Closing the Gap in Inner North West Melbourne. A Population Health Needs Assessment

Transcription

1 Closing the Gap in Inner North West Melbourne A Population Health Needs Assessment February 2013

2 Table of Contents 1 INTRODUCTION Project Purpose Project Methodology Availability and Quality of Data 1 2 POLICY CONTEXT AND ABORIGINAL SPECIFIC FUNDING Policy Context Specific Funding 3 3 DEMOGRAPHIC PROFILE INWMML CATCHMENT Demographics Household Income Employment, Disadvantage and Income Support Education Household Composition, Renting and Ownership Family Status Specific Services 9 4 HEALTH STATUS Overall Health Status in Victoria Chronic Disease Mental, Emotional and Social Wellbeing Injury and Poisoning Sexual Health Eye and Dental Health Age and Disability Maternal and Child Health 15 Inner North West Melbourne Medicare Local ABN Telephone: (03) Fax: (03) Street address: Level 1, 369 Royal Parade, Parkville, Victoria 3052 Postal address: PO Box 139, Parkville, Victoria enquiries: inwmml@inwmml.org.au Inner North West Melbourne Medicare Local. October, Closing the Gap in Inner North West Melbourne February 2013

3 5 DETERMINANTS OF HEALTH Physical Activity Nutrition and Food Security Overweight and Obese Status Tobacco, Alcohol and Drug Use Family Violence Crime 19 6 LOCAL SERVICE SYSTEM AND SERVICE USE Hospital Presentations Medicare Benefits Schedule (MBS) Items PIP Indigenous Health Incentive (IHI) Pharmacy Use of Allied Health Services Service Provider Perspective Consumer and Stakeholder Feedback 24 7 GAP ANALYSIS AND PRIORITIES 25 APPENDICES 26 Appendix A: Policy Context 26 Appendix B: LGA Demographic Profiles 30 City of Moonee Valley 32 City of Moreland 33 City of Yarra 37 City of Melbourne 41 Appendix C: Services in the Catchment 45 References 49 Acknowledgements INWMML acknowledges the Wurundjeri people and other peoples of the Kulin nation as the Traditional Owners of the land on which our work in the community takes place. We pay our respects to their Elders past and present. Medicare Locals gratefully acknowledge the financial and other support from the Australian Government Department of Health. Notes Throughout this document the term is used to refer to and also Torres Strait Islander people who may have moved to the region. Use of the terms Koori, Koorie and Indigenous are kept. Closing the Gap in Inner North West Melbourne February 2013

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5 Introduction PROJECT PURPOSE This report sets out the Health Needs Assessment undertaken by Inner North West Melbourne Medicare Local (INWMML). INWMML is an independent, locally governed and run, not for profit organisation dedicated to improving primary health care in our local community. INWMML S catchment encompasses the Local Government Areas of Melbourne, Moreland, Moonee Valley and Yarra. The needs analysis was developed to provide: An evidence base for future planning, and for prioritising actions to improve the health and wellbeing of people living in the catchment Direction and focus to the work of the INWMML Close the Gap and Care Coordination and Supplementary Services (CCSS) programs A catchment-wide context for local Closing the Gap and associated partnership work An informed INWMML s approach to vulnerable populations Direction for practice support and other programs. 1.2 PROJECT METHODOLOGY The Needs Assessment involved: Collecting data and information from a range of sources including the Social Health Atlas of Australia: Statistical Local Area and Local Government Area, the and Torres Strait Islander Health Performance Framework 2012, and the Inner North West Primary Care Partnership s Closing the Health Gap, Inner North West Region: Profile Report. A full list of references can be found at the end of this report Reviewing resources available in the catchment and surrounding areas including Community Controlled Health services and specific programs in mainstream services, through consultations and other sources of information A gap analysis comparing needs and local resources Preparing a report of the findings. 1.3 AVAILABILITY AND QUALITY OF DATA There has been significant progress in the availability and quality of statistical information on people over the last decade in Australia, however many challenges remain. 1 Two key challenges relevant to this report are: The limited amount of validated data available at LGA and Medicare Local catchment level The limited amount of health data specific for the community, which is perhaps the most important aspect of the local health analysis. These data gaps and data quality issues limit the ability to fully understand and assess the needs of people living in the INWMML catchment. Where available, data has been presented in the report by INWMML catchment area, and/or Local Government Area. Where data is only available at the Victorian or national level, the assumption has been made that it also has relevance for the communities residing in the INWMML catchment. KEY ISSUES: Data gaps and data quality issues limit the ability to fully understand and assess the needs of people living in the INWMML catchment. Introduction 1 AIHW (2013). Indigenous Australians data. Closing the Gap in Inner North West Melbourne February 2013 Introduction 1 1

6 Policy Context and Specific Funding 2Policy Context and Specific Funding 2.1 POLICY CONTEXT The policy context for Health is complex. There are many Commonwealth, state and local government policy frameworks, partnership agreements and plans in place to improve the health and wellbeing of Australians (see Appendix A of this report). The key documents are: The Statement of Intent and the National Indigenous Reform Agreement (2008) which set out six targets to close the gap on Indigenous disadvantage. Close the gap in life expectancy within a generation (by 2031) Halve the gap in mortality rates for Indigenous children under five within a decade (2018) Ensure all Indigenous four year olds in remote communities have access to early childhood education within five years (by 2013) Halve the gap in reading, writing and numeracy achievements for Indigenous children within a decade (2020) Halve the gap for Indigenous students in Year 12 equivalent attainment by 2020 Halve the gap in employment outcomes between Indigenous and non-indigenous Australians within a decade (2018). The National Partnership Agreement on Closing the Health Gap in Indigenous Health Outcomes sets out five priority areas which all states and territories must address as part of the Closing the Gap agenda: Tackling smoking Primary health care services that deliver Fixing the gaps in the patient journey Healthy transition to adulthood Making health everyone s business. Koolin Balit, the Victorian government s strategic directions for Health in Victoria , which identifies four priority areas: A healthy start to life A healthy childhood A healthy transition to adulthood Caring for older people. The North and West Metropolitan Region (NWMR) Closing the Health Gap Strategic Plan proposes action across the life span and has three priority areas for practical action over the four years. Screening for health issues (early, every time, everywhere) amongst vulnerable children, youth, adults and the elderly in the NWMR Engagement of people to assist understanding and acceptance of screening and the need for the follow-up of the health issues identified Assist people navigate the NWMR health system, once issues are identified and the need for more complex help is recognised. KEY ISSUES: The policy environment is complex, but has increasingly been focused around closing the gap in disadvantage There are numerous national, state, regional and local plans which seek to address disadvantage, each with specific targets, strategies and timelines Many policies, agreements and plans are set to expire in the near future (except Koolin Balit which is ) A new National Health Plan is currently being developed by the Commonwealth government and is due to be released in mid Closing the Gap in Inner North West Melbourne February 2013 Policy Context and Specific Funding

7 2.2 ABORIGINAL SPECIFIC FUNDING Funding arrangements are also complex and, at times, consumers and service providers find them difficult to navigate. Both the Commonwealth and Victorian governments currently fund a range of programs, initiatives and projects (recurrent and time limited) which target people. These include: specific Medicare Benefits Schedule (MBS) items including the People Health Assessment (715), Healthy Kids Check (10986) and Follow-up (10987), and the Health Worker Services (81300 and 10980) PBS co-payments to reduce cost as a barrier to use of medicines Practice Incentive Program (PIP) Indigenous Health Initiative (IHI), to support general practice and Health Services to provide better health care for patients, including best practice management of chronic disease Specific roles such as Tobacco Workers, and Healthy Life Style Workers, to address risk factors or health priority areas Specific programs such as the Care Coordination and Supplementary Services (CCSS) Program, and Closing the Gap programs, which are designed to build service system capacity, and increase peoples access to appropriate services Primary health care funding for Community Controlled Health organisations to deliver targeted services and programs to their Community, including medical, oral health, mental health, child and family welfare, alcohol and drugs, family violence, etc. 2 The Victorian Government also funds a range of specific programs, positions, projects and service system reform activities including: Improving Care for Patients (ICAP), Health Promotion and Chronic Care (AHPACC), the Koorie Maternity Service, In-Home Support, Best Start, and child and family welfare services. In addition, when funding universal programs such as Home and Community Care (HACC) and Out-of-Home Care, governments sometimes allocate specific funding to organisations for the provision of services to clients. Governments also require service providers to facilitate priority of access for people to a range of services, such as community health services, which are required to prioritise people and other vulnerable population groups using an agreed demand management framework. KEY ISSUES: The complexity and the variety of funding arrangements available to people can be confusing and difficult to understand, resulting in people and service providers not having a clear picture of what services people are entitled to. As a result, people may miss out on services which they are entitled to, and which are intended to improve health outcomes. Policy Context and Specific Funding Closing the Gap in Inner North West Melbourne February 2013 Policy Context and Specific Funding 3

8 Demographic Profile INWMML Catchment 3Demographic Profile INWMML Catchment 3.1 DEMOGRAPHICS The Australian Bureau of Statistics (ABS) estimates that 1,599 people live in the INWMML catchment. However, this is likely to be an under-estimate as the census is widely accepted as under-counting people. 2 The City of Yarra also has a high proportion of people who live in transient circumstances, or spend significant time in the area but may not be formally recognised as residing in the area. Table 1 shows: 4.2% of all Victorians live in the INWMML catchment 0.38% of residents living in the INWMML catchment identify as being of descent The INWMML catchment (and each LGA) has a lower percentage of residents than the Victorian average The median age of people living in the INWMML catchment is higher (25 years) than the average median age of people living in Victoria (22 years). The City of Yarra has the highest median age of 31 years, which is notably higher than the median age (22 years) of people living in Victoria The Cities of Yarra and Melbourne have a higher percentage of residents aged years, than the INWMML average The Cities of Moreland and Moonee Valley have more children aged (0 4 years and 5 14 years than the INWMML catchment average) Over 40% of the residents in the catchment are aged 24 years or younger, compared with 30% of all residents. Table 1: resident estimates Melbourne Moonee Valley Moreland Yarra INWMML INWMML All residents * Victoria Total residents , ,392 37,990 Percent of total population 0.28% 0.30% 0.48% 0.43% 0.38% 100% 0.81% Number of males ,674 Percent of males 62.20% 49.21% 51.14% 50.31% % 49.16% Number of females ,316 Percent of females 37.80% 50.79% 48.86% 49.69% 47.59% 50.90% 50.84% Median age Number of children 0 4 years ,823 4,690 Percent of children 0 4 years 5.70% 11% 10.10% 6.90% 8.90% 5.50% Number of children 5 14 years ,207 8,696 Percent of children 5 14 years 6.40% 18.30% 19% 8.40% 14.10% 8.20% Number of young people years ,543 7,394 Percent of young people years 27% 20.50% 17% 21% 20.20% 16.00% Number of adults years ,097 9,486 Percent of adults years 42.70% 35.10% 34.60% 41.80% 36.20% 37.80% Number of adults years ,311 6,100 Percent of adults years 1.52% 16.70% 13.50% 19.40% 15.60% 20.20% Number of mature adults 65+ years ,411 1,627 Percent of mature adults 65+ years 2.60% 7.50% 5.50% 3.10% 5% 12.30% Source: ABS. (2013) Census of Population and Housing. and Torres Strait Islander Peoples (Indigenous) * Profiles. * ID Profile (2013). INWMML Community Profile. 4 Closing the Gap in Inner North West Melbourne February 2013 Demographic Profile INWMML Catchment

9 KEY ISSUES: INWMML has a relatively small number and lower percentage of residents than Victoria as a whole The median age of people living in the catchment is slightly higher than for the population Victoria wide Moreland LGA is home to the highest number of people (43.9% of people living in the catchment). people living in Moreland are spread across the city, with the highest number of residents living in Coburg, Glenroy, Pascoe Vale, Brunswick, Brunswick East and Brunswick West. It should be noted that ACES (the residential aged care and hostel facility) is located in Brunswick East. A detailed demographic profile for the LGAs of Moreland, Moonee Valley, Yarra and Melbourne is provided in Appendix B. 3.2 HOUSEHOLD INCOME people are more likely to have lower incomes than non- people. Lower income levels and employment status explain from one-third to one-half 3 of the gap in self-assessment health between and non- Australians. 3 Table 2 indicates that people living in the City of Melbourne have the highest household incomes within the catchment, and the percentage of residents earning $1,000 or more per week (31.2%), is notably higher than for all people living in Victoria (13.9%). people living in the INWMML catchment are more likely (8.1%) to have negative/nil income, than all residents of the catchment (3.0%), and are less likely to earn over $1,000 per week (23.4% of residents only), than all residents (46.5%). KEY ISSUES: Australians are more likely to have lower incomes than non- Australians Lower income levels and employment status has been shown to have a negative impact on health and wellbeing residents in Melbourne had a higher median household income than non- residents. There was minimal difference for those residing in Moreland and Moonee Valley. However, Yarra showed a marked difference with households making $621 less per week. Demographic Profile INWMML Catchment Table 2: household incomes (weekly) Melbourne Negative/nil income % $1 $ % $ % $ % $ % $ % $ % $1000 or more % Median total household income ($/weekly) Non- Median total household income ($/weekly) Moonee Valley % % % % % % % % Moreland Yarra INWMML % % % % % % % % % % % % % % % % INWMML All Residents * % 3.4% % 2.3% % 3.2% % 5.6% % 7.5% % 6.7% % 6.4% % 54.4% Victoria 2, % 2, % 3, % 3, % 3, % 2, % 1, % 3, % 1,702 1,381 1,151 1, ,351 1,377 1,215 1, Source: ABS. (2013) Census of Population and Housing. and Torres Strait Islander Peoples (Indigenous) Profiles. * ID Profile (2013). INWMML Community Profile. 2 NACCHO. (2012). Definitions webpage. Community Profile. 3 VicHealth. (2012). Health in Victoria: Research Summary p5. O Closing the Gap in Inner North West Melbourne February 2013 Demographic Profile INWMML Catchment 5 5

10 Demographic Profile INWMML Catchment 33.3 EMPLOYMENT, DISADVANTAGE AND INCOME SUPPORT Victorians are less likely to participate in the labour force (58.3%) compared to (64.6%) non- Victorians. In 2011, 14.09% of Victorians were unemployed compared to 5.5% of the overall Victorian population. Unemployment increases the burden of financial distress and has detrimental psychological and social impacts. 4 Table 3 shows that people in the INWMML catchment are more likely to be employed (full-time and part-time) than people across Victoria. The highest rates of employment can be seen amongst the residents of Melbourne and Moonee Valley. Moreland has the highest percentage of people not in the workforce. Table 3: Disadvantage, work and employment status Melbourne Moonee Valley Moreland Yarra INWMML * Victoria SEIFA Index of 1,049 1, ,019 1,012 - Relative Socio-economic Disadvantage 5 in labor force ,147 employed full-time 60.43% 61.03% 51.52% 53.21% 55.36% 51.56% All employed full-time * 62.4% 61.0% 59.4% 65.5% employed part-time 23.74% 30.15% 27.27% 26.92% 27.06% 26.55% All employed part-time * 26.4% 32.3% 32.5% 28.6% 30.3% - unemployed 11.51% 4.41% 12.46% 12.18% 10.71% 14.09% Non- unemployed 8.1% 4.7% 5.8% 4.7% - - not in workforce 36.80% 34.18% 37.22% 38.58% 36.85% 41.70% Table 4: Education for 15+ year olds Percent who did not complete Year 12 Percent who have attained a higher education qualification Melbourne Melbourne All Residents Moonee Valley Moonee Valley All resident Moreland Moreland All Residents Yarra Yarra All Residents Victoria 41.1% 25.0% 51.1% 43.7% 53.8% 43.4% 54.9% 29.0% 70.86% 28.1% 70.3% 19.5% 58.3% 19.5% 58.1% 24.1% 70.9% 7.7% Source: ABS. (2013) Census of Population and Housing. and Torres Strait Islander Peoples (Indigenous) Profiles. 6 Closing the Gap in Inner North West Melbourne February 2013 Demographic Profile INWMML Catchment

11 Victorians not in the workforce A Commonwealth and State working paper concerning workforce participation and skill development (2012) 6 suggested that in Victoria in 2010 there were approximately 3,500 Victorians, not in the labour force who were receiving one or more of the following: ABSTUDY (968) Parenting Payment single (1,979) Parenting Payment partnered (279) Youth Allowance (apprenticeship and student) 270 Sickness Allowance approx 20 Partner Allowance approx 20. The paper also identified that there were a further 5,400 5,700 Victorians who were not employed and not receiving Commonwealth benefits that may be receiving Disability or a Carers payment, but that accurate numbers were not available at this time. INWMML catchment-wide and local government level data on the pension status, of residents was not available. KEY ISSUES: people living in the INWMML catchment are less likely to be in the labour force than non- Victorians people in the INWMML catchment are more likely to be employed (full-time and part-time) than people across Victoria The highest rates of employment can be seen amongst the residents of Melbourne and Moonee Valley Moreland has the highest percentage of people not in the workforce It is important not to assume that all those who are unemployed should or could be in the labour force. More information needs to be gathered at a catchment level concerning aboriginal income support (ie for study, disability, parenting, carer, etc) and employment needs. 3.4 EDUCATION 3 Victorian statistics indicate that for 22.8% of Victorians, Year 12 or equivalent is the highest year of school completed, and Australians are about 15 times less likely to have a bachelor degree or above, and around 23% less likely to have a certificate or diploma. 7 Table 4 shows that the education levels of people are lower than for non- people living in the catchment. However, the education levels of the people living in the catchment are higher than the average Victorian. residents of the City of Melbourne are more likely to have completed Year 12 and attained a higher education qualification than people living in the other three LGAs. KEY ISSUES: While the education levels of people living in the INWMML are notably lower than the non- people living in the catchment. They are higher than the average education levels of all Victorians. 3.5 HOUSEHOLD COMPOSITION, RENTING AND OWNERSHIP Issues around inadequate housing are particularly significant for Australians because of the association between shelter, health and dispossession from land. Victorians 8 are: More likely to live in rented dwellings, than non- Victorians More likely to move house, than non- Victorians More likely to live in larger households, than non- Victorians. Demographic Profile INWMML Catchment 4 VicHealth. (2012). Health in Victoria: Research Summary and ABS (2013) 2011 Census of Population and Housing. 5 Index has a base of 1000 for Australia: scores above 1000 indicate relative advantage and those below, disadvantage. 6 Vic DCPD (2012). workforce participation and skill development. 7 VicHealth. (2012). Health in Victoria: Research Summary pages Vic DoH. (2011). The health and wellbeing of Victorians: Victorian Population Health Survey 2008 Supplementary report. O Closing the Gap in Inner North West Melbourne February 2013 Demographic Profile INWMML Catchment 7 7

12 Demographic Profile INWMML Catchment 3Table 5 shows that people living in the INWMML catchment have a unique housing profile, which is different to both overall catchment statistics totals and to the average household across Victoria. Specific experiences of homelessness of people in the area are unknown at this time. However, rates of overall homelessness are high with the INWMML catchment experiencing 77 per 10,000 (Melbourne 141/10,000; Yarra 115/10,000; Moonee Valley 32/10,000; Moreland 53/10,000; and Victoria 42/10,000). Given homelessness has been identified by the North West Metro Region Closing the Gap Advisory Committee (see Appendix A for further information) as a concern, high numbers of those affected by homelessness in the region may involve a number of the INWMML population. Table 5: Household composition, renting and ownership Percent of family households Percent of single households Percent of group households Average number of people per household^ Average number of persons per bedroom^ Melbourne Melbourne All Residents or Non- Residents^ Moonee Valley Moonee Valley All Residents or Non- Residents^ Moreland Moreland All Residents or Non- Residents^ 46%^ 38.5% * 65.9%^ 65.9% * 68.4%^ 61.8% * 43.8%^ 49.7% * 54.8% * 77% * 30%^ 32.2% * 20.3%^ 25.0% * 18.7%^ 25.8% * 31.1%^ 28.9% * 27.8% * 15.85% * 24%^ 14.6% * 13.7%^ 4.6% * 12.7%^ 7.8% * 25.0%^ 13.8% * 9.8% * 6.84% * Yarra Yarra All Residents or Non- Residents^ INWMML All Residents * Victoria Source: ^ABS. (2013) Census of Population and Housing. and Torres Strait Islander Peoples (Indigenous) Profile. * ID Profile (2013). INWMML Community Profiles. Percent owns dwelling 6.5%^ 13.2% * 11.1%^ 38.6% * 12.4%^ 32.6% * 5.6%^ 19.8% * 26.4% * 13.23% * Percent buying dwelling 12.5%^ 16.7% * 21.1%^ 26.7% * 21.0%^ 27.6% * 12.6%^ 22.3% * 24.0% * 27.5% * Percent renting 75%^ 57.6% * 60%^ 25.6% * 60.7%^ 32.4% * 76.0%^ 48.7% * 40.7% * 54% * Median weekly rent^ $339 $400 $300 $300 $270 $310 $254 $ Closing the Gap in Inner North West Melbourne February 2013 Demographic Profile INWMML Catchment

13 KEY ISSUES: people living in the INWMML catchment are: Less likely to be living in family households than all Victorians More likely to be living in single households and group households than all Victorians Living in larger households than non- people, but have a lower average number of people per household than the average household in Victoria Have slightly higher numbers of people per household and bedroom to non- people More likely to be renting than buying or owning a property than other INWMML residents and also other Victorian people In all LGAs except Moonee Valley, communities pay lower rents than non- people Overall rates of homelessness are high in the catchment and this may affect the population. 3.6 FAMILY STATUS Table 6 shows that children living in the catchment are more likely to live in one parent families than non- children. However, children living in the cities of Moonee Valley, Moreland and Yarra are less likely to live in one parent families than children across Victoria. KEY ISSUES: children living in the catchment are more likely to live in one parent families than non- children children living in the Cities of Moonee Valley, Moreland and Yarra are less likely to live in one parent families than children across Victoria ABORIGINAL SPECIFIC SERVICES There are a number of specific programs and organisations delivered in the INWMML catchment. These are briefly described below and further information is set out in Appendix C. There are three core Community controlled organisations within the INWMML catchment Victorian Health Service (Yarra), Victorian Child Care Agency (Moreland) and Community Elders Service (Moreland). The Victorian Health Service (VAHS) with sites in Fitzroy, Preston and Thornbury is the largest provider of health and other services to people in Victoria. VAHS provides a comprehensive range of services including a large medical clinic with access to specialists, women s and children s programs, dental chairs and an oral health program, social and emotional wellbeing services including one-on-one counselling and group based programs and community programs for Elders. ASK a program of VAHS and Northern Melbourne Medicare Local provides case management and care coordination support for people with a chronic disease or complex needs. The Victorian Child Care Agency (VACCA), based in East Brunswick, is the largest provider of specific child and family welfare services in metropolitan Melbourne, delivering a range of services including: Integrated family services Playgroups Out-of-home care services Healing services Residential care Family violence Youth services ChildFIRST Lakidjeka ACSASS. The Community Elders Service (ACES), in East Brunswick, provides a 24-bed hostel, manages specific Community Aged Care packages for the Melbourne metropolitan area and runs, a HACC funded Planned Activity Group program. Demographic Profile INWMML Catchment Table 6: Family status percentages for Melbourne, Yarra, Moonee Valley, Moreland, and Victoria Melbourne ^ Melbourne All Residents or Non- Residents * Moonee Valley ^ Moonee Valley All Residents or Non- Residents * Moreland ^ Moreland All Residents or Non- Residents * Yarra ^ Yarra All Residents * Victoria % one parent families 11.5% 4.0% 19.2% 9.6% 21.1% 9.4% 15.0% 7.3% 27.3% Source: ^Source: ABS. (2013) Census of Population and Housing. and Torres Strait Islander Peoples (Indigenous) Profiles. *ID Profile (2013). INWMML Community Profile O Closing the Gap in Inner North West Melbourne February 2013 Demographic Profile INWMML Catchment 9 9

14 Demographic Profile INWMML Catchment 3There are a number of smaller Community Controlled Organisations also in the INWMML catchment such as Melbourne Youth, Sport and Recreation (MAYSAR) Access Services for Koories (ASK), Family Violence Prevention and Legal Service Victoria (AFVPLSV), Connecting Home, Hostels Limited, and Koorie Heritage Trust (KHT). In addition, a number of other organisations which provide services to the people living in the INWMML catchment are located nearby: Victorian Community Services Association Limited The Male Centre VAHS Family Counselling Yappera Childcare Service Margaret Tucker Hostel Minajalku Healing Service. Information about each of the above organisations can be found in Appendix C. programs delivered from mainstream services A number of dedicated positions and/or programs are delivered by mainstream services across the catchment. These include Community Health Services such as: The Access Team at North Yarra Community Health Service. This program has been very successful in engaging the community and runs a local program in the parks. The organisation s Annual Report shows that client contacts have increased from 348 contacts per year in 2008/09 to 974 client contacts per year in 2011/12 INWMML has also recently contracted North Yarra Community Health Service to run a new Care Coordination Service for people with chronic diseases (CCSS). This program will initially be delivered by North Yarra Community Health Service but will be expanded more broadly across the catchment in 2013/14 Merri Community Health employs an Community Engagement Officer whose role involves relationship building and training with community health service staff and other key partner organisations Doutta Galla Community Health was funded through the NWMR s Closing the Gap Plan to lead the Djederido project which involved a trial and evaluation of the music therapy program in two schools, delivered as a pro-active strategy for the prevention, early intervention and management of asthma by children and families. All the hospitals in the catchment have Liaison Officers and the Royal Women s Hospital has an Women s Health Unit. The hospitals in the catchment include: Royal Melbourne Hospital, Royal Children s Hospital, Royal Women s Hospital, Royal Melbourne Hospital, St. Vincent s hospital, the Royal Eye and Ear Hospital, and Peter MacCallum Cancer Institute. The four Councils in the catchment have dedicated positions, Reconciliation Action Plans, and formalised consultations mechanisms to engage with their community. The Inner North West Primary Care Partnership (INWPCP) currently leads a Victorian government project funded through the Closing the Health Gap initiative. This project brings together a range of agencies to explore how to develop and implement best practice health screening and evidence based responses focused on a life stage approach. (See Appendix C for details). KEY ISSUES: The INWMML catchment is comparatively well resourced with locally based Community Controlled Health services, dedicated positions and specific programs and services The community health services, local governments and hospitals in the catchment have been proactive in engaging with their communities as evidenced by the Reconciliation Action Plans (RAP), establishment of dedicated positions, and creation of culturally appropriate programs Existing partnerships and working relationships exist between the Community Controlled services and the mainstream services. This provides INWMML with an excellent platform upon which to support and facilitate work in this area There is currently significant work occurring to strengthen and improve the service system for people living in the catchment. This work is being led by the INWPCP. 10 Closing the Gap in Inner North West Melbourne February 2013 Demographic Profile INWMML Catchment

15 Health Status 4.1 OVERALL HEALTH STATUS IN VICTORIA At the population level, there is a significant gap between the health status of Victoria s residents and the general population. However, many Victorians do enjoy good health, with almost three-quarters assessing their health as excellent or very good. 9 Koolin Balit highlights the following areas of concern: The perinatal mortality rate of babies of mothers in Victoria is approximately twice that of babies of non- mothers The rate of low-birth weight babies born to mothers in Victoria is approximately twice that of non- mothers Child mortality in Victoria for children aged less than five years is more than double the non- rate Tobacco use by people in Victoria aged over 18 years is more than one and a half times the rate for non- people Rates of alcohol-related harm (ie injury) are higher for Victorians than the general population as evidenced in both emergency department and hospital admission data Hospitalisation rates for most causes are higher for people in Victoria. Overall rates are one and a half times those for non- people. Rates are more than double for several clinical specialities including dental, dialysis, psychiatry, neonatology and antenatal care Potentially preventable hospitalisations of people in Victoria are more than three times higher than for non- people Presentations to hospital emergency departments for people in Victoria are double the rate for non- people Mental-health-related admissions to hospitals and other services are notably higher than non- admission rates in Victoria people are 2.4 times more likely to have a disability than non- people. 10 Life expectancy figures are not available for Victoria at this stage. Nationally, life expectancy is considerably less for people than non- people, with a gap of 9.7 years for women and 11.5 years for men. 11 In addition, a Victorian study found that 27.4% of urban s identified that their health was fair or poor in comparison to 18.3% of non-s in an urban 4 area 12 suggesting a considerable difference in selfperceived health for the community. KEY ISSUES: At the population level, there is a significant gap between the health status of Victoria s population and other Victorians. It is postulated this trend would also be reflected in the INWMML catchment. 4.2 CHRONIC DISEASE Nationally, chronic disease contributes to 80% of the health gap between and non- Australians. 13 The majority (68%) of national deaths in were due to chronic disease including cancer, diabetes, and respiratory disease. 14 Nationally, the main contributors to the chronic disease health gap include ischaemic heart diseases (22%), diabetes mellitus (12%), diseases of the liver (core contributor alcoholic liver disease: 11%), other forms of heart disease (ie heart failure and cardiomyopathy: 6%), chronic lower respiratory diseases (6%) and cerebrovascular diseases (5%). 15 INWMML catchment-wide or local government level data on the prevalence of chronic disease amongst people was not available, so Victorian data has been used in this section of the report. Table 7 shows that in all categories of chronic disease, Victorian people have a higher prevalence than non- people. The prevalence of cancer, stroke ( women), heart disease ( men), osteoporosis ( women) and asthma are of particular concern. While the prevalence rates of diabetes is not as stark as some of the other chronic illnesses listed, previous literature indicates that: Many s may not know they have diabetes, which may indicate that the disease is under reported in this group 16 Diabetes occurs among Australians at approximately 3.5 times the rate of the total population 17 Diabetes is one of the leading causes for death and disability for men and women in Victoria 18 Hospital admissions for diabetes-related conditions are two to four times higher (depending on age and gender) in the Victorian population than the non- population, and more than double for renal dialysis. 19 Health Status 9 Vic DoH. (2012). Koolin Balit: Victorian Government Strategic Directions for Health Vic DoH. (2012). Koolin Balit: Victorian Government Strategic Directions for Health p Based on the latest mortality rates, a boy born in 2006 would be expected to live to 78.7 years on average, while a girl would be expected to live to 83.5 years. However, a man and woman aged 25 in 2006 would be expected to live to ages 79.7 and 84.2 years respectively. This shows that once people survive through childhood, the chance of dying as a young adult is very low and hence life expectancy increases. AHIW 12 Vic DoH (2011). The health and wellbeing of Victorians: Victorian Population Health Survey 2008 Supplementary report. 13 AIHW. (2011). Contribution of chronic disease to the gap in adult mortality between and Torres Strait Islander and other Australians. 14 Australian DoHA. (2012). and Torres Strait Islander Health Performance Framework, 2012 Report. 15 AIHW. (2011). Contribution of chronic disease to the gap in adult mortality between and Torres Strait Islander and other Australians. 16 AIHW. (2011). Contribution of chronic disease to the gap in adult mortality between and Torres Strait Islander and other Australians. 17 Australian DoHA. (2012). 18 and Torres Strait Islander Health Performance Framework, 2012 Report. 19 AIHW. (2011). Contribution of chronic disease to the gap in adult mortality between and Torres Strait Islander and other Australians. O Closing the Gap in Inner North West Melbourne February 2013 Health Status 11

16 Health Status 4 KEY ISSUES: There are high rates of Victorian s with cancer 20 and lower survival rates for people from cancer 21 High prevalence of stroke, osteoporosis, and asthma amongst women High blood pressure is a significant issue for both and non- populations While the prevalence of diabetes appears to be only slightly higher for people in Victoria, evidence shows that diabetes is a leading cause of death for Victorians, suggesting that late identification and/or poor diabetes management may be an issue for this population There is a lack of chronic disease data at the INWMML catchment and LGA levels. 4.3 Mental, Emotional and Social Wellbeing Victorians are more likely to experience higher rates of mental illness and lower levels of social and emotional wellbeing compared to other Victorians. Nationally, mental illness is estimated to contribute 15% of the burden of disease for Australians. The mental, emotional and social wellbeing of many Australians is compromised as a result of multiple layers of different types of trauma, including historical loss associated with the negative impact of colonisation, unresolved grief and loss, trauma and abuse, domestic violence, removal from family, substance misuse, family breakdown, cultural dislocation, racism and discrimination, and social disadvantage. 22 INWMML catchment-wide data on the mental, emotional and social wellbeing of people was not available hence Victorian data has been used in this section. Table 7: Prevalence of chronic disease related conditions males in Victoria * All males in Victoria * females in Victoria * All females in Victoria * All Persons in Victoria Urban People in Victoria^ All Urban People in Victoria^ Lifetime prevalence of cancer 11.8% 5.9% 11.5% 7.0% 11.8% 14.30% 6.4% Lifetime prevalence of heart disease 13.2% 8.1% 6.1% 5.1% 8.1% - 6.5% Lifetime prevalence of stroke - 2.8% 5.9% 2.1% 4.8% - 2.4% Lifetime prevalence of high blood pressure 24.4% 24.8% 26.5% 26.9% 25.6% 22.7% 25.9% Lifetime prevalence of arthritis 19.1% 16.3% 26.9% 23.3% 23.5% 24.6% 20.0% Lifetime prevalence of osteoporosis - 2.1% 8.2% 4.7% 8.2% - 4.7% Lifetime prevalence of asthma 26.7% 19.6% 33.2% 22.7% 29.3% 25.4% 21.2% Lifetime prevalence of type 2 diabetes 7.4% 5.8% 5.1% 3.8% 5.5% - 4.7% Table 8: Reported social and emotional wellbeing Reported high/very high levels of psychological distress males in Victoria * All males in Victoria * females in Victoria * All females in Victoria * All Persons in Victoria Urban People in Victoria^ All Urban People in Victoria^ 22.2% 9.5% 22.4% 13.0% 22.0% 22.0% 11.3% Use of mental health services 14.1% 8.50% 24.10% 14% 19.20% 17.20% 11.30% Lifetime prevalence of doctordiagnosed depression or anxiety 34.90% 14.80% 35.70% 24.30% 34.80% 35.40% 19.60% Source: Table 7: ^PHIDU (2011) Social Health Atlas of Australia: Statistical Local Area and Local Government Area.*Vic DoH (2011). The health and wellbeing of Victorians. Victorian Population Health Survey 2008 Supplementary report. Table 8: Source: Vic DoH (2011). The health and wellbeing of Victorians. Victorian Population Health Survey 2008 Supplementary report. 12 Closing the Gap in Inner North West Melbourne February 2013 Health Status

17 4 Table 8 shows that Victorians are more likely to report high/very high levels of psychological distress, higher use of mental health services and greater prevalence of doctor-diagnosed depression or anxiety. As shown in Table 9, Victorians rated fairly closely in the indicators of civic engagement. However, those who felt they were unable to gain assistance from family members was almost double that of other urban Victorians. In addition, more Victorians felt they did not have opportunities to have their say on important issues. Feeling valued by society was higher for Urban s than the total Victorian population Racism and discrimination The link between poorer physical and mental health, and self-reported perceptions or experiences of racism and discrimination has been well documented. Racism has been linked with: Low self-esteem and self-worth Reduced self-efficacy and increased sense of hopelessness Anxiety and depression Internalising, externalising and delinquent behaviour Anger and conduct problems Increased alcohol, tobacco and drug use Indicators of metabolic and cardiovascular disease Adverse pregnancy outcomes. 23 In Victoria, 21.6% of young people (15 24 years) and 31.5% of adults (25+ years) identified they have experienced discrimination within the previous 12 months 24. Additionally, 4.5% of young people and 10.6% of adults had avoided situations due to past experiences with discrimination. KEY ISSUES: Reported psychological distress amongst Victorians, use of mental health services and prevalence of doctor diagnosed depression /anxiety is notably higher Victorians are more likely to experience higher rates of mental illness and lower levels of social and emotional wellbeing, compared to other Victorians. Nearly one quarter of women in Victoria reported they had accessed a mental health service There is no notable difference between and non- people in getting support from friends or neighbours Racism and discrimination is associated with poorer mental health, physical health and reduced life chances for Victorians. Reducing the experience of racism is an important approach to improving health in this population. The VicHealth report Mental health impacts of racial discrimination in Victorian communities (2012) suggested strong links between mental and physical health and experiences of racism including: Racism is prevalent in the lives of many Victorians Racism is associated with poorer mental health and reduced life chances for Victorians. Reducing the experience of racism is an important approach to improving health in this population Organisational and community interventions are needed to reduce racism. Health Status Table 9: Reported social and civic engagement Adult population who can t or can t often get help from family when needed Adult population who feel they don t or don t often have opportunities to have a say on important issues persons in Victoria Urban people in Victoria All urban people in Victoria 15.1% 15.1% 22.4% 28.0% 33.4% 22.7% Attended a local community event in the past six months 49.5% 45.9% 53.2% Volunteering for a local group (yes or sometimes) 31.8% 22.7% 32.7% Adults who felt valued by society 48.2% 52.6% 52.6% 20 Vic DoH. (2011). The health and wellbeing of Victorians: Victorian Population Health Survey 2008 Supplementary report. 21 Australian Indigenous HealthinfoNet. (2012). Summary of Australian Indigenous health, VAHS (2011). Evidence Report for the Melbourne Metropolitan Mental Health Redevelopment Project. 24 Vic DEECD. (2009). The State of Victoria s Children 2009: children and young people in Victoria p68. Source: Vic DoH (2011). The health and wellbeing of Victorians. Victorian Population Health Survey 2008 Supplementary report. Closing the Gap in Inner North West Melbourne February 2013 Health Status 13

18 Health Status 44.4 INJURY AND POISONING Nationally, injury and poisoning is responsible for 15% of the health gap between and non- Australians. Injuries can cause long-term disadvantage to the individual, their families and the broader community. 25 Hospitalisations for injury reflect hospital attendances for the condition rather than the extent of the problem. Hospitalisations for injury and poisoning are the second most common reason for hospital admission for people (behind hospitalisation for dialysis). Hospitalisations for injury among Australians occur at twice the rate of non- Australians. In Victoria, hospitalisation rates for injury and poisoning was the third highest reason for admission (behind factors influencing health status and pregnancy/childbirth). 26 The percent of overall admissions that were attributed to this has risen from 6.8% in 2007/08 to 7.4% in 2009/ SEXUAL HEALTH Nationally the rate of HIV/AIDS is similar between and non- Australians. However, bacterial Sexually Transmissible Infections (STIs) are a considerable health problem for people. NWMR data on STIs contained in the Closing the Gap in Indigenous Health: Baseline Report (2009) indicates that there were very high rates of STIs for people living in the region. Table 10 shows that the STI rates for both adolescents and adults are notably higher than the non- population in the region, and for all people in Victoria. 27 KEY ISSUES: There are very high rates of STIs amongst adolescents and adults living the in the North and West Metropolitan Region that was also notably higher than all people across Victoria young people may be more likely to become sexually active at a younger age than their non- counterparts. Table 10: STI and hepatitis C notifications per 1,000 population The Victorian Government s State of Victoria s Children s report (2009) noted youth were significantly more likely to have been sexually active younger than non-s. 29 This was evident for year olds (22.2% versus 7.4%), year olds (42.4% versus 23.2%) and 16 year olds and over (77.4% versus 36.3%). However, the use of condoms was at a similar level to non- youth populations with under 16 year olds (54% versus 57%) and 16 years and over (62% versus 65%). 4.6 EYE AND DENTAL HEALTH As with many other areas of health, there is a lack of catchment specific information concerning eye and dental health. Nationally Australians aged over 40 years are six times more likely to experience blindness when compared to other Australians, with 94% of vision loss being preventable or treatable. 30 Issues with Trachoma (ie bacteria that causes roughening of the inner surface of the eyelids), refractive error (ie problems with light focusing), cataracts and diabetes-related complications have all been identified as problematic. Seventy nine per cent of Australian adults had self-reported eye problems and 83% of these had sought care. However, 64% of those seeking help reported that their vision issues had not been resolved. KEY ISSUES: Issues with vision and blindness are prevalent in populations. Special focus on ensuring eye checks within this group is needed, especially with those who have had a diabetes diagnosis Problems with oral health have been highlighted in child and adult populations with many not seeking treatment for dental issues for a range of reasons. Nationally, 65% of Australian adults reported having an eye examination. 31 Rates in Victoria are somewhat higher with similar rates for eye examinations between (males: 70.6%, females: 80.5%) and non- populations (males: 74.3%, females: 80.9%). 32 However, given the higher degree of eye issues within populations, it would be beneficial to increase rates of eye examinations within this population. Sexually transmissible infections 28 people in NWMR All people in the NWMR people in Victoria All people in Victoria Adolescence 15.4/1, /1, /1, /1,000 Adulthood 22.6/1, /1, /1, /1, Australian DoHA. (2012). and Torres Strait Islander Health Performance Framework, 2012 Report. 26 Vic DoH. (2012). Koori health counts! Victorian hospital data Australian DoHA. (2012). and Torres Strait Islander Health Performance Framework, 2012 Report. 28 Measure: STI and Hepatitis C notifications per 1,000 population. Proxy measure: Notifications of STIs is one indicator for unsafe sexual practices. Data source: NNDSS. All notifications in two year period (extracted 06/08/09). Service & Workforce Planning. ABS Census 2006 Estimated Resident Population.(extracted 17/07/09). 29 Vic DEECD, The State of Victoria s Children 2009: children and young people in Victoria. 30 AIHW. (2011). Eye health in and Torres Strait Islander people. 31 AIHW. (2011). Eye health in and Torres Strait Islander people Report. Source: URBIS. (2011). Closing the Gap in health outcomes in Victoria: Baseline report May Closing the Gap in Inner North West Melbourne February 2013 Health Status

19 4 Dental health of populations has also been highlighted previously as notably worse than non- populations. 33 Children are approximately twice as likely to experience caries (ie tooth decay or cavity) and a greater proportion of untreated caries. 34 Adults experience more missing teeth and periodontal health (ie gums, etc) is worse, with poor periodontal health also evident in younger populations. Common issues for not seeking dental health for children or as an adult have included cost, transport/distance, long waiting time or not available at time required, lack of time, dislikes service/professional/afraid/embarrassed, and 35, 36 inadequate services (ie not sought, not available). 4.7 AGE AND DISABILITY Age and aged care The rate of increase in Victoria s population aged over 55 years is three times the rate in the non- population. This means that caring for older people is becoming a more significant issue. 37 The INWMML catchment has a range of specific resources for the provision of aged care to the Community. Services include: Community Elders Service (ACES) which provides specific residential care, aged care packages and HACC planned activity groups Victorian Health Service (VAHS) which is funded to provide allied health and group based activities for the HACC target group The Aborigines Advancement League which is funded to provide in-home HACC services across the NWMR. people in the NWMR have a high uptake of HACC services. Table 11 shows that 538 people from the NWMR accessed at least one HACC service in Disability In 2008, half of Australians aged 15 years and over had a disability or long-term health condition and approximately 8% had a profound or severe core activity limitation. 38 Australians aged 15 years and over were 1.4 times as likely as non- Australians to have a disability or long-term health condition (non-remote areas). Data on the proportion of people with core activity need for assistance, by jurisdiction and remoteness (2006) shows that Victoria has the highest proportion of people with a disability (5.3%), compared to the national rate of 4.3%. 39 Table 12 provides details of the number of people providing unpaid assistance to a person with a disability, in the Cities of Moonee Valley, Moreland, Yarra, and Victoria wide. One hundred and five people reported needing assistance. KEY ISSUES: The population is ageing. There is a comprehensive service system in place to support people as they age in the INWMML catchment The Victorian Community has very high rates of disability. In particular, Victoria has the highest proportion of people with a disability (5.3%) with core activity need for assistance. The statistics for the four LGAs is consistent with Victorian rates. Health Status Graph 1. Population change for people aged over 55 in Victoria years 65+ years % % Non Source: DoH (2012). Koolin Balit: Victorian Government Strategic Directions for Health Vic DoH. (2011). The health and wellbeing of Victorians: Victorian Population Health Survey 2008 Supplementary report 33 Williams, et al. (2011) Review of Indigenous oral health. 34 Dental Health Services Victoria. (2010). Oral Health Plan Williams, et al. (2011) Review of Indigenous oral health. 36 Victorian DEECD. (2009). The State of Victoria s Children 2009: children and young people in Victoria. 37 Vic DoH. (2012). Koolin Balit: Victorian Government Strategic Directions for Health p9. 38 Severe or profound core activity limitation is defined as sometimes or always requiring personal assistance or supervision with self-care, mobility or communication. 39 Australian DoHA. (2012). and Torres Strait Islander Health Performance Framework, Closing the Gap in Inner North West Melbourne February 2013 Health Status 15

20 Health Status 4Table 11: Number of clients by agency region and agency type Agency region ACCO Health Service Local Govt. Major NGO RDNS Other All Clients NW Metro Barwon-SW Eastern Metro Source: DHS HACC (2012). Gippsland Grampians Hume Loddon Mallee Southern Metro Victoria 1, , MATERNAL AND CHILD HEALTH There is very little data available on the health for children in Victoria. 40 This makes it very difficult to assess the catchment needs. However, some key areas identified as problematic at state and national levels are explored below. Births Nationally, approximately 3.9% of women who gave birth in 2010 identified as and were generally younger than other Australian mothers (25.2 years compared to 30.2 years). 41 In Victoria the per cent of births registered as (ie having an aboriginal mother or father) was 1.38% of births in 2010 and 1.57% in Antenatal care Maternal health is one of the priority areas of reform identified by the Council of Australian Governments (COAG). Antenatal care provides opportunities to address health risks and support healthy behaviours throughout pregnancy and into the early years of childhood, however many women do not access services as early or as frequently as non- women. 43 Around 40% of women giving birth across Victoria are currently supported by the Koori Maternity Services (KMS) program. Additionally the KMS program supports a number of non- women having babies. 44 Smoking during pregnancy Smoking increases the risk of adverse events in pregnancy (ie miscarriage, ectopic pregnancy, preterm labour and antepartum haemorrhage), and is also associated with poor perinatal outcomes (ie low birth weight), and respiratory illnesses (ie bronchitis or pneumonia) during the child s first year of life. In 2009, mothers were 3.7 times as likely to smoke during pregnancy as non-indigenous mothers, and unlike other Australian mothers, the high rates persist across geographic areas and age groups. In 2010, it was suggested that almost half smoked at some stage during their pregnancy. 45 Victoria had the lowest proportion of mothers who smoked during pregnancy, by Indigenous status and state/territory (2009) at 39%, compared to 50% nationally (34% of non-indigenous). Only 13% of Victoria s non- mothers reported smoking during pregnancy. 46 Birth weights For babies born to mothers, the low birth weight rate increased by 11% between and the gap widened. Analysis of this data has found a strong relationship between smoking during pregnancy and low birth weight. 47 Victorian 2010 data suggests that 10.3% of babies born with an parent were classified as low birth weight. 48 NWMR Closing the Health Gap Baseline Report (2011) for the NWMR indicates that the percentage of low birth weight babies born in the region was 7.7%. This figure jumped to 17.4% of babies born to women living in the NWMR who were under 20 years of age, which is comparatively high compared to all young mothers in the NWMR catchment (8.3%) Vic DEECD. (2009). The State of Victoria s Children 2009: children and young people in Victoria p3. 41 AIHW. (2010). Australian Mothers and Babies ABS. (2012). Births Australia Australian DoHA. (2012). and Torres Strait Islander Health Performance Framework, 2012 Report p Vic DoH. (2012). Koori Maternity Service. Developmental Review. p vii. 45 AIHW. (2010). Australian Mothers and Babies ,46 AIHW. (2010). Australian Mothers and Babies ,47 Australian DoHA. (2012). and Torres Strait Islander Health Performance Framework, 2012 Report. p115, AIHW. (2010). Australian Mothers and Babies 2010 Australian. 49 Vic DoH: North and West Metropolitan Region. (2009). Closing the Gap in Indigenous Health p1. 16 Closing the Gap in Inner North West Melbourne February 2013 Health Status