Needs Assessment for the Rural Health Outreach Fund and Medical Outreach Indigenous Chronic Disease Fund

Transcription

1 Needs Assessment for the Rural Health Outreach Fund and Medical Outreach Indigenous Chronic Disease Fund Rural Workforce Australia Victoria November 2013 RHOF and MOICDP Needs Assessment 2013 Page 1

2 TABLE OF CONTENTS 1. INTRODUCTION About this Report BACKGROUND Funds Transition Program Overview: Rural Health Outreach Fund Program Overview: Medical Outreach Indigenous Chronic Disease Program Program Governance NEEDS ASSESSMENT METHODOLOGY Research and Data Analysis Methodology Consultation Methodology RHOF PRIORITIES: CHRONIC DISEASE Policy Priorities Chronic Disease Conditions Mortality Causes of Morbidity Risk Factors Cancer Cardiovascular disease Diabetes Respiratory health Renal Health LGA Priority Disease Indicators in Rural Victoria Local perspectives on chronic disease RHOF PRIORITIES: MENTAL HEALTH Policy Priorities Mental Health Trends LGA Mental Health Indicators in Rural Victoria What the consultations tell us about need RHOF PRIORITIES: MATERNITY AND CHILD HEALTH RHOF and MOICDP Needs Assessment 2013 Page 2

3 6.1. Policy Priorities Birth Trends LGA Maternal and Paediatric Indicators in Rural Victoria LGA Maternal Health Indicators in Rural Victoria What the consultations tell us about need MEDICAL OUTREACH INDIGENOUS CHRONIC DISEASE Policy priorities Aboriginal and Torres Strait Islander Health Trends LGA Aboriginal Health in Victoria Aboriginal and Torres Strait Islander perspectives on chronic disease NEXT STEPS: PLANNING OUTREACH SERVICES FOR RURAL, REGIONAL AND ABORIGINAL AND TORRES STRAIT ISLANDER COMMUNITIES APPENDIX A: VICTORIAN ADVISORY FORUM FOR THE RURAL HEALTH OUTREACH FUND AND MEDICAL OUTREACH INDIGENOUS CHRONIC DISEASE PROGRAM APPENDIX B: SOURCE DOCUMENTS APPENDIX C: LGA ANALYSIS- SUMMARY OF INDICATORS PRESENTED BY VICTORIAN LOCAL GOVERNMENT AREA APPENDIX D: SUMMARY TABLE OF HEALTH INDICATOR DATA BY LGA RHOF and MOICDP Needs Assessment 2013 Page 3

4 ABBREVIATIONS AND ACRONYMS USED IN THIS DOCUMENT ACCHS ACSC ASCG-RA MBS MOICD MSOAP MSOAP ICD MSOAP MS MSOAP Ophthalmology RA RHOF RWAV the national evaluation USOAP VAF Aboriginal Community Controlled Health Services Ambulatory Care Sensitive Conditions Australian Standard Geographical Classification Remoteness Area Medicare Benefits Schedule Medical Outreach Indigenous Chronic Disease Fund Medical Specialist Outreach Assistance Program Medical Specialist Outreach Assistance Program Indigenous Chronic Disease Medical Specialist Outreach Assistance Program Maternity services expansion Medical Specialist Outreach Assistance Program Ophthalmology expansion Remoteness Area (under the ASGC) Rural Health Outreach Fund Rural Workforce Agency Victoria Evaluation of the Medical Outreach Assistance Program and the Visiting Optometrists Scheme Final Report Urban Specialist Outreach Assistance Program Victorian Advisory Forum RHOF and MOICDP Needs Assessment 2013 Page 4

5 1. INTRODUCTION The Rural Workforce Agency Victoria (RWAV) is a not for profit, government-funded agency that specialises in the recruitment, placement and support of GPs, nurses and allied health professionals. RWAV was formed in 1998 in response to the substantial general practice workforce shortages in rural and remote areas. RWAV is an experienced administrator of health outreach programs, having operated the Medical Specialists Outreach Assistance Programs (MSOAP) in Victoria for over a decade. The Australian Government Department of Health s Rural Health Outreach Fund (RHOF) and Medical Outreach Indigenous Chronic Disease Program (MOICDP) are new flexible funds that consolidate a number of previous outreach health programs. These programs support multidisciplinary outreach health teams to improve mental health, maternal and paediatric health, eye health and chronic disease management in Victorian rural, regional and Aboriginal and Torres Strait Islander communities. The RHOF and MOICDP operate in each state and the Northern Territory. RWAV, the Victorian fundholder for both programs, promotes the programs collectively as VicOutreach About this Report This report presents the findings of a needs assessment for both programs conducted by RWAV from August to October Section 2 presents an overview of the programs, including the background to establishing the Funds, an overview of each fund and a summary of the national MSOAP evaluation. It presents some of the barriers and enablers for providing outreach health services in rural, regional and remote communities. Section 3 describes RWAV's needs assessment methodology. Sections 4 to 7 present the findings from the needs assessment for each of the Funds health priorities for which RWAV is responsible in : Chronic Disease Management, Mental Health and Maternal and Child Health. The first part of each section presents the local government area (LGA) analysis followed by a summary of the consultation findings. The report concludes with a discussion of the considerations when delivering outreach health services for rural, regional and Aboriginal and Torres Strait Islander communities in Victoria. Understanding the LGA Analysis A series of tables are presented in this document that analyse population and health indicators by LGA. In developing these tables, a search of key geographic, demographic and health indicators was undertaken. Criteria for choosing indicators included: The indicator is available for all 79 Victorian LGAs Most recent data that could be found was included. In relation to ranking data, based on the raw scores for the indicator, Victorian LGAs are ranked from 1 (worst) to 79 (best) in relation to the respective indicator. Other data such as population numbers or proportions are specified as such and not ranked. The following outlines how to read these tables. RHOF and MOICDP Needs Assessment 2013 Page 5

6 Figure 1: LGA Data Tables Predominant remoteness classification Health Indicators- shaded for different diseases Department of Health Region Local Government Area Health Region Hume RA CANCER Malignant PER 100,000 RANK (2011) CANCER Avoid-able deaths per 100,000 RANK (2011) CVD Avoidable deaths per 100,000 RANK (2008) CVD Circulatory disease (2008) RANK CVD Hypertension ACSC admissions rate RANK (2008) Mitchell (S) Murrindindi (S) Strathbogie (S) Greater Shepparton Moira (S) RANKING SCORES: In this example, Moira Shire is ranked 12 out of 79 LGAs for Malignant Cancers per 100,000 people in Victoria. It is not shaded and therefore is not in the top 10 in rural Victoria. Ranking scores in the Top Ten LGAs in rural Victoria are shaded. In this example, Greater Shepparton is ranked 13 of the LGAs in Victoria for Cardiovascular Circulatory disease per 100,000 in Rural Victoria. It is shaded because it is ranked in the top 10 of rural LGAs. RHOF and MOICDP Needs Assessment 2013 Page 6

7 2. BACKGROUND The Australian Government established the RHOF and MOICDP in 2010 following a strategic review of the administrative arrangements in the Health and Ageing portfolio. After the review, a number of health care program funding streams were consolidated into larger funds to reduce the administrate cost for grant holders, increase flexibility, and more efficiently provide evidence-based funding for the delivery of health outcomes in the community. In 2011, the Australian Government commissioned the Evaluation of the Medical Outreach Assistance Program and the Visiting Optometrists Scheme Final Report 1 (the national evaluation), a comprehensive review of the outreach health services programs. In designing the new funds' guidelines, the Australian Government accepted the national evaluation's recommendations to broaden outreach services funding support to include allied health and promote multidisciplinary teams. This model had been employed for recent expansions to the MSOAP including the Maternity Services and Indigenous Chronic Disease, but is a significant change for the outreach medical specialists funded through MSOAP Core. With the advent of the new funds, the national total of funds for outreach health services was preserved; however, the Australian Government implemented a new model to allocate funding across jurisdictions. The model applied remoteness weightings to the costs of providing outreach health services to more effectively support the health needs of communities in remote and very remote areas of Australia. Under this model, Victoria received less funding for the RHOF than was previously allocated through MSOAP due to the relatively close proximity of the Victorian population to the nearest urban centre, as defined under the Australian Standard Geographical Classification system. The $1 million (approx.) reduction in funding available for the RHOF requires RWAV to review and prioritise the outreach health services previously funded through the MSOAP. The funding allocated under the MOICDP has remained at previous levels Funds Transition There are standing contractual arrangements between the Australian Government and other organisations delivering outreach programs that will be consolidated into the RHOF. The Royal Flying Doctor Service is the current fundholder for the Rural Women's GP Service and the Australian Society of Ophthalmologists currently administers the MSOAP Ophthalmology expansion. As the previous fundholder, RWAV has immediate responsibility for the funds held in the MSOAP Core, MSOAP Indigenous Chronic Disease, MSOAP Maternity Services (MSOAP-MS), Paediatric Surgery Outreach Program, and Urban Specialist Outreach Assistance Program (USOAP). Funds held in the MSOAP Ophthalmology and Rural Women's GP program will transition to RWAV to operate as single fund as the existing contracts expire. Figure 2: New Funds for outreach health services New Victorian flexible fund Rural Health Outreach Fund Previous Victorian program Medical Specialists Outreach Assistance Program (MSOAP) - Core MSOAP Maternity services expansion 1 Health Policy Analysis (2011) Evaluation of the Medical Specialist Outreach Assistance Program and the Visiting Optometrists Scheme Final report, Department of Health and Ageing, Canberra, accessed at RHOF and MOICDP Needs Assessment 2013 Page 7

8 Paediatric Surgery Outreach Program (Victorian component only) Rural Women's GP service (from 2015) MSOAP Ophthalmology expansion (from 2014) Medical Outreach Indigenous Chronic Disease Program MSOAP Indigenous Chronic Disease Urban Specialist Outreach Assistance Program 2.2. Program Overview: Rural Health Outreach Fund The aim of RHOF is to improve health outcomes for people living in regional, rural and remote locations by supporting the delivery of outreach health activities. The objectives are to: provide both public and private outreach health services that address prioritised community needs broaden the range and choice of health services available in regional, rural and remote locations remove the financial disincentives that create barriers to service provision Priority Areas Financial support is provided by RHOF to support travel, accommodation and service expenses for medical specialist and allied health teams providing outreach health services for the following: Maternal and paediatric health Mental health Support for chronic disease management Eye health. RHOF will focus on all regional and rural locations in Victoria classified as ASGC-Remoteness Area 2 4 locations Inner Regional (RA2), Outer Regional (RA3) and Remote (RA4). This includes all Victorian areas outside of Melbourne and Geelong. There are no very remote (RA 5) locations in Victoria Program Overview: Medical Outreach Indigenous Chronic Disease Program The aim of the MOICDP is to increase access to a range of health services, including expanded primary health for Aboriginal and Torres Strait Islander people in the treatment and management of chronic diseases. The objectives are to: increase access to multidisciplinary care in primary health care settings increase the range of services offered by visiting health professionals to prevent, detect and manage chronic disease more effectively. RHOF and MOICDP Needs Assessment 2013 Page 8

9 Priority Areas The MOICDP will focus service delivery on the following chronic conditions: Cardiovascular disease Diabetes Chronic respiratory disease Chronic renal (kidney) disease Cancer. MOICDP will focus on all Aboriginal and Torres Strait Islander communities in Victoria (RA 1 4) Program Governance The Australian Government defines the operations and eligible services for outreach funding support through Service Delivery Standards for each of the programs. A copy of these Service Delivery Standards can be found at The programs are guided by a Victorian Advisory Forum (VAF) comprising a broad range of stakeholders with relevant knowledge and involvement with existing health delivery arrangements in regional, rural and Aboriginal and Torres Strait Islander communities in Victoria. The VAF membership is listed at Appendix A. The VAF has a dual function: Provide a consultative mechanism for RWAV and the Department of Health (the department) to determine how best to deploy resources to address the identified priorities in Victoria. Evaluate all outreach proposals presented by the RWAV and endorse those proposals that meet both the priorities of the programs and the needs of the proposed locations. RHOF and MOICDP Needs Assessment 2013 Page 9

10 3. NEEDS ASSESSMENT METHODOLOGY The transition to the new programs provides RWAV with an opportunity to implement a new model for planning, prioritising and delivering outreach services to align with the recommendations of the national evaluation and the National Health Reform directions. This needs assessment will assist RWAV to target services to communities with the highest levels of need, identified by analysing health status indicators of Victorian LGAs and through consulting with local communities. Notes on the needs assessment This needs assessment focuses on identifying the health needs in line with the national priorities for each fund. As planning responsibility for eye health and female GP services will not transition to RWAV until 2014, the data analysis and consultations focused on the mental health, maternal health and chronic disease management needs in Victorian rural and Aboriginal and Torres Strait Islander communities. The needs assessment will be updated in 2014 to include a comprehensive analysis of the available eye health data and the distribution of female GPs in rural Victoria. The new RHOF eligibility criteria and reduced funding will have the biggest impact on the services established through MSOAP Core. The service delivery plan for MSOAP Core, developed in 2002, comprises only medical specialists, as dictated by the program's Service Delivery Standards. While RWAV reviewed the program annually and responded by either renewing current services or making minor changes to the service mix, the service plan as a whole has not been thoroughly reviewed for some period. The needs assessment will help RWAV to reshape the service plan and prioritise funding support according to current health needs. When the MSOAP MS, MSOAP ICD and USOAP commenced in 2010, target communities were identified through health data and consultations with health services. Outreach services support was prioritised and allocated to communities based on RA classification, overall funding availability, population, and burden of disease and birth data. The Service Delivery Standards for these programs supported funding for allied health and nursing professionals, as well as medical specialists, to encourage multidisciplinary teams. As these service plans were based on a recent assessment of community need, the activity undertaken for this needs assessment focused on confirming that the current maternity services were still meeting the needs of the local community. The needs assessment process involved: Conducting desktop research into health status and service usage data to identify priority areas for RHOF and MOICDP services Consulting with health services and other organisations on local area health needs, current and planned health services, and to assess infrastructure support. RHOF and MOICDP Needs Assessment 2013 Page 10

11 3.1. Research and Data Analysis Methodology RWAV contracted Rural Health Workforce Australia to undertake the research and data analysis component of this needs assessment. The research and data analysis were designed to: Identify Victorian LGAs in the priority order of RA-4, RA-3 and RA-2 locations For RHOF, to analyse demographic, epidemiological and health status data by LGA in the priority health domains of: - Incidence of chronic disease, including: Chronic respiratory disease Cancer Cardiovascular disease Diabetes Chronic renal disease - Maternity and paediatric health - Mental health. For MOICDP, to analyse demographic, epidemiological and health status data for Aboriginal and Torres Strait Islander population by LGA in the priority health domains of: - Incidence of chronic disease, including: Chronic respiratory disease Cancer Cardiovascular disease Diabetes Chronic renal disease Analyse the available data on chronic disease determinants such as physical activity, risky alcohol consumption, obesity and smoking Method The desktop analysis was undertaken over a one month period in August September An extensive search was conducted to source data, and key stakeholders were contacted to provide advice on appropriate data sources. The project methodology has involved: 1. Literature search for publicly available data and information on the priority health domains and chronic disease determinants and data available by LGA (see Appendix 1). This included Government policies and program guidelines, published reports, statistical data and special data requests and analyses for Australia, Victoria, and Victorian LGAs. 2. Analysis and summary of the evidence available for the priority health domains and chronic disease determinants. 3. Ranking and prioritising of these determinants by LGAs for RA2-4 locations in Victoria. RHOF and MOICDP Needs Assessment 2013 Page 11

12 Data Limitations Whilst mortality and morbidity data is available for Australia and Victoria, the data available at Victorian LGA level is limited. The LGA analysis includes key public indicators for priority geographic and health areas. Limitations in the data include: 1. Data available is for different time periods 2. For some indicators, synthetic indicators have been developed and applied to LGAs, drawing on selfreported National Health Survey data 3. For some chronic diseases, such as renal disease, there was very limited data available at Victorian LGA level. This research therefore draws on the best publicly available data; however, it cannot provide an assessment of the data accuracy or quality. Aboriginal and Torres Strait Islander data In 2011, Census data reported 37,991 Aboriginal and Torres Strait Islander people in Victoria. This represents 0.7% of Victoria s population. With 4.6% of Victorians not specifying their Aboriginal or Torres Strait Islander status, this may be an under-representation of this population in Victoria. At LGA level, Aboriginal and Torres Strait Islander populations ranged from 15 people to 2240 people. The relatively small population counts mean that there is no publicly available health indicator data at Victorian LGA level specifically related to Aboriginal and Torres Strait Islander people within those LGAs. From a data point of view, the report relies on the available national, state and regional information in regards to Aboriginal and Torres Strait Islander people, locally available information and information gained from consultations Consultation Methodology Over a six-week period in September October 2013, RWAV consulted with a range of stakeholders through semi-structured interviews conducted either in person or by telephone, an ed feedback form, and via questions on health need and service access included in RWAV s Annual GP survey. The consultation plan was designed to: Validate the service needs identified through the data, identify existing health services to address needs and service gaps, and support future health service planning Establish or strengthen productive relationships with organisations with health service planning responsibilities Assess the outreach services established under MSOAP Core in order to prioritise services according to community need Confirm that the service mix established under USOAP, MSOAP ICD and MSOAP MS is responding to the current health needs and trends, and that host locations are satisfied with the current visiting health services Engage potential outreach health professionals and host services Communicate the fund changes to stakeholders and prepare them for change. Stakeholder groups RWAV identified four key stakeholder groups to consult: RHOF and MOICDP Needs Assessment 2013 Page 12

13 Medicare Locals and Department of Health regional offices hold knowledge about regional trends and service systems. RWAV consulted with these organisations to: prioritise communities in need identify key informants for local consultations identify the capacity of the current health system in different locations to support outreach health services establish working partnerships to assist in future needs assessments and other program planning activity. Local health services, including hospitals, community health services and local Aboriginal Community Controlled Health Services hold knowledge on local area health needs and gaps in the local system. RWAV consulted with these organisations to: Validate the service needs identified through the data and identify health teams to address needs and service gaps Identify potential host services and assess locations for capacity to establish, support and sustain outreach health services Determine appropriate service delivery models Identify existing local networks to ensure outreach service planning is aligned and integrated with local needs assessments, service plans and current service delivery. Current outreach service providers and host locations were consulted on the current outreach program to improve the new outreach program operations. As current recipients of outreach funding, these stakeholders were informed and prepared for potential changes to funding allocation arising from: New program Service Delivery Standards that: specify that services are to be targeted at regions and communities with the highest levels of need encourage multidisciplinary teams by supporting allied health and nursing professionals to provide outreach services, either by accompanying a medical specialist or working as part of a local health team Reduced funding of approximately $1 million for Rural Health Outreach Fund. General Practitioners are the entry point into the health system and have a frontline understanding of the health needs of their communities. They develop care plans for patients and refer patients to outreach services. RWAV consulted with General Practitioners to seek feedback on health need. 4. RHOF PRIORITIES: CHRONIC DISEASE 4.1. Policy Priorities National and State policies aim to create effective responses to the significant health challenge presented by chronic diseases to protect the quality of life and well-being of all Australians. By the year 2020, almost three quarters of all deaths internationally will be due to chronic diseases according to the World Health Organisation 2. In Australia, the burden of chronic disease is growing in line with this trend. 2 World Health Organisation, Global status report on noncommunicable diseases 2010, Geneva, World Health Organization, RHOF and MOICDP Needs Assessment 2013 Page 13

14 The following definition of chronic disease is defined by the Medicare Benefits Schedule: A 'chronic medical condition' is one that has been, or is likely to be, present for at least six months or is terminal. This includes but is not limited to asthma, cancer, cardiovascular illness, diabetes mellitus, musculoskeletal conditions and stroke 3. Most of the disease burden for Australians is due to chronic disease, and its prevalence is rising. Chronic disease is estimated to be responsible for around 80% of the total burden of disease when measured in terms of disability-adjusted life years National Health Priorities In 2006, the Australian Government released the National Chronic Disease Strategy 4 that, in addition to the supporting National Service Improvement Frameworks, was designed as a nationally-agreed agenda to address and manage chronic diseases into the future. The framework focuses on seven principle areas: Adopt a population health approach and reduce health inequalities Prioritise health promotion and illness prevention Achieve person-centred care and optimise self-management Provide the most effective care Provide coordinated and integrated multidisciplinary care across services, settings and sectors Achieve significant and sustainable change Monitor progress. The National Chronic Disease Strategy outlines four key actions to address health priority: 1. Prevention across the continuum 2. Early detection and early treatment 3. Integration and continuity of prevention and care 4. Self-management. Nine national health priority areas contribute significantly to the burden of illness and injury, and have potential for health gains and reduction in the burden of disease. These are: arthritis and musculoskeletal conditions asthma cancer control cardiovascular health diabetes mellitus injury prevention and control mental health obesity 3 Commonwealth Department of Health and Ageing, MBS Chronic Disease Items, Accessed at 27 August National Health Priority Action Council (NHPAC) 2006, National Chronic Disease Strategy, Australian Government Department of Health and Ageing, Canberra RHOF and MOICDP Needs Assessment 2013 Page 14

15 dementia Victorian Service Priorities In May 2011, the Victorian Government released the Victorian Health Priorities Framework that sets the outcomes, principles and priorities for health planning and service delivery in Victoria, including for the management of chronic disease. Accompanying the Framework, the Victorian Government has also released the Rural and Regional Health Plan which outlines key priorities and associated actions for rural and regional services. The Rural and Regional Health Plan identifies continuing demand on rural and regional communities and their healthcare services, with particular challenges being variability in health status, health outcomes and service availability. Whilst there is variability within and between communities, the Plan and its associated technical documents identify that rural and regional Victorians display poorer health-related characteristics and behaviours, and are less healthy overall than metropolitan Victorians. The Rural and Regional Health Plan focusses on the following priorities: reducing the disparity in health behaviours and health outcomes among rural Victorians addressing the social determinants and relative disadvantage experienced by some rural and regional communities (these are significant drivers of poorer health outcome and health status) improving the health literacy of all rural and regional Victorians, with a particular focus on those most disadvantaged reducing unnecessary and avoidable variability of service access across rural and regional areas ensuring that service design and capacity is flexible enough to respond to the changes in demand across rural and regional Victoria developing a better understanding of rural and regional health outcomes ensuring a viable rural and regional health service system Chronic Disease Conditions Chronic diseases have a prolonged course of illness and can have long latency periods. They can have complex causality and multiple risk factors resulting in functional impairment or disability 6. Some patients have multiple chronic diseases. The RHOF chronic disease program prioritises a group of conditions that include: Cardiovascular diseases are heart, stroke and blood vessel diseases. Cardiovascular disease includes ischaemic heart disease (or coronary heart disease), cardiomyopathy, angina, hypertensive heart disease, heart failure, cardiac dysrhythmias, cerebrovascular disease such stroke and congestive heart failure 7. Risk factors for cardiovascular disease include family history, 5 Australian Institute of Health and Welfare. Accessed at on 4 September Australian Institute of Health and Welfare. About Chronic Disease. Accessed at on 6 Sept Heart Foundation. Cardiovascular diseases. Accessed at on 6 Sept RHOF and MOICDP Needs Assessment 2013 Page 15

16 age, tobacco exposure, high blood pressure (hypertension), high cholesterol, obesity, physical inactivity, diabetes, unhealthy diets, and harmful use of alcohol 8. Cancer is a disease of body cells that potentially grow and spread through the body. Types of cancer include bowel, brain, breast, cervical, head and neck, kidney, leukaemia, lung, lymphoma, ovarian, pancreatic, prostate, skin, stomach and testicular cancers. Risk factors for cancer include ageing, tobacco, sunlight, ionizing radiation, certain chemicals and other substances, some viruses and bacteria, certain hormones, family history of cancer, alcohol, poor diet, lack of physical activity, or being overweight 9. Diabetes Mellitus (type 2 diabetes) is where the pancreas makes insulin, but in a lesser amount than the body needs. Major risk factors for diabetes include genetics and lifestyle factors such as high blood pressure, overweight or obesity, insufficient physical activity and poor diet 10. Chronic respiratory diseases are lung diseases that affect the flow of air in and out of the lungs such as asthma, chronic obstructive pulmonary disease and bronchiectasis. Major risk factors for respiratory disease are tobacco smoke, air pollutants and allergens 11. Renal diseases are diseases of the kidneys. Common risk factors for kidney disease are high blood pressure, diabetes and inherited kidney diseases. Kidney disease can lead to complications including cardiovascular disease Mortality Life expectancy In Victoria, a woman born in 2007 can expect to live 84.4 years and a male can expect to live 80.3 years, with life expectancy having increased by 2 4 years between 1996 and However, for both men and women, life expectancy at birth in rural Victoria is significantly lower (78.9 for males and 83.8 for females) than the state and metropolitan estimate (80.8 for males and 84.7 years for females). The difference in life expectancy at birth, between rural and metropolitan Victoria, was 1.9 years in males and 0.8 years in females. Amongst health regions, life expectancy at birth was significantly below the state estimate for males in Barwon South West (79.4 years), Gippsland (78.1 years), Grampians (79.1 years), Hume (79.3 years) and Loddon Mallee (78.6 years) regions and for females in Loddon Mallee (83.4 years) region. The difference between the highest and lowest male life expectancy among LGAs is 7.5 years (Melbourne 82.8 and Loddon 75.3 years). The difference between the highest and lowest female life expectancy among LGAs is 7.3 years (Melbourne 88.9 and Glenelg 81.5 years) for the period World Heart Federation. Cardiovascular Disease Risk Factors. Accessed at on 6 Sept Cancer Council of Australia. Types of Cancer. Accessed at on 6 Sept Diabetes Australia. Type 2 Diabetes. Accessed at Diabetes/ on 6 Sept Australian Institute of Health and Welfare. Chronic respiratory conditions including asthma and COPD. Accessed at on 6 Sept Kidney Health Australia. What is Kidney Disease. Accessed at on 6 Sept Victorian Department of Health. Life Expectancy at birth: Victoria 2003 to Accessed at on 9 Sept RHOF and MOICDP Needs Assessment 2013 Page 16

17 Causes of death Ischaemic heart disease and cerebrovascular diseases, particularly stroke, are the leading cause of death in Australia and Victoria. In Victoria, ischaemic heart disease (5,670 deaths) and cerebrovascular disease (2,744 deaths) were the leading underlying causes of death in Dementia and Alzheimer's disease was the third leading cause of death in 2008, with deaths increasing by 139% between 1999 and (Table 1) The top 10 underlying causes of death, both in Australia and Victoria in 2011, were: cardiovascular diseases (ischaemic heart disease, cerebrovascular disease and heart failure) cancers (lung, colon and blood cancer) dementia and Alzheimer disease chronic respiratory disease diabetes renal disease or diseases of the urinary system. In Victoria, these accounted for 54% of all deaths, with the top 20 underlying causes of death accounting for 68% of all deaths. Notable differences between Australian and Victorian trends were: In Victoria, deaths due to diabetes and accidental falls are decreasing whilst in Australia overall deaths due to diabetes and accidental falls are increasing Deaths due to suicide and intentional self-harm and incidence of colon cancer are increasing in Victoria, whilst nationally these are reducing. RHOF and MOICDP Needs Assessment 2013 Page 17

18 Table 1: Underlying causes of death for top 20 conditions: Australia 2002 and 2011; and Victoria 2003 and Australia Australia Change Victoria Victoria Change No. Rank No Rank No Rank No Rank or Ischaemic heart diseases Cerebrovascular diseases Dementia and Alzheimer disease Lung cancer Chronic lower respiratory diseases Diabetes Colon cancer Blood and lymph cancer Heart failure Diseases of the urinary system Prostate cancer Breast cancer Maintained Influenza and pneumonia Pancreatic cancer Intentional self-harm Skin cancers Accidental falls Hypertensive diseases Cardiac arrhythmias Cirrhosis and other diseases of liver Causes of Morbidity High rates of chronic disease are also responsible for burden of disease in Victoria. Burden of disease provides an estimate of healthy life lost due to premature death, prolonged illness or disability. Disability Adjusted Life Years measure the number of years lost due to ill health, disability or early death 13. In Victoria, cancer, cardiovascular disease and mental disorders account for more than half of the disease burden in the state 14. Chronic diseases are more prevalent in populations groups that include older Australians, the frail, those experiencing socio-economic disadvantage, rural and remote populations, people with mental illness and those with physical and intellectual disabilities. 6 RHOF and MOICDP Needs Assessment 2013 Page 18

19 4.5. Risk Factors An increase in exposure to risk factors is seen as driving the increase in chronic diseases alongside the ageing of the population. These risk factors centre on the following: Tobacco smoking: Smoking is the single most important cause of ill health and death in Australia. In , there were 2.8 million Australians aged 18 years and over who smoked daily (or 16.3%) 14 Risky and high risk alcohol use: almost one in ten Australians over 14 years of age in 2007 drank at levels considered risky or high risk to health, with those living in remote or very remote areas more likely to drink at risky or high risk levels than those living in other areas 15. In Victoria, alcohol-related harms are increasing, and heavy drinking among young adults is rising significantly from approximately 25% in 2002 to over 40% in Physical inactivity: In , more than two in every three (66.9%) adult Australians were either sedentary or had low levels of exercise 14 Poor diet and nutrition: Overall, Australians are having an adequate intake of nutrients. Poor dietary choices are reflected in the declining percentage of people who consume the recommended volume of fruit and vegetables only 7.9% of Victorians met the guidelines for vegetable intake in 2008 compared with 12.3% in Obesity: Close to two in every three (63.3%) adult Australians are overweight or obese, with 28.3% obese and 35% overweight. Obesity is increasing, and 25% of children now report as overweight or obese. The prevalence of overweight and obesity since 1995 has increased by 12%, with adult males more likely to be overweight or obese than adult females. Based on past trends and in the absence of effective interventions, by 2025 this figure in predicted to increase to 33% 14 High blood pressure: In , just over 3.1 million adult Australians (21.5%) measured high blood pressure 14 High blood cholesterol: In , 6.8% or 1.5 million Australians reported having high cholesterol levels LGA Indicators of Exposure to Risk Factor for Chronic Disease in Rural Victoria The key chronic disease risk indicators available for Victorian LGAs include: Ambulatory Care Sensitive Conditions (ACSC) Hospital Admissions rates. These represent hospital admissions by LGA for chronic diseases that could be managed in primary care. Appendix One provides the rate ratios by LGA where Victoria=1. Rates higher than 1 indicates higher admissions rates. Proportion of the LGA population that is estimated to have the risk factors: Overweight or obesity, physical inactivity, risk of short-term harm from alcohol use and smoking. These are estimates derived from the Victorian Population Health Survey Australian Bureau of Statistics2012 Australian Health Survey: First Results, Catalogue number Australian Medical Association, Alcohol Use and Harms in Australia Information Paper. Accessed at on 5 September Vic Health Victorian Public Health and Wellbeing Plan , Government of Victoria. 17 Australian Institute of Health and Welfare Australia s Food & Nutrition 2012: in brief. Cat. no. PHE 164. Canberra: AIHW. 18 Heart Foundation. Data and Statistics. Accessed at on 23 August 2013 RHOF and MOICDP Needs Assessment 2013 Page 19

20 Table 2 outlines the ranking of rural LGAs by Department of Health area ranked against all Victorian LGAs for these indicators of risk. The ranking ranges from 1=worst to 79=best. The shaded areas reflect the top ten LGAs with the highest indicator of need in rural Victoria. Rural Victoria ranks highly for risk factors of chronic disease. The LGAs that have top ten indicators in rural Victoria include: Barwon South West: Surf Coast, Glenelg, Warrnambool, Corangamite, Southern Grampians Grampians: Horsham, Yarriambiack, Hindmarsh, West Wimmera Gippsland: Baw Baw, Bass Coast, Latrobe and East Gippsland Hume: Mitchell, Murrindindi, Strathbogie, Greater Shepparton, Moira, Mansfield and Indigo Loddon Mallee: Greater Bendigo, Campaspe, Buloke, Gannawarra, Swan Hill and Mildura. Table 2: Rural Victoria, Local Government Areas, ranking for chronic disease hospital admissions (2012) and selected risk factors (2008). Health Region and LGA ACSC 19 chronic admit RANK Overweight & Obese RANK Physical Inactivity RANK Alcohol risk RANK Smoking RANK Barwon South West Greater Geelong Surf Coast Queenscliff Colac-Otway Corangamite Warrnambool Moyne Southern Grampians Glenelg Grampians Northern Grampians Horsham Yarriambiack Hindmarsh West Wimmera Moorabool Golden Plains Hepburn Ballarat Pyrenees Ararat Gippsland Baw Baw South Gippsland Bass Coast Latrobe Wellington East Gippsland Hume Mitchell Murrindindi Ambulatory care sensitive conditions RHOF and MOICDP Needs Assessment 2013 Page 20

21 Health Region and LGA ACSC 19 chronic admit RANK Overweight & Obese RANK Physical Inactivity RANK Alcohol risk RANK Smoking RANK Strathbogie Greater Shepparton Moira Mansfield Benalla Wangaratta Indigo Alpine Wodonga Towong Loddon Mallee Macedon Ranges Mount Alexander Greater Bendigo Central Goldfields Campaspe Loddon Buloke Gannawarra Swan Hill Mildura Cancer Cancer is the leading cause of burden of disease in both Australia and Victoria. In Victoria, the number of people with cancer is expected to continue to increase, with the number of new diagnoses predicted to increase faster than the rate of population growth. Over 28,000 Victorians develop cancer each year, with prostate cancer the leading cause of new cancer in 2009 at 20% of all new reports, followed by bowel cancer (13%), breast cancer (12%), melanoma and lung cancer (8% each). Lung cancer, however, is the most common cause of cancer deaths (19%) followed by prostate cancer (13%) and bowel cancer deaths (8%). 20 Cancer is very age-dependent, with less than 1% of tumours occurring before age 15 and 57% in persons over 65 years. More men than women develop cancer: 134 for every 100 females. The male excess was largely due to tobacco-related cancers and the large number of prostate cancer. 3 Cancer rates for men and women in Victoria are consistent with national rates. At least 1 in 3 Victorians will develop a cancer other than non-melanocytic skin cancer by the age of Australian data also indicates that cancer outcomes worsen for Aboriginal and Torres Strait Islander status, by remoteness area and socio-economic status. For all cancers combined, Australians identifying as Aboriginal and Torres Strait Islander experienced higher incidence and mortality rates. Incidence rates and survival were lower for people living in remote areas compared with those in major cities. Mortality rates rose with increasing remoteness. Incidence and mortality rates rose, and survival from all cancers fell as a person s socio-economic status decreased Cancer Council Victoria. 2011, Canstat: Cancer in Victoria, Cancer Epidemiology Centre 2011 Accessed at on 15/08/ Australian Institute of Health and Welfare & Australasian Association of Cancer Registries Cancer in Australia: an overview, Cancer series no. 74. Cat. no. CAN 70. Canberra: AIHW. RHOF and MOICDP Needs Assessment 2013 Page 21

22 In Victoria, Melbourne residents have better survival rates from cancer than those for residents from the rest of Victoria. The reasons for this are not clear, although it is possible that poorer access to cancer services may be a contributing factor Cardiovascular disease Risk factors for cardiovascular, heart diseases and stroke include high blood pressure, high cholesterol, overweight and obesity, physical inactivity, low fruit and vegetable intake, alcohol and smoking. Nine in 10 adult Australians have at least one risk factor for cardiovascular disease, and one in four (25%) have three or more risk factors. In Victoria, approximately 750,000 of Victorians aged 18+ (estimated from self-reported health surveys) have cardiovascular disease, with the most common condition being high blood pressure. Cardiovascular disease is responsible for one-fifth of the total disease burden in Victoria. Ischaemic heart disease and stroke are the major contributors to cardiovascular disease burden, (accounting for 58% and 26% of CVD respectively) and are the top two causes of burden of disease in both males and females in Victoria. The Heart Foundation Heart maps show the rate of heart attack where early treatment is crucial across Victoria. Rural and regional Victorian rates of heart attack were 37% higher than in metropolitan Melbourne with 36 rural and regional LGAs having a standardised morbidity ratio higher than expected Diabetes Diabetes is Australia s fastest growing chronic disease, with an estimated 275 Australians developing diabetes every day 24. It is estimated that 1.7 million Australians have diabetes, but that up to half of type 2 diabetes cases remain undiagnosed. By 2031, it is estimated that 3.3 million Australians will have type 2 diabetes. 25 Amongst Aboriginal and Torres Strait Islander people, the reported prevalence in 2002 was two to four times higher than in the wider population. When accounting for the differences in life expectancy and population spread across age-based demographics, the ratio is four times higher in the broader community. The prevalence of diabetes in Victoria in was lower than that reported for Australia as a whole, at 4.6% compared to 7.5%. Of the 4.6% of Victorians suffering from diabetes, type 1 diabetes accounted for 0.6% of the population and type 2 diabetes captured the remaining 4.5% of the population. Along with those with diabetes, it was determined that a further 4.3% of Victorians are at risk of developing type 2 diabetes. This population at risk was found to be physically inactive, to sit for more than 8 hours a day, as well as those who are obese and suffering from hypertension Heart Foundation. Victorian Heart Maps. Accessed at on 15 Aug Vos T, Goss J, Begg S and Mann N Australian Burden of Disease and Injury Study, Projected Health Care Costs Report. University of Queensland and AIHW. 24 Tanamas SK, Megaliano DJ, Lynch B, Sethi P, Willenberg L, Polkinghorne KR, Chadben S, Dunstan D and Shaw JE AusDiab The Australian Diabetes, Obesity and Lifestyle Study. Melbourne: Baker IDI Heart and Diabetes Institute 25 ABS (2004) Diabetes in Australia: A snapshot, Australian Bureau of Statistics 26 Department of Health 2012, The Victorian Health Monitor, State Government, Accessed at on 11 Aug RHOF and MOICDP Needs Assessment 2013 Page 22

23 4.9. Respiratory health State and National Governments have worked closely in recent years to identify ways to prevent, treat, understand and manage these diseases, recognising the significant personal, social and economic costs of asthma and other respiratory diseases. According to the Australian Health Survey, an estimated 6.3 million Australians suffered from a chronic respiratory condition in Respiratory conditions are believed to be the most commonly managed problems in general practice. Data from the Bettering the Evaluation and Care of Health survey of general practitioners suggest that they were managed at a rate of approximately 20 times per 100 encounters from to Chronic respiratory conditions include asthma, chronic obstructive pulmonary disease (COPD), bronchiectasis and other chronic lung diseases. An estimated 2.3 million Australians had asthma in Asthma affects 10 12% of Australian adults and 14 16% of Australian children, which is high by International standards. There were increases in the proportion of people suffering from asthma in the 1980s and 1990s; however, no further significant increases have been observed. Aboriginal and Torres Strait Islander Australians have higher rates of hospitalisation for asthma than the broader population. Rates are also higher in people living in remote areas and people living in more disadvantaged localities. COPD is a serious long-term disease that mainly affects older people. An estimated 530,000 Australians had COPD in Renal Health Occupational lung diseases result from breathing in harmful dusts or fumes, such as silica, asbestos and coal dust. This exposure typically occurs in the workplace. Pneumoconiosis, or scarring of the lung tissue caused by inhaled dust, is one of the most common forms of occupational lung disease. 11 Chronic kidney disease is increasing across Australia, with lifestyle and behavioural factors being the major contributors to this increase. These increases are exacerbated in rural and Aboriginal and Torres Strait Islander communities. The 2012 Australian Kidney Health report 29 identifies the following trends: one in three adults are at increased risk of developing chronic kidney disease one in nine adults have at least one clinical sign of existing chronic kidney disease approximately 1.7 million Australians may be affected by early-stage kidney disease and do not know it 11.3% of all deaths in Australia are due to, or associated with, kidney failure every day about six Australians commence expensive dialysis or transplantation to stay alive 27 Australian Institute of Health and Welfare. Chronic Respiratory Conditions including Asthma and COPD. Accessed at on 15 Aug Britt H, Miller G, Charles J, Henderson J, Valenti L, Harrison C et al A decade of Australian general practice activity to General practice series no. 32. Sydney: Sydney University Press. 29 Kidney Health Australia. Fast Facts on CKD in Australia. Accessed at on 15 Aug 2013 RHOF and MOICDP Needs Assessment 2013 Page 23