Socioeconomic status is widely recognised to have an impact on health outcomes.

Chapter 1. Demographic Profile of South Australia Introduction Understanding the health status of the South Australians, requires a knowledge of the different characteristics of our communities and what drives their health and wellbeing. Personal and community health status is widely recognised to be linked to social and economic capital. Differences in a range of factors including income, employment, education, housing, and social environment can produce inequalities in health outcomes. This chapter provides an outline of South Australia s demographic profile and provides information on important health determinants of the South Australian population. The first section of Chapter 1, Population, outlines information about South Australia s population and specific groups within it. These groups include Aboriginal, culturally and linguistically diverse, migrant, refugee and carer populations. Also presented in this section is how South Australia s population has changed over time and projections of how it may change in the future. The second section of Chapter 1, Determinants of Health, considers the social environment of South Australia by focusing on a range of determinants of health: Socioeconomic status is widely recognised to have an impact on health outcomes. Education can influence a person's health through participation in employment, income and access to health care. The longer an individual spends in education and the higher their attainment, the better their overall health and wellbeing is likely to be. Income levels can affect the way that people live, the quality of their home environment, and the ability for parents to provide the care they want for their children. A relationship between income and health exists across many health indicators. Economy and employment can benefit health in a number of ways, including social contact, living conditions, access to income, and mental wellbeing. Unemployment rates, claimants of job seekers allowance, jobless families, financial stress and occupation are considered in this section. Private health expenditure is a demand for health insurance supplementary to the Medicare system. Housing and households are cornerstones of good health and wellbeing. Overcrowded and poorly built housing with a lack of amenities are major contributors to poor health. Housing stress and affordability, homelessness, living alone, and access to a computer, the internet and transportation can all impact health. Religious affiliation can have protective effects for well-being. Community safety and perceptions of safety can have an effect on quality of life. This section presents South Australians' feelings of safety and some information about experiences of violence. WORKING DRAFT FOR DISCUSSION (MAY 2013) HPC State of Our Health 1

Chapter 1. Demographic Profile of South Australia Demographic Profile of South Australia Population The resident population of South Australia is 1.6 million people, at 1.7 persons per square kilometre. Three-quarters of the population live in metropolitan Adelaide [1-1 and 1-2]. Between 2006 and 2011 the South Australian population increased by 5.6%, predominantly in the Outer Adelaide Statistical Division. Across the State, population increase was observed mainly in the older (particularly 60 years and over) age groups. South Australia's population is projected to increase by 11.6% between 2011 and 2021 [1-3 and 1-4]. In terms of population composition, South Australia has a relatively older population compared to Australia, with 16.1% of South Australians aged 65 years and over. Aboriginal persons living in South Australia account for 1.9% of the South Australian population, and represent 5.5% of the Australia's Aboriginal population [1-5]. Over one in five South Australians were born overseas, and 12.7% of South Australians were born in predominantly non-english speaking countries. 14.4% of South Australians do not speak English as a main language at home, while 2.5% of the South Australian population cannot speak English well or not at all [1-6]. Net Overseas Migration accounts for nearly two-thirds of South Australia's population growth, the second highest nationally [1-7]. 13.4% of South Australians are carers providing unpaid care, help or assistance to a family member or others. This is the highest proportion nationally [1-8]. Socioeconomic Status South Australia recorded the third highest proportion of the population in the quintile of highest socioeconomic disadvantage [1-9]. Education Less than half of South Australians aged 15 years and over completed Year 12 or equivalent as their highest year of school, below the national average and third lowest nationally. Less than a quarter of Aboriginal South Australians aged 15 years and over completed Year 12 or equivalent as their highest year of school, also below the national average and third lowest nationally [1-10-1 and 1-10-2]. 10.9% of South Australians aged 15-64 years are participating in vocational education and training (VET). This is below the national average and third lowest nationally. Conversely, the proportion of Aboriginal South Australians aged 16 years and over participating in VET is the second highest nationally [1-10-3 and 1-10-4]. Less than a quarter of South Australians aged 25-64 years have a Bachelor Degree or above. This is below the national average and second lowest nationally, although the trend is increasing [1-10- 5]. More than half of South Australians aged 15-74 years score below Level 3 for health literacy, regarded as the minimum required for individuals to meet the complex demands of everyday life and work in the emerging knowledge-based economy [1-10-6]. Income The mean equivalised disposable household income (reflecting the requirement for a larger household to have a higher level of income to achieve the same standard of living as a smaller household) in South Australia is $798 per week, the second lowest nationally [1-11-1]. More than one in five South Australian children are living in welfare dependent and other low income families, a rate higher than the national average and third highest nationally [1-11-2]. WORKING DRAFT FOR DISCUSSION (MAY 2013) HPC State of Our Health 2

Chapter 1. Demographic Profile of South Australia Economy and Employment 5.6% of South Australians aged 15 years and over are unemployed, a rate higher than the national average and second highest nationally. The rate of unemployment is correlated with socioeconomic status and more than half of job-seekers were long-term [1-12-1 to 1-12-3]. 15.6% of all families in South Australia with children under 15 years are families with no parents in employment [1-12-4]. Nearly one in five households in South Australia experienced four or more indicators of financial stress in the previous 12 months [1-12-5]. Almost half of South Australian Aboriginal households are unable to raise $2000 in a week in an emergency, an indicator of household financial stress. 31.4% of South Australian Aboriginal households had run out of money for basic living expenses [1-12-6]. Professional occupations are the most prevalent in South Australia, with just under one in five workers in these roles [1-12-7]. Health Expenditure 45.1% of South Australians have private health insurance for hospital cover, below the national average and ranked fourth highest of the states and territories. Nationally, more than half of nongovernment funding comes from out-of-pocket payments by individuals [1-13]. Housing and Households 21.4% of Aboriginal South Australians age 18 years and over are living in overcrowded households [1-14-1]. There has been an increase in the number of South Australians experiencing housing stress. 13.5% of South Australian households have housing costs that are more than 3 of their gross income. Data reveals an increasing trend in recent years [1-14-2 and 1-14-3]. 6.4% of households in South Australia are in rental accommodation owned by state government housing authorities. There are 1,753 SOMIH households in South Australia [1-14-4 and 1-14-5]. 10.8% of 15-64 year olds and 29.7% of 65-and-over year olds in South Australia are living alone, above the national average and second highest nationally [1-14-6 and 1-14-7]. The rate of rough sleepers in South Australia is 5 per 10,000 population. 3 of rough sleepers are in metropolitan Adelaide, 2% in regional centres including Whyalla and Pt Pirie, and 68% in rural and remote parts of the state [1-14-8]. South Australians are among the least likely of all Australians to live in a home with a computer, internet access or a motor vehicle. [1-14-9 to 1-14-11]. Religious affiliation Over a quarter of South Australians identify that they have no religious affiliation, third highest of the states and territories [1-15]. Community Safety 94.3% of South Australians aged 18 years and over feel very safe or safe at home alone during the day, while 83. feel very safe or safe at home alone after dark. Less than half of South Australians aged 18 years and over feel very safe or safe when walking alone in their local area after dark. Perceptions of safety varied significantly between males and females [1-16-1 to 1-16-3]. Just under one in ten South Australian adults report that they have been a victim of physical or threatened violence in the last 12 months [1-16-4]. WORKING DRAFT FOR DISCUSSION (MAY 2013) HPC State of Our Health 3

Chapter 1. Demographic Profile of South Australia Demographics Measures Population... 5 1-1. Resident Population... 5 1-2. Population Density... 6 1-3. Population Change... 7 1-3-1. Population Change (2006 2011)... 7 1-3-2. Population Change (2006 2011): Age and Sex... 8 1-4. Population Projections by Statistical Division... 9 1-5. Population Composition in South Australia... 12 1-5-1. Population Composition in South Australia: Age and Sex... 12 1-5-2. Aboriginal Population Composition: Age and Sex... 13 1-6. South Australia's Culturally and Linguistically Diverse (CALD) Population... 14 1-6-1. Population Born Overseas... 14 1-6-2. Born in Predominantly Non-English Speaking Countries... 15 1-6-3. Main Language Spoken at Home... 15 1-6-4. Proficiency in Spoken English... 16 1-7. Migration and Refugees... 17 1-7-1. Migration... 17 1-7-2. Age Profile of Migrants... 18 1-7-3. Refugees... 18 1-8. Carers... 19 1-8-1. Carers... 19 1-8-2. Young Carers... 20 1-8-3. Aboriginal Young Carers... 21 1-8-4. Culturally and Linguistically Diverse (CALD) Young Carers... 22 Determinants of Health... 23 1-9. Relative Socioeconomic Disadvantage... 23 1-10. Education... 24 1-10-1. Highest Year of School Completed: Year 12 or Equivalent... 24 1-10-2. Aboriginal Population Highest Year of School Completed: Year 12 or Equivalent... 24 1-10-3. Participation in Vocational Education and Training (VET)... 25 1-10-4. Aboriginal Participation in Vocational Education and Training (VET)... 25 1-10-5. Educational Attainment: People with Degrees (aged 25-64 years)... 26 1-10-6. Health Literacy... 27 1-11. Income... 28 1-11-1. Disposable Income... 28 1-11-2. Children in Welfare Dependent and Other Low Income Families... 29 1-12. Economy and Employment... 30 1-12-1. Unemployment Rate... 30 1-12-2. Unemployment and Socioeconomic Disadvantage... 31 1-12-3. Job Seeker Allowances... 31 1-12-4. Jobless Families with Children Under 15 Years... 32 1-12-5. Financial Stress... 32 1-12-6. Aboriginal Financial Stress... 33 1-12-7. Occupation... 34 1-13. Health Expenditure... 35 1-13-1. Private Health Insurance for Hospital Cover... 35 1-13-2. Out-of-Pocket Expenditures... 36 1-14. Housing and Households... 36 1-14-1. Aboriginal Overcrowded Households... 36 1-14-2. Housing Stress... 37 1-14-3. Affordable Housing (housing costs 3 and over of gross income)... 38 1-14-4. Affordable Housing: State and Territory Owned Rental Housing... 38 1-14-5. Aboriginal Housing... 39 1-14-6. Persons Living Alone (Aged 15-64 Years)... 40 1-14-7. Persons Living Alone (Aged 65 Years and Over)... 40 1-14-8. Homelessness... 41 1-14-9. Household Computer Access... 41 1-14-10. Household Internet Connection... 42 1-14-11. Households with No Motor Vehicle... 42 1-15. Religious Affiliation... 43 1-16. Community Safety... 43 1-16-1. Feelings of Safety at Home Alone During the Day... 43 1-16-2. Feelings of Safety at Home Alone After Dark... 44 1-16-3. Feelings of Safety Walking Alone in Local Area After Dark... 44 1-16-4. Victims of Violence... 45 WORKING DRAFT FOR DISCUSSION (MAY 2013) HPC State of Our Health 4

Chapter 1. Demographic Profile of South Australia Population 1-1. Resident Population As at the 2011 Census, the resident population of South Australia totalled just under 1.6 million people, mainly concentrated in metropolitan Adelaide. The Australian Bureau of Statistics divides South Australia into seven Statistical Districts: Metropolitan Adelaide, Outer Adelaide, Yorke and Lower North, Murray Lands, South East, Eyre, and Northern (illustrated in the map below). South Australia Resident Population (Census) Latest data: 2011 Statistical Division No. % Metropolitan Adelaide 1,168,427 73.2% Country SA sub-total 425,070 26.6% Outer Adelaide 136,354 8.5% Yorke & Lower North 46,000 2.9% Murray Lands 67,749 4.2% South East 63,076 4. Eyre 34,213 2.1% Northern 77,678 4.9% Migratory Offshore Shipping Unknown 3,072 0.2% South Australia total 1,596,569 100. SA Target Increase South Australia's population to 2 million by 2027. Increase regional populations, outside of Greater Adelaide, by 20,000 to 320,000 or more by 2020. Source: South Australia's Strategic Plan (2011). Source: Based on Australian Bureau of Statistics, Census 2011, DataPacks, Basic Community Profile, Statistical Local Areas. Latest Issue Released at 11.30am (AEST) 21/06/2012. Source: Based on Australian Bureau of Statistics, South Australia, Regional Population Growth, 2010-11, Cat. no. 3218.0. Released at 11.30am (AEST) 31/07/2012. WORKING DRAFT FOR DISCUSSION (MAY 2013) HPC State of Our Health 5

Chapter 1. Demographic Profile of South Australia 1-2. Population Density The population density of an area can have an effect on a number of issues and on overall deprivation. For example, with densely populated areas come environmental issues such as noise pollution, emissions, and overcrowding as well as social problems like crime and violence. Conversely, people living in sparsely populated areas can have issues around access to services and social isolation (Gilthorpe & Wilson, 2003). As at 30 June 2011, the population density of South Australia was 1.7 persons per square kilometre (km 2 ). This was the third lowest of all states and territories. Within South Australia itself, population density in country areas ranged from 0.1 persons/ km 2 in the Northern Statistical Division to 659.7 persons/ km 2 in metropolitan Adelaide. South Australian Population Density by Statistical Division Persons/km 2 Latest data: 2011 Metropolitan Adelaide 659.7 Country SA sub-total 0.4 Outer Adelaide 11.9 Yorke and Lower North 2.3 Murray Lands 1.4 South East 3.0 Eyre 0.5 Northern 0.1 South Australia 1.7 State Population Density Persons/km 2 Latest data: 2011 ACT 156.4 Vic 24.3 NSW 9.0 Tas 7.5 Qld 2.6 SA 1.7 WA 0.9 NT 0.2 Australia 2.9 Source: Gilthorpe, M.S. and Wilson, R.C. (2003) Rural/urban differences in the association between deprivation and healthcare utilisation. Social Science & Medicine. Volume 57, pp. 2055 2063. Source: Based on Australian Bureau of Statistics, Regional Population Growth, Australia, 2011. Cat. No. 3218.0, Population Estimates by Statistical Area Level 2, 2001 to 2011. Table 10. Estimated Resident Population, State and Territory Summary. Released at 11.30am (AEST) 31 July 2012. Source: Based on Australian Bureau of Statistics, Regional Population Growth, Australia, 2011. Cat. No. 3218.0, Population Estimates by Statistical Local Area, 2001 to 2011. Table 4: Estimated Resident Population, Statistical Local Areas, South Australia. Released at 11.30am (AEST) 31 July 2012. WORKING DRAFT FOR DISCUSSION (MAY 2013) HPC State of Our Health 6

Chapter 1. Demographic Profile of South Australia 1-3. Population Change 1-3-1. Population Change (2006 2011) Between the 2006 and 2011 Censuses, the population of South Australia increased by 84,568 persons, an increase of 5.6%. The increase in the population is due to both natural increase and migration (overseas and interstate). Metropolitan Adelaide and Country SA both recorded similar growth over the five years, up 5.9% and 4.9% respectively As illustrated below, between 2006 and 2011 the greatest population increase occurred in the Outer Adelaide Statistical Division where the population increased by 10.6% (or 12,886 people). The population of the Eyre statistical division area changed very little with a 0.2% increase over the same time period. South Australian Population Change by Statistical Division 2006 to 2011 Statistical Division % popn. change Metropolitan Adelaide 5.9% Country SA sub-total 4.9% Outer Adelaide 10.6% Yorke and Lower North 5.2% Murray Lands 1.3% South East 1.4% Eyre 0.2% Northern 3.6% South Australia 5.6% SA Target Increase South Australia's population to 2 million by 2027. Increase regional populations, outside of Greater Adelaide, by 20,000 to 320,000 or more by 2020. Source: South Australia's Strategic Plan (2011). South Australian Population Change, All Persons by Statistical Division, 2006 2011 Metropolitan Adelaide Outer Adelaide Yorke and Lower North Murray Lands South East Eyre Northern South Australia 2% 4% 6% 8% 1 12% Source: Based on Australian Bureau of Statistics, 2011 Census of Population and Housing, Census Community Profiles, Time Series Profile, South Australia. Latest Issue Released at 11.30am (AEST) 21/06/2012. WORKING DRAFT FOR DISCUSSION (MAY 2013) HPC State of Our Health 7

Chapter 1. Demographic Profile of South Australia 1-3-2. Population Change (2006 2011): Age and Sex As noted above, South Australia's population increased by 5.6% between the 2006 and 2011 Censuses, and the population increase mainly occurred in the 60 years and over age cohorts. The greatest percentage increase during this time was observed for males aged 85 years and over, at 31.8%. The greatest population change in percentage terms for females was for those aged 60-64 years, with a 26.9% increase. Conversely, population decreases were observed within some age-sex cohorts between the two Census periods. The greatest decrease for females occurred in the 75-79 age group, down 7.2%. The greatest decrease for males occurred in the 35-39 years age group, down 3.6% between the 2006 and 2011 Census periods. 85+ 80-84 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 South Australian Population Change, All Persons by Age and Sex, 2006 2011 Males Females SA Target Increase South Australia's population to 2 million by 2027. Increase regional populations, outside of Greater Adelaide, by 20,000 to 320,000 or more by 2020. Source: South Australia's Strategic Plan (2011). -1 1 2 3 4 Source: Based on Australian Bureau of Statistics, 2011 Census of Population and Housing, Census Community Profiles, Time Series, South Australia. Latest Issue Released at 11.30am (AEST) 21/06/2012. WORKING DRAFT FOR DISCUSSION (MAY 2013) HPC State of Our Health 8

Chapter 1. Demographic Profile of South Australia 1-4. Population Projections by Statistical Division Adelaide Statistical Division (metropolitan Adelaide) Projected Population Change 2011-2021 Proj. Popn. Change 2011-2021 Age (yrs) % 0-19 8.7% 20-44 8.4% 45-64 6.1% 65-84 34.8% 85+ 26.1% Total 11.8% 6 5 4 3 2 1-1 '11 '12 '13 '14 '15 '16 '17 '18 '19 '20 '21 0-19 20-44 45-64 65-84 85+ Projected population growth in the Adelaide Statistical Division (i.e. metropolitan Adelaide) is estimated to be greatest amongst the 65-84 years age group, with an increase of 34.8% projected between 2011 and 2021. Population projections for children, young people and adults under 65 years are expected to increase, however at a slower rate compared to older age groups. Outer Adelaide Statistical Division Projected Population Change 2011-2021 Proj. Popn. Change 2011-2021 Age (yrs) % 0-19 20. 20-44 23.6% 45-64 11.3% 65-84 52.7% 85+ 51.7% Total 24.2% 6 5 4 3 2 1-1 '11 '12 '13 '14 '15 '16 '17 '18 '19 '20 '21 0-19 20-44 45-64 65-84 85+ Projected population growth in the Outer Adelaide Statistical Division is estimated to be greatest amongst the 65-84 years age group, with an increase of 52.7% projected between 2011 and 2021. The 45-64 years age cohort is projected to have the slowest growth between 2011 and 2012, at an increase of 11.3% over the period. Yorke and Lower North Statistical Division Projected Population Change 2011-2021 6 Proj. Popn. Change 2011-2021 Age (yrs) % 0-19 4.2% 20-44 1.5% 45-64 0.4% 65-84 23.5% 85+ 13.9% Total 6.3% 5 4 3 2 1-1 '11 '12 '13 '14 '15 '16 '17 '18 '19 '20 '21 0-19 20-44 45-64 65-84 85+ Projected population growth in the Yorke and Lower North Statistical Division is estimated to be greatest amongst the 65-84 years age group, with an increase of 23.5% projected between 2011 and 2021. The 45-64 years age cohort is projected to increase only very slightly over the next 10 years. Source: Based on Department of Planning and Local Government, Government of South Australia, 2010. Population Projections for South Australia and Statistical Divisions, 2006-36, December 2010 release. (Medium Projection Series). WORKING DRAFT FOR DISCUSSION (MAY 2013) HPC State of Our Health 9

Chapter 1. Demographic Profile of South Australia 1-4. (cont'd). Population Projections by Statistical Division Murray Lands Statistical Division Projected Population Change 2011-2021 Proj. Popn. Change 2011-2021 Age (yrs) % 0-19 -3.3% 20-44 2.9% 45-64 -3.5% 65-84 26.2% 85+ 36.5% Total 3.9% 6 5 4 3 2 1-1 '11 '12 '13 '14 '15 '16 '17 '18 '19 '20 '21 0-19 20-44 45-64 65-84 85+ Projected population growth in the Murray Lands Statistical Division is estimated to be greatest amongst the 85 years and over population, with an increase of 36.5% projected between 2011 and 2021. The proportion of 0-19 year olds and 45-64 year olds is projected to decrease by 3.3% and 3.5% respectively over the next 10 years. South East Statistical Division Projected Population Change 2011-2021 Proj. Popn. Change 2011-2021 Age (yrs) % 0-19 -1.2% 20-44 -2.1% 45-64 1.8% 65-84 39.1% 85+ 41.4% Total 5.6% 6 5 4 3 2 1-1 '11 '12 '13 '14 '15 '16 '17 '18 '19 '20 '21 0-19 20-44 45-64 65-84 85+ Projected population growth in the South East Statistical Division is estimated to be greatest amongst the 85 years and over age group, with an increase of 41.4% projected between 2011 and 2021. The proportion of 0-19 year olds and 20-44 year olds is expected to decrease by 1.2% and 2.1% respectively over the next 10 years. Eyre Statistical Division Projected Population Change 2011-2021 Proj. Popn. Change 2011-2021 Age (yrs) % 0-19 -2.3% 20-44 -2.8% 45-64 -0.1% 65-84 35.7% 85+ 23.8% Total 3.8% 6 5 4 3 2 1-1 '11 '12 '13 '14 '15 '16 '17 '18 '19 '20 '21 0-19 20-44 45-64 65-84 85+ Projected population growth in the Eyre Statistical Division is estimated to be greatest amongst the 65-84 years age group, with an increase of 35.7% projected between 2011 and 2021. Eyre is projected to experience a decrease in the proportion of younger people (aged 0-19 and 20-44 years), down 2.3% and 2.8% respectively. Northern Statistical Division Projected Population Change 2011-2021 Proj. Popn. Change 2011-2021 Age (yrs) % 0-19 0.5% 20-44 4. 45-64 1.8% 65-84 17.8% 85+ 33.3% Total 4.7% 6 5 4 3 2 1-1 '11 '12 '13 '14 '15 '16 '17 '18 '19 '20 '21 0-19 20-44 45-64 65-84 85+ Projected population growth in Northern Statistical Division is estimated to be greatest amongst the 85 years and over population group, with an increase of 33.3% projected between 2011 and 2021. The 0-19 years age cohort is projected to increase only very slightly over the next 10 years. Source: Based on Department of Planning and Local Government, Government of South Australia, 2010. Population Projections for South Australia and Statistical Divisions, 2006-36, December 2010 release. (Medium Projection Series). WORKING DRAFT FOR DISCUSSION (MAY 2013) HPC State of Our Health 10

Chapter 1. Demographic Profile of South Australia 1-4. (cont'd). Population Projections by Statistical Division Country SA sub-total Projected Population Change 2011-2021 Proj. Popn. Change 2011-2021 Age (yrs) % 0-19 6.1% 20-44 8.1% 45-64 3.7% 65-84 35.5% 85+ 38.1% Total 11. 6 5 4 3 2 1-1 '11 '12 '13 '14 '15 '16 '17 '18 '19 '20 '21 0-19 20-44 45-64 65-84 85+ Projected population growth in Country SA is estimated to be greatest amongst the 85 years and over population, with an increase of 38.1% projected between 2011 and 2021. The 65-84 years age group is expected to increase by 35.5%. The proportion of 45-64 year olds is projected to increase by just 3.7%. SOUTH AUSTRALIA Projected Population Change 2011-2021 Proj. Popn. Change 2011-2021 Age (yrs) % 0-19 8. 20-44 8.3% 45-64 5.4% 65-84 35. 85+ 29. Total 11.6% 6 5 4 3 2 1-1 '11 '12 '13 '14 '15 '16 '17 '18 '19 '20 '21 0-19 20-44 45-64 65-84 85+ Projected population growth in South Australia is estimated to be greatest amongst the 65-84 years age bands with an increase of 35. projected between 2011 and 2021. Overall, South Australia's population is projected to increase by 11.6% between 2011 and 2021. Source: Based on Department of Planning and Local Government, Government of South Australia, 2010. Population Projections for South Australia and Statistical Divisions, 2006-36, December 2010 release. (Medium Projection Series). WORKING DRAFT FOR DISCUSSION (MAY 2013) HPC State of Our Health 11

Chapter 1. Demographic Profile of South Australia 1-5. Population Composition in South Australia 1-5-1. Population Composition in South Australia: Age and Sex South Australia has a relatively older population when compared nationally. At the time of the 2011 Census, the proportion of South Australians aged 65 years or over was 16.1% compared to 14. for Australia as a whole. An ageing population in South Australian may pose implications for both health and aged care demand and workforce issues (Australian Bureau of Statistics, 2009). The age and sex distribution of the South Australian 2011 Census population highlights that there is a relative underrepresentation of both males and females in the 0 to 44 years age cohorts compared to the national average, and, conversely, a relative over-representation in the 45 years and over age groups. There are proportionally more females in the 80 years and over cohorts than males, both in South Australia and nationally. Population Composition of South Australia Compared to Australia by Age and Sex, 2011 85+ 80-84 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 8% 6% 4% 2% 2% 4% 6% 8% SA - Males SA - Females AUS - Males AUS - Females Source: Based on Australian Bureau of Statistics, 2011 Census of Population and Housing, Census Community Profiles, South Australia and Australia. Latest Issue Released at 11.30am (AEST) 21/06/2012. Source: Based on Australian Bureau of Statistics, Australian Social Trends, March 2009. Cat. No. 4102.0, Released at 11.30am (AEST) 25/03/2009. WORKING DRAFT FOR DISCUSSION (MAY 2013) HPC State of Our Health 12

Chapter 1. Demographic Profile of South Australia 1-5-2. Aboriginal Population Composition: Age and Sex As at the 2011 Census there were 30,432 Aboriginal people in South Australia, which accounted for 1.9% of the South Australian population and represented 5.5% of the total Aboriginal population in Australia. The population pyramid below presents a comparison of the South Australian Aboriginal and non-aboriginal population by age and sex. Proportionally, the Aboriginal population in South Australia is relatively over-represented in the 0 to 29 years age groups and, conversely, under-represented in the 30 years and over age cohorts, when compared against the non- Aboriginal South Australian population structure. The considerably differences in the age distributions can at large be explained by inequalities in life expectancy and the higher premature mortality rates that are experienced in the Aboriginal populations. (Australian Bureau of Statistics, 2011). Aboriginal Population Composition of South Australia by Age and Sex, 2011 65+ 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 2 15% 1 5% 5% 1 15% 2 Aboriginal males Aboriginal females Non-Aboriginal males Non-Aboriginal females Source: Based on Australian Bureau of Statistics, 2011 Census of Population and Housing, Census Community Profiles, South Australia and Australia. Latest Issue Released at 11.30am (AEST) 21/06/2012. Source: Based on Australian Bureau of Statistics, Deaths, Australia, 2010. Cat. No. 3302.0. Deaths of Aboriginal and Torres Strait Islander Australians. Released at 11.30am (AEST) 10/11/2011. WORKING DRAFT FOR DISCUSSION (MAY 2013) HPC State of Our Health 13

Chapter 1. Demographic Profile of South Australia 1-6. South Australia's Culturally and Linguistically Diverse (CALD) Population 1-6-1. Population Born Overseas Over 1 in 5 (or 22.1%) of South Australians identified in the 2011 Census that they were born overseas. South Australia accounted for 6.7% of Australia s total population born overseas. South Australia had a lower proportion of its population born overseas compared to the national average, and was ranked fifth highest when compared to all states and territories. Proportion of the Population Born Overseas by State and Territory, 2011 35% 3 25% 2 15% 1 5% Tas NT Qld SA ACT NSW Vic WA AUSTRALIA = 24.6% Proportionally, the largest group of South Australians born overseas were aged between 75 and 84 years at 38.2%. The chart below illustrates the proportion of South Australians who were born overseas according to age group and sex. Proportion of South Australian s Born Overseas by Age and Sex, 2011 5 4 Males Females 3 2 1 0-4 5-14 15-24 25-44 45-54 55-64 65-74 75-84 85+ Total Source: Based on Australian Bureau of Statistics, 2011 Census of Population and Housing, Expanded Community Profile, X02 Country of Birth (Major Group) of Person by Age by Sex. Latest Issue Released at 11.30am (AEST) 21/06/2012. WORKING DRAFT FOR DISCUSSION (MAY 2013) HPC State of Our Health 14

Chapter 1. Demographic Profile of South Australia 1-6-2. Born in Predominantly Non-English Speaking Countries The Census 2011 found that 12.7% of South Australians were born in predominantly non-english speaking (NES) countries. This was lower than the national average of 15.7%. Proportion of the Population Born in Predominantly Non-English Speaking Countries, 2011 2 15% 1 5% Tas Qld NT SA WA ACT NSW Vic AUSTRALIA = 15.7% Source: Based on Australian Bureau of Statistics, 2011 Census of Population and Housing, Basic Community Profile, B09 Country of Birth of Persons by sex. Latest Issue Released at 11.30am (AEST) 21/06/2012. 1-6-3. Main Language Spoken at Home There were 229,549 South Australians who did not speak English as a main language at home as at the 2011 Census, representing 14.4% of the South Australian population. Of those mainly speaking a language other than English at home, Italian was the most common at 14.5% of the non- English languages spoken at home, followed by Greek and Mandarin at 11. and 7.2% respectively. The table below summarises the top 10 non-english languages mainly spoken at home in South Australia in 2011. Top 10 non-english Languages Spoken at Home in South Australia Latest data: 2011 Language Number Percentage % Italian 33,290 14.5% Greek 25,250 11. Mandarin 16,499 7.2% Vietnamese 15,970 7. Cantonese 9,000 3.9% Arabic 7,468 3.3% German 7,458 3.2% Polish 6,240 2.7% Spanish 4,909 2.1% Punjabi 4,426 1.9% Source: Based on Australian Bureau of Statistics, 2011 Census of Population and Housing, Basic Community Profile, B13 Language Spoken at Home by Sex. Latest Issue Released at 11.30am (AEST) 21/06/2012. WORKING DRAFT FOR DISCUSSION (MAY 2013) HPC State of Our Health 15

Chapter 1. Demographic Profile of South Australia 1-6-4. Proficiency in Spoken English A total of 39,931 South Australians spoke a language other than English at home, and could not speak English well or not at all, as at the 2011 Census. Proportionally, this accounted for 2.5% of the population. South Australia was ranked fourth highest of the states and territories. Proportion of Persons Who Speak English Not Well or Not at All, 2011 5% 4% 3% 2% 1% Tas Qld WA ACT SA NSW Vic NT AUSTRALIA = 3. Of the South Australians who were born overseas, a total of 31,754, or 9., spoke English not well or not at all as at the 2011 Census, predominantly in the 75 years and over age cohorts. Proportion of South Australians Born Overseas and Who Speak English Not Well or Not at All by Age, 2011 2 15% 1 5% 0-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+ TOTAL Source: Based on Australian Bureau of Statistics, 2011 Census of Population and Housing, Expanded Community Profile, X05 Language Spoken At Home By Proficiency in Spoken English Language by Sex. Latest Issue Released at 11.30am (AEST) 21/06/2012. Source: Based on Australian Bureau of Statistics, 2011 Census of Population and Housing, Expanded Community Profile, X04 Proficiency in Spoken English/Language by Year of Arrival in Australia by Age Country of Birth. Latest Issue Released at 11.30am (AEST) 21/06/2012. WORKING DRAFT FOR DISCUSSION (MAY 2013) HPC State of Our Health 16

Chapter 1. Demographic Profile of South Australia 1-7. Migration and Refugees 1-7-1. Migration Over the 2011 calendar year, South Australia's population grew by 13,862 persons. Net overseas migration formed the main component of growth, accounting for 8,967 additional persons (64.7% of total growth). An additional 7,220 persons came from natural increase (52.1% of total growth), while 2,325 persons were lost to net interstate migration (-16.8% of total growth). Components of Population Growth by State and Territory, 2011 20 15 10 5-5 -10-15 -20 Net interstate migration Net overseas migration Natural increase SA NSW Vic Qld WA Tas NT ACT Source: Based on Australian Bureau of Statistics, Australian Demographic Statistics, Cat. No. 3101.0, Table 2. Population Change, Components States and Territories (Number). Released 26/06/2012. WORKING DRAFT FOR DISCUSSION (MAY 2013) HPC State of Our Health 17

Chapter 1. Demographic Profile of South Australia 1-7-2. Age Profile of Migrants The age profile of South Australian overseas migrants in 2006 was older than that for Australia as a whole. South Australia had a higher proportion of its migrant population aged over 50 years compared to Australia. The age distribution of overseas migrants is presented in the chart below. Age Profile of South Australian Migrants, 2006 75+ 70 74 65 69 60 64 55 59 50 54 45 49 40 44 35 39 30 34 25 29 20 24 15 19 10 14 5 9 0 4 South Australia Australia 2% 4% 6% 8% 1 12% Source: Based on Australian Bureau of Statistics, Migration, Australia 2007-08, Cat. No. 3412.0, Table 3.5 Estimated resident population, Selected countries of birth, South Australia by age 30 June 2006. Released at 11.30am (AEST) 28/07/2009. 1-7-3. Refugees A major challenge facing many countries today is the protection of refugees who have been forced to leave their home. Australia has a commitment to protecting refugees and resolving refugee situations which is strongly expressed through the Humanitarian Program (Department of Immigration and Citizenship, 2011). In 2010-11, a total of 1,144 permanent additions were accepted under the Offshore component of the Humanitarian Program in South Australia. Of these, 881 were made under the Refugee category and 263 under the Special Humanitarian Program. Offshore Humanitarian Permanent Additions in South Australia, 2006-07 to 2010-11 1000 800 600 400 200 0 '06-07 '07-08 '08-09 '09-10 '10-11 Special Humanitarian Program Refugees Source: Based on Department of Immigration and Citizenship (2011) Fact Sheet 60 Australia s Refugee and Humanitarian Program [Internet] Available from: http://www.immi.gov.au/media/fact-sheets/60refugee.htm [Accessed: 18/07/2012]. Source: Based on Department of Immigration and Citizenship (2012) Population flows: Immigration aspects 2010-11 edition, Chapter 5. WORKING DRAFT FOR DISCUSSION (MAY 2013) HPC State of Our Health 18

Chapter 1. Demographic Profile of South Australia 1-8. Carers 1-8-1. Carers Data for 2009 shows that there were 213,700 carers in South Australia, representing 13.4% of people of the population. A higher proportion of South Australian females than males were carers (14.6% and 12.2% respectively). South Australia had the highest proportion of carers when compared to all states and territories. Proportion of Carers by State and Territory, 2009 15% 1 5% ACT NT Qld WA NSW Vic Tas SA AUSTRALIA = 12.2% Of the 213,700 carers in South Australia, 60,000 (or 28.1%) were primary carers. Primary carers are those aged 15 years and over who identified themselves as providing the most informal assistance with core activities to a person with a disability or to a person aged 60 years and over. A higher proportion of females were primary carers compared to their male counterparts (35. and 19.6% of all carers, respectively). Source: Based on Australian Bureau of Statistics, Caring in the Community, Australia 2009, Cat. No. 4436.0. Released at 11.30am (AEST) 20/01/2012. WORKING DRAFT FOR DISCUSSION (MAY 2013) HPC State of Our Health 19

Chapter 1. Demographic Profile of South Australia 1-8-2. Young Carers For young people, caring for family members can have an impact on education, relationships and employment (Carers Australia, 2012). Young Carers are defined here as people aged between 15 and 19 years who responded positively to the question about the provision of unpaid care, help or assistance on the Census form: In the last two weeks did the person spend time providing unpaid care, help or assistance to family members or others because of a disability, a long term illness or problems relating to old age?. In 2006, 3.9% of South Australian males aged 15-19 years identified that they were providing unpaid care, help or assistance to a family member or others. When compared to all states and territories, this was ranked (equal) third lowest (with Victoria). Proportion of 15-19 Year Old Males Who Were Carers, 2006 7% 6% 5% 4% 3% 2% 1% WA Qld SA Vic ACT Tas NSW NT Australian figure is not available Young females aged 15-19 years were more likely to be carers than young males. In South Australia, 4.9% of females aged 15-19 identified that they were providing unpaid care, help or assistance to a family member or others. When compared to all states and territories, this was ranked fourth highest. Proportion of 15-19 Year Old Females Who Were Carers, 2006 7% 6% 5% 4% 3% 2% 1% WA Qld ACT Vic SA Tas NSW NT Australian figure is not available Source: Based on Carers Australia (2012), The Impact of Caring [Internet] Available from: http://www.youngcarers.net.au/parents-and-professionals/the-impact-of-caring/ [Accessed: 21/08/2012]. Source: Based on Social Policy Research Centre, Young Carers, Social Policy Impacts of the Caring Responsibilities of Children and Young Adults. WORKING DRAFT FOR DISCUSSION (MAY 2013) HPC State of Our Health 20

Chapter 1. Demographic Profile of South Australia 1-8-3. Aboriginal Young Carers Aboriginal Young Carers are defined here as Aboriginal people aged between 15 and 19 years who responded positively to the question about the provision of unpaid care, help or assistance on the Census form: In the last two weeks did the person spend time providing unpaid care, help or assistance to family members or others because of a disability, a long term illness or problems relating to old age?. In 2006, 4.6% of Aboriginal South Australian males aged 15-19 years identified that they were providing unpaid care, help or assistance to a family member or others. When compared to all states and territories, South Australia was ranked third lowest. Proportion of 15-19 Year Old Aboriginal Males Who Were Carers, 2006 7 6 5 4 3 2 1 Vic ACT SA NSW Qld WA Tas NT Australian figure is not available Proportionally, 4.7% of Aboriginal South Australian females aged 15-19 years identified that they were providing unpaid care, help or assistance to a family member or others. When compared to all states and territories, South Australia was ranked third lowest. Proportion of 15-19 Year Old Aboriginal Females Who Were Carers, 2006 7 6 5 4 3 2 1 Vic ACT SA NSW Qld Tas WA NT Australian figure is not available Source: Based on Social Policy Research Centre, Cass, B, Brennan, D, Thomson, C, Hill, T, Purcal, C, Hamilton, M, and Adamson, E (2011) Young carers: Social policy impacts of the caring responsibilities of children and young adults, Report prepared for ARC Linkage Partners, October 2011. WORKING DRAFT FOR DISCUSSION (MAY 2013) HPC State of Our Health 21

Chapter 1. Demographic Profile of South Australia 1-8-4. Culturally and Linguistically Diverse (CALD) Young Carers In 2006, 13.9% of culturally and linguistically diverse (CALD) South Australian males aged 15-19 years identified that they were providing unpaid care, help or assistance to a family member or others because of a disability, a long term illness or problems relating to old age. CALD is defined here as young people who speak a language other than English at home and do not identify as Aboriginal. When compared to all states and territories, South Australia was ranked fourth highest. Proportion of 15-19 Year Old CALD Males Who Were Carers, 2006 25% 2 15% 1 5% Tas NT Qld WA SA ACT Vic NSW Australian figure is not available In 2006, 12.6% of CALD South Australian females aged 15-19 years identified that they were providing unpaid care, help or assistance to a family member or others because of a disability, a long term illness or problems relating to old age. CALD is defined here as young people who speak a language other than English at home and do not identify as Aboriginal. When compared to all states and territories, South Australia was ranked fourth highest. Proportion of 15-19 Year Old CALD Females Who Were Carers, 2006 25% 2 15% 1 5% Tas NT Qld WA SA ACT Vic NSW Australian figure is not available Source: Based on Social Policy Research Centre (SPRC), Young carers: Social policy impacts of the caring responsibilities of children and young adults. Social Policy Research Centre, University of New South Wales, October 2011. WORKING DRAFT FOR DISCUSSION (MAY 2013) HPC State of Our Health 22

Determinants of Health As stated by the World Health Organisation (WHO) and recognised within health literature, there are many factors that affect individual and community health. Ultimately a person s health status can be determined by personal circumstance and the environment within which they live. The determinants of health include many factors and are presented within this report: Income and socioeconomic status Education Employment Physical environment, such as housing and living conditions Social and community networks 1-9. Relative Socioeconomic Disadvantage A commonly used measure of socioeconomic status in Australia is the Australian Bureau of Statistics' Socioeconomic Index for Areas Index of Relative Socioeconomic Disadvantage (SEIFA IRSD). In 2010, 31.3% of the South Australian population lived in the top 2 most relatively disadvantaged socioeconomic areas in the state, while 14.1% lived in the top 2 least relatively disadvantaged socioeconomic areas. The chart below illustrates the population distribution of the states and territories by quintile of relative socioeconomic disadvantage. The quintiles shown are ranked according to Socioeconomic Indexes for Areas (SEIFA) Index of Relative Socioeconomic Disadvantage (IRSD) area scores at the national level, where the 20 per cent of the population living in Statistical Local Areas (SLA) with the lowest scores (relatively most disadvantaged) are given a quintile number of 1, and the 20 per cent of the population living in areas with the highest scores (relatively least disadvantaged) are given a quintile number of 5. South Australia recorded the third highest proportion of the population in the quintile of highest socioeconomic disadvantage of the states and territories. 10 Proportion of the total population living in areas of relative disadvantage, 2010 8 6 4 2 ACT WA Vic NSW Qld SA NT Tas Quintile 5 (least disadvantaged) Quintile 4 Quintile 3 Quintile 2 Quintile 1 (most disadvantaged) Source: Based on SCRGSP (Steering Committee for the Review of Government Service Provision) 2011, National Agreement Performance Information 2010-11: Appendix Health, Affordable Housing, Disability and Indigenous Reform, Productivity Commission, Canberra using AIHW (unpublished) data. WORKING DRAFT FOR DISCUSSION (MAY 2013) HPC State of Our Health 23

1-10. Education 1-10-1. Highest Year of School Completed: Year 12 or Equivalent As at the 2011 Census, 44.8% of persons aged 15 years and over who were not longer attending primary or secondary school had completed Year 12 or equivalent as their highest year of school attainment. This was lower than the national average of 49.2%. When compared to all states and territories South Australia was ranked third lowest. Persons Aged 15 Years and Over No Longer Attending Primary or Secondary School Who Have Completed Year 12 or Equivalent as Their Highest Year of School, 2011 7 6 5 4 3 2 1 Tas NT SA Qld WA NSW Vic ACT AUSTRALIA = 49.2% Source: Based on Australian Bureau of Statistics, 2011 Census of Population and Housing. Basic Community Profile, Cat. No. 2001.0. B16: Highest Year of School Completed by Age and Sex. Released at 11.30am (AEST) 21/06/2012. 1-10-2. Aboriginal Population Highest Year of School Completed: Year 12 or Equivalent As at the 2011 Census, 22.1% of Aboriginal persons aged 15 years and over who were not longer attending primary or secondary school had completed Year 12 or equivalent as their highest year of school attainment. This was lower than the national average of 25.. When compared to all states and territories South Australia was ranked third lowest. Aboriginal Persons Aged 15 Years and Over No Longer Attending Primary or Secondary School Who Have Completed Year 12 or Equivalent as Their Highest Year of School, 2011 7 6 5 4 3 2 1 NT WA SA Tas NSW Vic Qld ACT AUSTRALIA = 25. Source: Based on Australian Bureau of Statistics, 2011 Census of Population and Housing, Aboriginal and Torres Strait Islander Peoples (Indigenous) Profile, Cat. No. 2002.0. I06: Highest Year of School Completed by Indigenous Status by Sex. Released at 11.30am (AEST) 21/06/2012. WORKING DRAFT FOR DISCUSSION (MAY 2013) HPC State of Our Health 24

1-10-3. Participation in Vocational Education and Training (VET) Data for 2011 revealed that the rate of participation in vocational education and training (VET) of South Australians aged 15-64 years was 10.9%. This was below the national average of 12.. Trend data between 2007 and 2011 shows that participation in VET has remained steady over the five years in South Australia, while the national participation rate increased slightly between 2009 and 2011. When compared to all states and territories, South Australia was ranked third lowest in 2011 for VET participation amongst the population aged 15-64 years. VET Participation Rate of Persons Aged 15-64 Years :: Trend, 2007-2011 and by State and Territory, 2011 2 2 15% 15% 1 1 5% South Australia Australia 2007 2008 2009 2010 2011 5% Qld WA SA ACT NSW Tas NT Vic AUSTRALIA = 12. Source: Based on National Centre for Vocational Education Research (2007-11), Australian vocational education and training statistics: Students and courses 2011, South Australia, Table 2: VET participation rate (%) of persons aged 15 years and older. 1-10-4. Aboriginal Participation in Vocational Education and Training (VET) As at the 2006 Census, South Australia had the second highest proportion of its Aboriginal population aged 16 years or more who were involved in vocational educational and training (VET), at 17.9%. This is above the national average for Aboriginal people of 15.. VET Participation Rate of Aboriginal Persons Aged 16 Years and Over, 2006 2 15% 1 5% Tas ACT Qld Vic NSW WA SA NT AUSTRALIA = 15. Source: Based on Public Health Information Development Unit, Aboriginal and Torres Strait Islander Social Health Atlas, Statistical Local Areas, SA, 2009. Compiled using data from the National Centre for Vocational Education Research, 2006 and ABS Estimated Resident Population 2006. WORKING DRAFT FOR DISCUSSION (MAY 2013) HPC State of Our Health 25

1-10-5. Educational Attainment: People with Degrees (aged 25-64 years) In 2011, 22.9% of South Australians aged 25-64 years had a Bachelor degree or above, below the national average of 27.9%. When compared to all states and territories, South Australia was ranked second lowest. However, the South Australian trend has been increasing over the last 14 years, up a total of 10.1 percentage points between 1997 and 2011. Proportion of 25-64 Year Olds with a Bachelor Degree or Above, 1997-2011 3 2 1 South Australia Australia '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09 '10 '11 Proportion of 25-64 Year-Olds with a Bachelor Degree or Above, 2011 5 4 3 2 1 Tas SA Qld WA NT NSW Vic ACT AUSTRALIA = 27.9% Source: Based on Australian Bureau of Statistics, Australian Social Trends, Data Cube Education and training National and state summary tables, Cat No. 4102.0, Table 2.4 Education and training, SA Summary, 1997 2011. Released at 11.30am (AEST) 26/06/2012. WORKING DRAFT FOR DISCUSSION (MAY 2013) HPC State of Our Health 26

1-10-6. Health Literacy Linked to education is the notion of health literacy. Health literacy relates to an individual s ability to analyse their own experience of health within the larger context of health related knowledge. For example making informed decisions about health, personal awareness of the social, environmental and economic determinants of health, and acting upon procedures and directions from medical personnel (South Australian Council of Social Service, 2008). In 2006, 58.7% of South Australians aged 15-74 years achieved scores below Level 3 for health literacy. Level 3 is regarded as the "minimum required for individuals to meet the complex demands of everyday life and work in the emerging knowledgebased economy". The South Australian rate was only slightly below the national average of 59.5%, fourth lowest of the states and territories. People Aged 15-74 Years Achieving Scores Below Minimum Level of Health Literacy, 2006 7 6 5 4 3 2 1 ACT WA NSW SA Qld Vic NT Tas AUSTRALIA = 59.5% Source: Based on South Australian Council of Social Service (2008), The Social Determinants of Health: SACOSS Information Paper, December 2008 [Internet] Available from: http://www.sacoss.org.au/online_docs/0812120social%20determinants%20of%20health%20report.pdf [Accessed: 20/07/2012] Source: Based on Australian Bureau of Statistics, Health Literacy Australia, 2006. Cat. No. 4233.0. Table 2: Skill Level, By State or Territory of Usual Residence. Released at 11.30am (AEST) Wed 25 Jun 2008. WORKING DRAFT FOR DISCUSSION (MAY 2013) HPC State of Our Health 27