHIDU). The data is self-reported data, reported to interviewers in the 2007â&#x20AC;&#x201C;08 National Health Survey. Circulatory Diseases includes all heart, stroke, vascular and hypertensive diseases. Respondents to the NHS were asked whether they had been diagnosed with any long term health condition (a condition which has lasted or is expected to last for 6 months or more), and were also asked whether they had been told by a doctor or nurse that they had COPD.

8.7 Asthma 2007-2008 Respiratory disease affects the quality of life chronic obstructive pulmonary disease for many Australians. Common respiratory (COPD), asthma and hayfever. These diseases that impact on health include illnesses and conditions can range from mild to life-threatening, and are considered to be particularly amenable through prevention interventions. The risk factors for respiratory disease differ. Smoking is a major risk factor for COPD as well as environmental pollutants and chemicals which affect both COPD and Asthma. While the main determinants for respiratory disease are linked to environmental factors, socio-economic and cultural factors are also linked. In 2007-2008 the percentage of the population in the DDSWQ region that reported that they had been diagnosed with asthma was 12.0%, compared to the state percentage of 11.44% and the national percentage of 9.7%. Within the region, the percentage of the population who reported that they had been diagnosed with asthma ranged from a high of 12.8% in Kingaroy South to a low of 11.5% in Crows Nest. In six of the 22 statistical areas in the region the percentage of people who reported that they had been diagnosed with asthma exceeded the region average of 12.0%. In all of the 22 statistical areas in the region the percentage of people who reported that they had a respiratory disease was below the state average of 11.4%.

Statistical areas with high rates included Kingaroy South, Tara, Kingaroy North, and St George, Statistical areas with low rates included Crows Nest, Goondiwindi, Pittsworth, Miles, Oakey and Chinchilla.

MAP 8.7: ASTHMA 2007-2008. The statistical areas in the map with higher proportion of the population who reported that they had been diagnosed with Asthma have darker shading than areas with lower rates.

8.8 Arthritis 2007-2008 Musculoskeletal diseases, including arthritis, rheumatism, back pain, sciatica and osteoporosis, are one of the major causes of disability around the world, and

are considered to be important causes of disability-adjusted-life years in both the developed and developing world. Studies in over 17 countries around the world have identified back and knee pain as common in the community and are likely to increase with the ageing population. Musculoskeletal conditions are an enormous cost to the community in economic terms, however the burden of musculoskeletal diseases can be reduced by encouraging exercise and obesity prevention campaigns. In 2007-2008 the percentage of the population in the DDSWQ region that reported that they had been diagnosed with arthritis was 16.2%, compared to the state percentage of 15.2% and the national percentage of 14.9%. Within the region, the percentage of the population who reported that they had been diagnosed with arthritis ranged from a high of 17.7% in Tara to a low of 14.7% in Crows Nest. In eight of the 22 statistical areas in the region the percentage of people who reported that they had been diagnosed with arthritis exceeded the region average of 16.2%. In all but three of the statistical areas in the region the percentage of people who reported that they had been diagnosed with arthritis exceeded the state average of 15.2%.

MAP 8.7: ARTHRITIS 2007-2008. The statistical areas in the map with higher proportion of the population that reported that they had been diagnosed with Arthritis have darker shading than areas with lower rates.

Statistical areas with high rates included Tara, Kingaroy South, Kingaroy North, Millmerran and Stanthorpe, Statistical areas with low rates included Crows Nest, St George, 8.8Pittsworth, Arthritis Goondiwindi and Roma.

14.9% 15.2% AUST

QLD

16.2%

DDSWQ

The number of people with arthritis was higher in the region than in both QLD and Australia.

SOURCE: Social Health Atlas of Australia, Data by Medicare Locals (incl. Statistical Local Areas (SLAs - or part SLA), Metropolitan/ Country areas & States/ Territories), January 2013, Public Health Information Development Unit (PHIDU). The data is self-reported data, reported to interviewers in the 2007â&#x20AC;&#x201C;08 National Health Survey. Respondents to the NHS were asked whether they had been diagnosed with any long term health condition (a condition which has lasted or is expected to last for 6 months or more), and were also asked whether they had been told by a doctor or nurse that they had arthritis.

8.9 Avoidable death rates 2003-2007 Public health experts classify causes of deaths as avoidable and unavoidable. An avoidable death is one that, theoretically, could have been avoided given an understanding of causation, the adoption of available disease prevention initiatives and the use of available health care. Avoidable deaths are broken down into two groups. A preventable death is defined as one in which there are effective means of

preventing the condition that led to the death from occurring (such as by addressing risk factors and behaviour / lifestyle factors (eg smoking, substance use, nutrition, physical activity). A treatable death is defined as one in which it is reasonable to expect the death could have been averted even after the condition had developed through early detection and effective treatment (such as cancer screening programs and blood pressure lowering medication). In the DDSWQ region, the latest available annual avoidable death rate (20032007) was 109 deaths per 100,000 population per annum. This rate is higher than both the state rate of 101 deaths per 100,000 population and the national rate of 100 deaths per 1000,000 population. Within the region, the annual avoidable death rate varied considerably from a high of 301 deaths per 100,000 population in Kingaroy North to a low of 82 deaths per 100,000 population in Millmerran. Fourteen out of the 22 statistical areas (64%) recorded annual avoidable death rates

above the region average and 17 statistical areas (77%) recorded avoidable premature 8.9 Avoidable deaths death rates above the state and national average.

100

101

AUST

QLD

109

MAP 8.9: AVOIDABLE DEATH RATES 2003-2007. The statistical areas in the map with higher avoidable death rates have darker shading than areas with lower rates.

DDSWQ

The number of avoidable deaths was higher in the region than in both QLD and Australia.

SOURCE: Social Health Atlas of Australia, Data by Medicare Locals (incl. Statistical Local Areas (SLAs - or part SLA), Metropolitan/ Country areas & States/ Territories), January 2013, Public Health Information Development Unit (PHIDU). Data produced by PHIDU from deaths data supplied by ABS on behalf of state and Territory Registrars of deaths for 2003 to 2007; and ABS Estimated Resident Population, 30 June 2003 to 30 June 2007.

8.10 Deaths from all Cancers 2003-2007 Cancer was the largest cause of premature death in Queensland (39% in 2010), the second largest cause of all deaths (30% in 2010), and the largest cause of total burden of disease and injury (19% in 2007).58

In the DDSWQ region, the latest available data on the annual death rate from all cancers, (2003-2007) was 100.9 deaths per 100,000 population per annum. This rate is lower than both the state rate of 103.9 deaths per 100,000 population and the national rate of 104.3 deaths per 1000,000 population. Within the region, the annual death rate from all cancers varied considerably from a high of 169.7 deaths per 100,000 population in Tara to a low of 79.1 deaths per 100,000 population in Stanthorpe. Ten out of the 22 statistical areas (45%) recorded annual death rates from all cancers above the regional rate and nine (41%) were above the state and national rates. Statistical areas with high rates included Tara, Miles, St George and Kingaroy North. Statistical areas with low rates included Stanthorpe, Warwick, Pittsworth, Crows Nest and Roma.

8.10 Cancers

104.2 103.9

AUST

MAP 8.10: DEATHS FROM ALL CANCERS. The statistical areas in the map with a higher annual death rate from all cancers have darker shading than areas with a lower rate.

QLD

100.9

DDSWQ

The number of deaths from all cancers was lower in the region than in both QLD and Australia.

SOURCE: Health Atlas of Australia, Data by Medicare Locals (incl. Statistical Local Areas (SLAs - or part SLA), Metropolitan/ Country areas & States/ Territories), January 2013, Public Health Information Development Unit (PHIDU). Data produced by PHIDU from deaths data supplied by ABS on behalf of State and Territory Registrars of deaths for 2003 to 2007; and ABS Estimated Resident Population, 30 June 2003 to 2007.

8.11 Dementia 2011-2021 Dementia is a major health problem in Australia. It has profound consequences for the health and quality of life of people with the condition, as well as for their families and friends.59 Dementia is also reported to be â&#x20AC;&#x153;without question the single biggest health issue facing Australia in the 21st centuryâ&#x20AC;?, principally because it is an age related disease and as the population ages the numbers of people with dementia also rises.60 There is no epidemiological study of the incidence and prevalence of dementia in

Australia. (See Technical Appendix Note 8.11). However, estimates of the number of people with dementia at the national and state level for the years between 2011 to 2020 and forward to 2050 are available. In the DDSWQ region the estimated number of people with dementia in 2011 was 3,467, with the number growing to 4,378 by 2016 and to over 5,000 by 2020. The rate per 100,000 people is estimated to increase from a rate of 1,186 people per 100,000 in 2011 to 1,327 people per 100,000 in 2016 and 1,406 people per 100,000 in 2020. In an attempt to estimate the demand for health services to manage dementia in the DDSWQ region, the estimated number of people with the condition in each statistical area in 2011 has been correlated with the number of hi care residential aged care beds in each area in 2011. This analysis suggests that the regional average number of beds per 100 people estimated to have dementia in 2011 was 38. Within the region, the rate ranged from a high of 85 beds per 100 people in Oakey to a low of 13 beds per 100 people in Millmerran.

MAP 8.11: DEMENTIA. The statistical areas in the map with a higher rate of hi care RACF beds per 100 people estimated to have dementia in 2011 have darker shading than areas with a lower rate.

SOURCE: AIHW 2012 Estimated number of people with dementia, by sex, and state and territory, 2011 to 2020. Rates derived by the AIHW based on ADI (2009)61 and Harvey et al. (2003) 62and applied to population data for 2011 (ABS, 2012) and population projections for 2012-2020 (ABS, 2008).

8.12 Australia Early Development Index (AEDI) 2012 There is clear evidence from Australia and overseas that the early years of a childâ&#x20AC;&#x2122;s life have a profound impact on their future health, development, learning and wellbeing. Research shows investing in resources to support children in their early years of life brings long-term benefits to them and the whole community.

of which are reported here (see Technical Appendix Note 8.10 for details).

The Australian Early Development Index (AEDI) is a population measure of young childrenâ&#x20AC;&#x2122;s development based on a teachercompleted checklist (the AEDI Checklist) across five developmental domains, three

Within the region, percentage of children identified as vulnerable on one or more domains ranged from a high of 46.9% in Cunnamulla to a low of 17.8% in Millmerran.

In 2012, 29.1% of the surveyed children in the DDSWQ region were identified as developmentally vulnerable on one or more domains. By comparison, the state percentage was 26.2% and the national 22.0%.

Fourteen statistical areas reported more children vulnerable on one or more domains that the regional average and 18 areas reported more children vulnerable on one or more domains that the state average. Statistical areas with high rates included Cunnamulla, Clifton, Kingaroy North, Quilpie, Thargomindah, Kingaroy South and Charleville. Statistical areas with low rates included Millmerran, Pittsworth, Crows Nest, Dalby and Chinchilla.

MAP 8.12: AEDI. The statistical areas in the map with higher percentages of children identified as vulnerable on one or more domains have darker shading than areas with lower percentages.

SOURCE: AEDI Community Profiles 2012, www,aedi.org.au, accessed 22/04/2013.

8.13 Childhood development – Immunisation 2011-2012 Immunisation helps protect individuals and the community generally against potentially serious diseases such as measles, polio, tetanus and whooping cough (pertussis). Although the great majority of children in the DDSWQ region are immunised, it is important to maintain high immunisation rates to reduce the risk of outbreaks of these and other diseases recurring. Ideally, 100 per cent of children should be immunised and the World Health Organisation has advocated an

immunisation rate of greater than 93–95% to ensure measles elimination.

CHILDHOOD IMMUNISATION RATES The data shows the percentages of children who were fully immunised at 1 year, 2 years and 5 years, as published by the National Health Performance Authority (NHPA) and sourced from the Australian Childhood Immunisation Register (ACIR). The data cover the period from July 2011 to June 2012. Data was not available for four statistical areas. In 2011-12, the childhood immunisation rate for the region was 92% for one year old children, 94% for two year olds and 92% for five year olds. This compares to a national immunisation range of 85% to 94% for one year old children, 89% to 96% for two year olds and 84% to 95% for five year olds.

ABORIGINAL AND TORRES STRAIT CHILDHOOD IMMUNISATION RATES In 2011-12, the childhood immunisation rate for the region one year old Aboriginal and Torres Strait population was significantly below the ‘all children’ rate (81% compared to 92%) while the two year old rate was above 90% and at 92% close to the ‘all children’ rate of 94%. The five year old rate was 91% and even closer to the ‘all children’ rate (92%).

This compares to a national Aboriginal and Torres Strait population immunisation range of 69% to 94% for one year old children, 80% to 97% for two year olds and 70% to 95% for five year olds.

MAP 8.13: CHILDHOOD IMMUNISATION RATES. The statistical areas in the map with lower immunisation coverage rates have darker shading than areas with higher rates.

SOURCE: National Health Performance Authority 2013, Healthy Communities: Immunisation rates for children in 2011–12, NHPA, Sydney.

Section 9: Notes 9.1 Technical appendices Statistical Area Level 2 (SA2). Defined

3.4: Birth and Fertility Rates. The Birth

by the Australian Bureau of Statistics (ABS) in its Australian Statistical Geography Standard (ASGS), effective from July 2011. SA2 areas are new general-purpose medium-sized statistical areas that represent a community that interacts together socially and economically. The population size of SA2s can be between 3,000 and 25,000. The SA2 is the lowest level of the ASGS structure for which Estimated Resident Population (ERP), Health and Vitals and other non-Census ABS data are generally available.

Rate is defined as the number of live births per 1,000 population, based on registration of births data collected by state governments. The Total Fertility Rate is defined as the sum of age specific fertility rates (live births at each age of mother per 1,000 of the female population of that age) divided by 1,000. It represents the number of children a female would bear during her lifetime if she experienced current age-specific fertility rates at each age of her reproductive life.

3.1: Estimated Resident Population.

Since 1976, the total fertility rate for Australia has been below replacement level. That is, the average number of babies born to a woman throughout her reproductive life (measured by the TFR) has been insufficient to replace herself and her partner. The TFR required for replacement is currently considered to be around 2.1 babies per woman. SOURCE: Australian Bureau of Statistics, Births, Australia, 2011, cat no 3301.0.

The official Australian Bureau of Statistics (ABS) estimate of population, based on results of the population census, compiled as at 30 June of each census year and updated annually between censuses for migration, births and deaths. The ABS has revised the 2011 Estimated Resident Population (ERP) data, resulting in not insignificant population reductions for the 2011 ERP for all statistical areas in the DDSWQ region. In this report, we uses the revised June 30, 2011 ERP data for the estimated 2011 population. For more information on this issue, see Section 3.9 Expected population growth 2011-2031.

3.3: Population Distribution. A population pyramid is a graphical illustration that shows the distribution of a population by age groups and/or gender. Population pyramids are often viewed as the most effective way to graphically depict the age and gender distribution of a population, partly because of the very clear image these pyramids present and the story they tell.66 Population pyramids typically consists of two back-to-back bar graphs, with the population plotted on the X-axis and age on the Y-axis, one showing the number of males and one showing females in a particular population in five-year age groups (also called cohorts). Males are conventionally shown on the left and females on the right, and they may be measured by raw number or as a percentage of the total population. There are three basic types or shapes to a population pyramid: Expansive or ‘pyramid’ shaped population pyramids show larger percentages of the population in the younger age groups. Population growth is positive; Constrictive or ‘coffin’ shaped population pyramids display larger percentages of the population in the older age groups. Population growth is negative; and Stationary or ‘Beehive’ population pyramids display somewhat equal numbers or percentages for almost all age groups. Population growth is neutral.67

3.8: Core Activity Need for Assistance. This variable is considered to be the most reliable, and defines a person with profound or severe limitation as someone who needs help or supervision always (profound) or sometimes (severe) to perform activities that most people undertake at least daily, that is, the core activities of self-care, mobility and/ or communication, as the result of a disability, long-term health condition (lasting six months or more), and/or older age.

5.1: SEIFA and IRSAD. Each index is constructed based on a weighted combination of selected variables. For information of the variables used to generate the IRSAD, see ABS Cat No: 2033.0.55.001 - Census of Population and Housing: Socio-Economic Indexes for Areas (SEIFA), Australia, March 2011. The ABS points out that the indexes are assigned to areas, not to individuals and indicate the collective socio-economic characteristics of the people living in an area. As measures of socioeconomic conditions, the indexes are best interpreted as ordinal measures that rank areas and recommends using the index rankings for analysis, rather than using the index scores directly. The indexes are primarily designed to compare the relative socio-economic characteristics of areas at a given point in time, and therefore it can be very difficult to perform useful longitudinal or time series analysis. For this reason, the 2011 SEIFA IRSAD Index scores are not compared to the 2006 scores at this point in time.

5.5: People on Government Support (and other datasets). These datasets have been compiled by PHIDU using modelled estimates from the 2010 General Social Survey, ABS (unpublished); and ABS Estimated Resident Population, 30 June 2010. The ABS survey was conducted by personal interview (using a Computer Assisted Interviewing questionnaire) and included people aged 18 years and over resident in private dwellings, throughout the not very remote areas of Australia, from August to November 2010. The 2010 GSS achieved a response rate of 87.6%, with a total sample from the survey of 15,028 dwellings. The survey excluded persons residing in collection districts in Very Remote areas under the ABS remoteness classification and estimates were not produced for SLAs with more than 50% of their populations residing in Very Remote regions, SLAs with populations under 1,000, and SLAs in which Aboriginal people comprise 75% or more of the population. The modelled estimates presented have been synthetically predicted at the Statistical Local Area (SLA) level. The model used for predicting small area data is determined by analysing data at a higher geographic level, in this case Australia. The relationship observed at the higher geographic level between the characteristic of interest and known characteristics is assumed to also hold at the small area level. Users of these modelled estimates should note that they do not represent data collected in administrative or other data sets. As such, they should be used with caution, and treated as indicative of the likely social dimensions present in an area with these demographic and socioeconomic characteristics.

6.1: Self reported difficulty accessing services. Modelled data, see 5.5 above. 6.3: Health concession cards. Includes those who hold either a Health Care Card or a Pensioner Concession Card. For details on eligibility for either care see www.humanservices.gov.au.

6.4: Private health insurance. Modelled data, see 5.5 above. The data on which the predictions are based are self-reported data, reported to interviewers in the 2007-08 NHS. Respondents to the NHS were asked whether they were currently covered by private health insurance.

6.8: Hospital bed numbers. This dataset

8.11 Dementia. Dementia is not one

was compiled from unpublished data provided to the DDSWQ Medicare Local by the Darling Downs Health and Hospital Service, from data previously available on the Queensland Health website and from various AIHW reports. Beds counted are those available for use—with appropriate staffing.

condition but a term encompassing a range of conditions characterised by impairment of brain functions, including language, memory, perception, personality and cognitive skills. There are many types of dementia, the most common being Alzheimer‘s disease. 68 Conditions associated with dementia are typically progressive, degenerative and irreversible, for which there is currently no cure.69

6.9: RACF. High-level care is nursing home care provided when health deteriorates to such a degree that a person becomes very frail or ill and can no longer be cared for adequately in their present accommodation. It provides 24hour nursing and personal care for the very frail or ill, with support for the activities of daily living – dining, showering, continence management, rehabilitation, medications etc. Allocation is based on availability and the assessment of an individual’s needs, as compared with other residents. Low-level care is hostel accommodation, offering a greater quality of life for people who benefit significantly from supportive services, companionship and activities, and for whom living without assistance is difficult. Independence is encouraged in maintaining daily living skills. Services provided may include showering, dressing, bed making, room cleaning, supervision of medication, provision of all meals and laundry.

7.1: Self-assessed health status. Modelled data, see 5.5 above

To date, there has been no national study of dementia prevalence and incidence in Australia using clinical diagnoses. The prevalence of dementia refers to the number of people in the population with dementia at a given time, while the incidence of dementia refers to the number of new cases of dementia in a specified period, such as a year. Due to the lack of epidemiological data, a number of studies have explicitly estimated current and projected future dementia prevalence in Australia, and these have been summarised by AIHW and reported in their 2012 Dementia in Australia report. AIHW Dementia prevalence estimates. These estimates have been derived by applying the same prevalence rates to ABS population data (for 2011) and ABS population projections (for 2012 onwards). The application of the same prevalence rates across time assumes that dementia prevalence rates have been stable since 2005 and will continue to be so into the future. As a result, the projections provide

estimates of the number of people who would have dementia into the future, with change over time due solely to projected population growth and continued ageing of the population. No modelling was done to take into account any other changes that might occur in the future. Changes in risk factors and in the prevention, management and treatment of the condition may affect the accuracy of these estimates. For example, improved medical and social care might increase prevalence by allowing more people to survive longer with dementia. The estimates are also sensitive to deviations from projected changes in the age-sex structure or total size of the projected populations. Therefore, these estimates (especially those further into the future) should be interpreted with caution.

8.12: AEDI Profiles. AEDI provide communities and schools with information about how local children have developed by the time they start school across five areas of early childhood development: physical health and wellbeing, social competence, emotional maturity, language and cognitive skills (schoolsbased), and communication skills and general knowledge. In 2012, the AEDI was completed nationwide for the second time (first time in 2009). AEDI checklists were completed for 289,973 children representing 96.5 per cent of all Australian children enrolled to begin school in 2012.

9.2 Acronyms ACRONYM

FULL NAME

ACRONYM

FULL NAME

ABS

Australian Bureau of Statistics

ERP

Estimated Residential Population

ACIR

Australian Child Immunisation Register

HHS

Health and Hospital Service

DDSWQML Darling Downs South West Queensland Medicare Local

DSEWPC Department of Sustainability, Environment, Water, Population and Community

DOHA

Department of Health and Ageing

HACC

LGA

Local Government Authority

RACF

Residental Aged Care Facility

LRSAD Low Relative Socio-Economic Advantage and Disadvantage

SEIFA

Socio-Economic Indicator for Areas

NHS

National Health Survey

DNR Department of Natural Resources and Mines

NDSS

National Diabetes Services Scheme

AEDI

Australian Early Development Index

OESR

Office of Economic and Statistical Research

BMI

Body Mass Index

PHIDU

Public Health Information Development Unit

BOM

Bureau of Meteorology

SLA

Statistical Local Area

DEEWAR Department Edication, Employment and Workforce Relations

SA2

Statistical Area Level 2

TFR

Total Fertility Rate

General Practitioner

TSS

Taxi Subsidy Scheme

CALD

Culturally and Linguistically Diverse

PTSS

Patient Transport Subsidy Scheme

Commonweath Home and Community Care

9.3 References 1 Healthcare 2011-12: Comparing outcomes by remoteness, COAG Reform Council, 2013

23 Information Package, Health Contact Centre, undated publication,

2 ASGC Remoteness Structure, ABS 2006, 2nd Edition

24 Dunbar, J and Peach, E, 2012: The disparity called rural health:

3 The World Health Report 2008, Primary Health Care - Now More Than Ever, World Health Organisation, 2008. http://www.who.int/whr/2008/en/index.html

4 Building a 21st Century Primary Health Care System, Australia’s First National Primary Health Care Strategy. DoHA, 2009

5 The Social Determinants of Health, SACOSS Information Paper December 2008

6 Folland S Goodman A and Stano M, Economics of Health and Health Care 7th edition 2012, Prentice Hall

7 Australia’s Health 2012, 2012 Canberra, Australian Institute of Health and Welfare, p12

8 Howat, P & Stoneham, M, 2010 Why Australia needs a Sustainable Population Policy, published in Issues, Vol 91, June 2010.

9 World Health Organisation: Older people and primary health care http://www.who.int/topics/ageing/en/

10 Australian Bureau of Statistics (1999) Older people, Australia: a social report. Canberra

11 McMichael T, Montgomery H, Costello A: Health risks, present and future, from global climate change. BMJ 2012, 344(e1359)

12 What are the consequences of floods? Office of the Queensland Chief Scientist, www.chiefscientist.qld.gov.au

13 Surat Basin Future Directions Statement, QLD Govt, Feb 2010; Surat Basin Regional Planning Framework, QLD Govt, July 2011; Surat Basin Resource Town Housing Affordability Strategy, QLD Govt, July 2011.

14 Paul R. Ward,at al, Food Stress in Adelaide: The Relationship between Low Income and the Affordability of Healthy Food, Journal of Environmental and Public Health Volume 2013

15 Mathers, C., D., and Schofield, D., J. 1998. The Health Consequences of unemployment: the evidence, Medical Journal of Australian, 1998; 168:178-182

16 Queensland Health. 2001. Social Determinants of Health – the Role of Public Health Services, 2001

17 Canadian Council on Learning 2008, Health Literacy in Canada, A healthy understanding 2008, Ottawa.

18 ABS, Cat No: 4102.0 - Australian Social Trends, June 2009 19 National Health Performance Authority 2013, Healthy Communities: Australian‘s experiences withprimary health care in 2010–11, p iv

20 Ibid, p2 21 The Use of Online Health Information and Call Centres in Australia, Australian Self Medication Industry Conference, 2010, Sydney

22 See for example: http://www.healthinsite.gov.au/about-us

QLD Health, page 3 What is it, and what needs to be done?, Editorial, Aust. Journal of Rural Health (2012) 20, 290–292

25 The Social Determinants of Health, SACOSS Information Paper December 2008, page 12

26 See www.health.gov.au/internet/main/publishing.nsf/Content/haccindex.htm for more information on the services provided under the HACC program.

27 Australian Institute of Health and Welfare 2012. Residential aged care in Australia 2010–11: a statistical overview. Aged care statistics series no. 36. Cat. no. AGE 68. Canberra: AIHW, p10.

28 Ibid, p8. 29 Australian Bureau of Statistics 2010, Measures of Australia’s Progress, 2010, cat. no. 1370.0, ABS, Canberra

30 Seppo Miilunpalo at al, 1997, Self-rated health status as a health measure: The predictive value of self-reported health status on the use of physician services and on mortality in the working-age population, Journal of Clinical Epidemiology, May 1997

31 Queensland Health. The health of Queenslanders 2012: advancing good health. Fourth report of the Chief Health Officer Queensland. Brisbane 2012, page 67.

32 Promoting Healthy Weight Department of Health and Ageing, www. health.gov.au, accessed 23/04/2013

33 Queensland Health. The health of Queenslanders 2012: advancing good health. Fourth report of the Chief Health Officer Queensland. Brisbane 2012, page 67.

34 Promoting Healthy Weight Department of Health and Ageing, www. health.gov.au, accessed 23/04/2013

35 Queensland Health. The health of Queenslanders 2012: advancing good health. Fourth report of the Chief Health Officer Queensland. Brisbane 2012, page 90.

36 Australian Bureau of Statistics, 2010, Measures of Australia’s Progress, 2010, cat. no. 1370.0, ABS, Canberra.

37 Queensland Health. The health of Queenslanders 2012: advancing good health. Fourth report of the Chief Health Officer Queensland. Brisbane 2012, page 96.

38 Queensland Health. The health of Queenslanders 2012: advancing good health. Fourth report of the Chief Health Officer Queensland. Brisbane 2012, page 83.

39 National Physical Activity Guidelines for Adults, Department of Health and Aged Care, 1999, Canberra, reprinted 2005

40 Diabetes Australia, www.diabetesaustralia.com.au/UnderstandingDiabetes/What-is-Diabetes/Type-2-Diabetes/, accessed 9/7/2013

41 Diabetes Australia, www.diabetesaustralia.com.au/UnderstandingDiabetes/What-is-Diabetes/Type-2-Diabetes/, accessed 9/7/2013.

42 Diabetes Australia, www.diabetesaustralia.com.au, accessed 8/5/2013.

43 Queensland Health. The health of Queenslanders 2012: advancing good health. Fourth report of the Chief Health Officer Queensland. Brisbane 2012, page 38.

44 www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/ Hypertension_means_high_blood_pressure, accessed 9/7/2013

45 Heart Foundation, www.heartfoundation.org.au/your-heart/ cardiovascular-conditions/pages/blood-pressure.aspx, accessed 9/7/2013

46 Heart Foundation, www.heartfoundation.org.au, accessed 8/5/2013.

47 Fraser CE, Smith KB, Judd F, Humphreys JS, Fragar LJ & Henderson A, 2005: Farming and mental health problems and mental illness, International Journal of Social Psychiatry, 51(4): 340349.

48 Roufeil, L, 2011, Getting mental health services to the bush: The innovative delivery of best practice psychological services, InPsych, Australian Psychological Society, 2011.

49 Queensland Health. The health of Queenslanders 2012: advancing good health. Fourth report of the Chief Health Officer Queensland. Brisbane 2012, page 34.

50 Asthma Foundation, www.asthmafoundation.org.au, accesses 8/5/2013.

51 Queensland Health. The health of Queenslanders 2012: advancing good health. Fourth report of the Chief Health Officer Queensland. Brisbane 2012

52 ibid 53 J Rheumatol, at al, Relative importance of musculoskeletal disorders as a cause of chronic health problems, disability, and health care utilization: findings from the 1990 Ontario Health Survey, 1994 Mar;21(3):505-14. Arthritis Community Research and Evaluation Unit (ACREU), Wellesley Hospital Research Institute, Toronto, ON, Canada.

54 Peter M. Brooks, The burden of musculoskeletal disease—a global perspective, Clinical Rheumatology, November 2006, Volume 25, Issue 6, pp 778-781.

55 Australian Bureau of Statistics, 2010, Measures of Australia’s Progress, 2010, cat. no. 1370.0, ABS, Canberra.

56 For information on the avoidable mortality concept; rationale for including conditions; and ICD-10 codes, please refer to the information available in the Australian and New Zealand Atlas of Avoidable Mortality, available from: http://www.publichealth.gov. au/publications/australian-and-new-zealand-atlas-of-avoidablemortality.html

57 The annual avoidable death rate is the indirectly age-standardised death ratio as provided by PHIDU.

58 Queensland Health. The health of Queenslanders 2012: advancing good health. Fourth report of the Chief Health Officer Queensland. Brisbane 2012, page 30.

59 AIHW (Australian Institute of Health and Welfare) 2012. Dementia in Australia. Cat. No. AGE 70. Canberra, page 12.

60 Alzheimer‘s Australia 2011. Dementia across Australia 2011-2050, Deloitte Access Economics Pty Ltd, page 7.

61 Alzheimer’s Disease International World Alzheimer Report 2009 Available from: http://www.alz.co.uk/research/files/ WorldAlzheimerReport.pdf .

62 Harvey et al 2003 The prevalence and causes of dementia in people under the age of 65 years. J Neurol Neurosurg Psychiatry. 2003 Sep;74(9):1206-9.

63 Australian Government 2013. A Snapshot of Early Childhood Development in Australia 2012 - AEDI National Report, Australian Government, Canberra, page 8.

64 National Health Performance Authority 2013, Healthy Communities: Immunisation rates for children in 2011–12, NHPA, Sydney.

65 World Health Organisation, Measles vaccines: WHO position paper, Weekly epidemiological record, No 35, 84, 349–360, WHO, Geneva, 2009.

66 100 Years of Australian Lives – Population, Reflecting a Nation: Stories from the 2011 Census, ABS Pub 207.0

67 Howat, P & Stoneham, M, 2010 Why Australia needs a Sustainable Population Policy, published in Issues, Vol 91, June 2010.

68 AIHW (Australian Institute of Health and Welfare), 2007, Dementia in Australia. National data analysis and development, Australian Institute of Health and Welfare, Cat No. AGE 53, Canberra.

69 Access Economics. Keeping dementia in front of mind: incidence and prevalence 2009–2050. Available from www.apo.org. au/ research/keeping-dementia-front-mind-incidence-andprevalence-2009–2050.

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