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

Transcription

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

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

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

4

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

21 4 Table 12: Number of people 15 years and over providing unpaid assistance to a person with a disability Number of people providing unpaid assistance to a person with a disability (aged 15 years and over) Number of people aged 0 4 years in need of assistance Melbourne Moonee Valley Moreland Yarra Victoria , Number of people aged 5 14 years Number of people aged years Number of people aged years Number of people aged years Number of people aged years Number of people aged years Number of people aged years Number of people aged 65 years and over Total ,453 Breastfeeding Exclusive breastfeeding is recommended by the World Health Organisation as the best source of food for infants up to six months of age (WHO 2009). In Victoria, while most mothers (85%) initiate breastfeeding after birth, only 32% of mothers are still breastfeeding when their babies are six months old. 50 Child protection rates Victoria has very high rates of child protection substantiations for children. In 2010/11 the rate of substantiation per 1,000 children was 53/1,000 in Victoria and 35/1,000 for children nationally. This compares to 5/1,000 for non- Australian children. 53 Source: ABS. (2013) Census of Population and Housing. and Torres Strait Islander Peoples (Indigenous) Profiles. Health Status Immunisation rates Australian immunisation rates for 2011/12 are close but not equal for and non- children. 51 Nationally, children are less likely to be fully vaccinated than all Australian children combined by one year old (85%, 92% respectively), two years old (92%, 93% respectively) and five years old (87%, 90% respectively). Vaccination rates in the INWMML catchment between 2011/12 suggest similarities between and all of population children up to one year old (88%, 91% respectively), two year old (93%, 93% respectively) but unknown for five year olds (90% of all INWMML population). 52 KEY ISSUES: Low birth-weights for adolescent mothers in the NWMR Child protection substantiation rates are higher in Victoria Around 40% of women giving birth across Victoria are currently supported by the Koorie Maternity Services (KMS) program. Additionally the KMS program supports a number of non- women having babies Access to the Women s Health Unit at the Royal Women s Hospital, which resides within the catchment. 50 Thorpe & Browne (2009). Closing the nutrition & physical activity gap in Victoria: Victorian nutrition & physical activity strategy. 51 NHPA (2013) Healthy Communities: Immunisation rates for children in NHPA (2013) Healthy Communities: Immunisation rates for children in Vic DEECD. (2009). The State of Victoria s Children 2009: children and young people in Victoria. Closing the Gap in Inner North West Melbourne February 2013 Health Status 17

22 5Determinants of Health Determinants of Health Social determinants of health underlie specific health risk factors and can impact on access to health care. Australians are relatively disadvantaged compared to non- Australians. Data was not available for the INWMML catchment, however the Victorian data presented in Table 13 shows: people (particularly women) are less likely to meet physical activity guidelines, than non- Victorians people are less likely to meet the daily intake of fruit and vegetable consumption, than non- Victorians people (particularly women) are more likely to run out of food and not be able to afford more, than non- Victorians Victorians are more likely to be a current smoker, than non- Victorians Victorians are more likely to be obese than non- Victorians. 5.1 PHYSICAL ACTIVITY Physical inactivity is responsible for 8.4% of the total disease burden for Australians. Structural barriers such as limited access to facilities and high costs associated with transport, membership and uniforms can decrease participation in sport. Racism can also exclude participation of people in community-based activities NUTRITION AND FOOD SECURITY Unhealthy eating can lead to being overweight or obese, which is the second highest level of risk among Australians. Diet related issues such as high blood pressure and low fruit and vegetable intake are major contributors to the Australians burden of disease. people aged 12 years and over were twice as likely to report no usual daily fruit intake and seven times as likely to report no daily vegetable intake as non-indigenous Australians in this age group. Food insecurity (running out of food in the last 12 months and being unable to afford to buy more) affects around 20% of the Victorian population. Food insecurity affects dietary habits and have been linked to obesity OVERWEIGHT AND OBESITY Nationally, rates of overweight and obesity increased between 1995 and 2004/05. Among Victorians, 58.5% are overweight or obese compared to 48.2% of all Victorians TOBACCO, ALCOHOL AND DRUG USE In 2008, 46% of people aged 15 years and over reported drinking at low risk levels and 35% had abstained from drinking alcohol in the prior 12 months. A further 17% reported drinking at chronic risky/high risk levels in the past 12 months, representing no significant change since 2002 (15%). 57 In Victoria, a higher number of s use tobacco and this difference was also noticeably higher for females (See Table 14). However, risky drinking, (long term or short term), showed no marked difference between and non- populations. Smoking contributes more to the burden of disease for Victorians than any other single risk factor. Smoking is estimated to account for 10% of the health gap between and non- people. Smoking rates among Victorians have not declined in the past ten years. 58 Smoking is also detrimental to the health of others due to second-hand smoke or passive smoking. Compared to 9% of non- children, 28% of children live with a regular smoker who smokes at home indoors. 59 Both the Commonwealth and Victorian governments are currently implementing programs and activities to address the high rates of tobacco use in the community. These include tobacco workers, access to QUIT programs, and promoting the use of nicotine patches. Two of these workers are based at VAHS. Local data from the NWMR Closing the Health Gap Baseline Data report (2009) indicates very high levels of risky alcohol consumption, cannabis use, and use of drugs and other substances (including inhalants), by adolescents living in the region suggesting that substance misuse may be an issue for this group. 54 Thorpe & Browne (2009). Closing the nutrition & physical activity gap in Victoria: Victorian nutrition & physical activity strategy. 55 Thorpe & Browne (2009). Closing the nutrition & physical activity gap in Victoria: Victorian nutrition & physical activity strategy. 56 VicHealth. (2012). Health in Victoria: Research Summary Identifying the determinants of physical and mental health. 57 Vic DoH. (2011). The health and wellbeing of Victorians: Victorian Population Health Survey 2008 Supplementary report. 58 VicHealth. (2012). Health in Victoria: Research Summary Identifying the determinants of physical and mental health. 59 VicHealth. (2012). Health in Victoria: Research Summary Identifying the determinants of physical and mental health. 18 Closing the Gap in Inner North West Melbourne February 2013 Determinants of Health

23 5 Table 13: key determinants of health for people and non- Victorians Per cent of people who do not meet physical activity guidelines Fruit and vegetable consumption persons who did not meet recommended daily intake Food security ran out of food in the past 12 months and could not afford to buy more Males in Victoria Non- Males in Victoria Females in Victoria Non- Females in Victoria All Persons in Victoria Non- Urban People in Victoria Urban People in Victoria Current smoker 28.6% 21.3% 32.6% 16.8% 30.4% 19.0% 26.8% Short-term risk of alcohol related harm Long-term risk of alcohol related harm males in Victoria All males in Victoria females in Victoria All females in Victoria All Persons in Victoria Urban People in Victoria All Urban People in Victoria 25.1% 32.7% 41.2% 33.0% 34.4% 32.9% 38.1% 70.2% 57.3% 55.2% 45.0% 62.7% 51.0% 63.2% 14.6% 4.4% 20.7% 6.4% 17.7% 5.4% 18.1% Overweight 31.7% 40.1% 29.5% 24.3% 30.1% 32.0% 29.9% Obese 27.1% 17.2% 21.6% 16.2% 22.8% 16.7% 19.6% Table 14: Victorian rates of alcohol and tobacco use 50.3% 54.0% 38.1% 37.3% 43.9% 45.5% 42.5% 3.9% 4.3% 3.4% 3.1% 3.6% 3.7% 3.4% Source: Vic DoH (2011). The health and wellbeing of Victorians. Victorian Population Health Survey 2008 Supplementary report. Source: Vic DoH (2011). The health and wellbeing of Victorians. Victorian Population Health Survey 2008 Supplementary report. Determinants of Health Closing the Gap in Inner North West Melbourne February 2013 Determinants of Health 19 19

24 Determinants of Health 55.5 FAMILY VIOLENCE In Victoria in 2009/10, the total number of Family Incident Reports by aggrieved family members was 1, Charges were laid in 27.0% of these cases. Of the Family Incident Reports made by aggrieved family members in 2009/10, 899 incidents required repeat attendance from Victoria Police and charges were laid in 28.7% of cases. An increase in repeat attendances has occurred over the previous four years. 5.6 CRIME Nationally, people are almost ten times more likely to be imprisoned than non- people. individuals, families and communities were 13 times more likely than other Australians to be, or have a family member, sent to jail or already incarcerated. Nineteen percent of respondents reported having a family member sent to jail or in jail, with a higher proportion in remote areas [25%]. 61 The proportion of offenders on remand (un-sentenced) in Victoria in 2009/2010 was 21% compared with 18.8% of non- offenders. 62 In Victoria 67.6% of prisoners are parents compared with 46.7% 63 non- parents in prison. In Australia, populations are also more likely to have individually, or had family members and/or close friends who experienced (7.6% versus 2.3%) or witnessed (9% versus 2.2%) abuse or a violent crime in the last 12 months. 64 These rates were also higher within major cities with 9.2% experiencing and 10.3% witnessing abuse or a violent crime. KEY ISSUES: Victorians are less likely to meet the physical activity and daily fruit and vegetable intake guidelines Victorians were more likely to experience food insecurity and experience obesity Victorians are more likely to smoke but have similar risk indicators for alcohol as non- Victorians Available data indicates that adolescents in the NWMR have the high rates of: risky levels of alcohol consumption cannabis use drug and other substance use individuals, families and communities were 13 times more likely than other Australians to be, or have a family member, sent to jail or already incarcerated populations are more likely to experience or witness violent crimes than non- populations and this likelihood increases in major cities. 60 Vic DCPD (2011). Victorian Government Indigenous Affairs Report pages 25, Kulunga Research Network. (2010). Working together: and Torres Strait Islander mental health and wellbeing principles and practice p Vic DPCD. (2011). Victorian Government Indigenous Affairs Report pages 66, Vic DEECD. (2009). The State of Victoria s Children 2009: children and young people in Victoria p7. 64 Australian DoHA. (2012). and Torres Strait Islander Health Performance Framework, 2012 Report. 20 Closing the Gap in Inner North West Melbourne February 2013 Determinants of Health

25 Local Service System and Service Use 6.1 HOSPITAL PRESENTATIONS Victorian data shows that people living in Victoria have a relatively low hospitalisation rate of 342/1,000 people, compared with people nationally (435/1,000). However, the hospitalisation rate of Victorian people is still higher than non- people (305/1,000). 65 Potentially preventable hospitalisations of people in Victoria are more than three times higher than for non- people. Presentations to hospital emergency departments for people in Victoria are double the rate for non- people. 66 Victorian data concerning 2009/10 hospital use suggests that the top ten reasons for admission included: 67 Factors influencing health status (including renal dialysis which was high for repeated episodes for smaller numbers of people) 5,291: 37.1% Pregnancy, childbirth 1,147: 8.0% Injury, poison external causes 1,056: 7.4% Digestive disorders 1,048: 7.3% Symptoms, signs 884: 6.2% Respiratory diseases 772: 5.4% Mental disorders 660: 4.6% Circulatory diseases 534: 3.7% Genito-urinary disorders 419: 2.9% Neoplasms 331: 2.3%. A current project being undertaken by INWMML, Northern Medicare Local and the Department of Health is exploring the use of the local Hospital Emergency Departments (ED) using the Victorian Emergency Department 2010/11 data. A brief analysis of ED use has shown that: 1,110 presentations to emergency departments for residents in the INWMML catchment Across the two MLs (INWMML, Northern ML) there were 873 presentations triaged as Category 4-5 (semi-urgent and not urgent). This totalled 1.1% of all ED presentations (81,087). Of these: The peak age group for presentations was The time of presentation was mainly and consistently from 10am to 11pm The top five diagnoses made were: abdominal pain, alcohol intoxication, wound of wrist/hand, fracture of wrist/hand, and feared complaint no diagnosis made Very few (only 14 of the 873) presentations were related to chronic disease, while presentations for mental health and substance abuse related conditions were also similarly uncommon Alcohol was associated with 38 (4.4%) of presentations, with 28 of these related to simple intoxication. Psychiatric and drug behaviour related presentations were even rarer Assault was the cause of 47 presentations (5.4%) For 153 presentations (17.5%), an intent to admit as an in-patient was recorded Only nine clients (1.0%) arrived by police vehicle, but 205 (23.5%) arrived by ambulance The pattern of presenting to ED after hours for Primary Care Type (ie Category 4 5) conditions is similar to the rest of the population for the same locations of residence. Further exploration of the use of Hospital EDs is being conducted for triage Categories MEDICARE BENEFITS SCHEDULE (MBS) ITEMS 6Local Service System and Service Use Nationally, there has been a significant increase in a range of Medicare Benefits Schedule (MBS) services claimed by people for identifying and managing chronic disease since the introduction of the Indigenous Chronic Disease Package under the National Partnership on Closing the Gap in Indigenous Health Outcomes. In particular, there has been an increase in the number of GP Management Plans (GPMP) and Team Care Arrangements (TCA) claimed by Australians through Medicare. Rates are higher for these services for Australians than non- Australians. There has also been a corresponding increase in a range of allied health items linked to health assessments and management plans/team care arrangements including a number of other allied health services and dental services (with 98% of these dental services bulk billed). In comparison, Victoria has relatively low rates per 1,000 persons receiving Medicare Benefits Schedule health checks. The number of people who received an over 55 years health check (115/1,000) was less than half of the non- over 75s who received a health check (256/1,000) Australian DoHA. (2012). and Torres Strait Islander Health Performance Framework, 2012 Report, p Australian DoHA. (2012). and Torres Strait Islander Health Performance Framework, 2012 Report. 67 Vic DoH. (2012). Koori health counts! Victorian hospital data Australian DoHA. (2012). and Torres Strait Islander Health Performance Framework, 2012 Report, p128. Closing the Gap in Inner North West Melbourne February 2013 Local Service System and Service Use 21

26 Local Service System and Service Use 6Data on the utilisation of MBS items by people was not available for the INWMML catchment. However, some information on the uptake of the specific items was extracted from the Medicare data for the Northern Division of General Practice (now Infiniti) and the Melbourne GP Network catchments. As shown in Table 16, the data suggests that the general practices located in the Northern Division of General Practice catchment did not claim for any of the specific MBS items during This was not the case for the Melbourne GP Network catchment where 213 health assessments, 80 services by a practice nurse/ Health Worker, and 1,212 services by a practice nurse/ Health Worker were claimed. 6.3 PIP INDIGENOUS HEALTH INCENTIVE (IHI) As at 30 April 2012, more than 2,900 practices and health services across Australia had signed on to the PIP Indigenous Health Incentive. Recent data suggests that 60% of GP practices nationally have signed up for the PIP Indigenous Health Incentive. At the time this report was being prepared, INWMML was able to identify 20 general practices (9.7% of all general practices in the INWMML catchment) that were registered for PIP IHI. Compared to the up-take nationally (60%) this is a low percentage of practices. Table 16: Medicare data on the MBS items (January December 2011) January 2011 December 2011 Northern Division of General Practice Melbourne GP Network MBS 715 Health Assessment Nil Service provided by a practice nurse or Health Worker Nil Immunisation provided by an Health Worker Nil Nil Treatment of wound provided by an Health Worker Nil Nil 1097 Services provided by a Practice Nurse or Health Worker Nil 1,212 Source: MBS (2012). Division of General Practice MBS data report. Screening Nationally, it has been suggested that Primary Health Care services were well placed to increase the screening activities for Australians. 70 In an Australian study of these services (of which 11% were Victorian), a range of screening activities were identified. These included: Well persons checks (80%) Pap tests/cervical screening (80%) STI screening (73%) Hearing screening (72%) Eye disease screening (69%) Renal disease screening (54%) Diabetic screening (78%) Cardiovascular screening (66%) Child growth monitoring (64%). Australian women do not get screened by the National Breast Screen Australia as often as non- women. 71 Victoria also has relatively low participation rates for breast screening (40+ years). 72 In 2008/09, 17% of women had a breast screen compared to 29% of non- women. 6.4 PHARMACY Data on the uptake of PBS co-payment measures for the INWMML catchment is not currently available. However, internal research undertaken in 2012 by INWMML provides useful information. INWMML undertook a survey of the pharmacies and allied health in its catchment and 75% of the 147 pharmacies responded. The questionnaire found that 68% of surveyed pharmacies were dispensing PBS scripts for patients under the PBS Closing the Gap Co-payment Measure, and a further 21.76% of the pharmacies indicated that they were interested in receiving more information in relation to dispensing PBS scripts for patients under the PBS Closing the Gap Co-payment Measure. 6.5 USE OF ALLIED HEALTH SERVICES The National Health Performance Framework notes that there has been an increase in the number of GP Management Plans (GPMP) and Team Care Arrangements (TCA) claimed by Australians through Medicare. Rates are higher for these services for Australians than non- Australians. There has also been a corresponding increase in a range of allied health items linked to health assessments and management plans/team care arrangements including a number of other allied health services and dental services. 22 Closing the Gap in Inner North West Melbourne February 2013 Local Service System and Service Use

27 Table 17: PIP IHI practices in the INWMML catchment (January 2012) Local Government Area Number of PIP IHI registered practices Number of residents Melbourne Moonee Valley Moreland Yarra Total 20 1,599 Table 18: Summary of INWMML pharmacy survey results (2012) Number of pharmacies dispensing PBS scripts for and Torres Strait Islander patients under the PBS Closing the Gap Co-payment Measure Number of pharmacies more information about Dispensing PBS scripts for and Torres Strait Islander patients under the PBS Closing the Gap Co-payment Measure 6Local Service System and Service Use Melbourne Moonee valley Moreland Yarra Total % % Source: INWMML (2012). General Practice Survey. Source: INWMML (2012). Pharmacy Survey. Table 19: Summary of INWMML allied health provider survey responses (2012) Number of services that indicated that they specialise with and/or Torres Strait Islander patients Number of services that indicated that they have the capacity to see more clients or patients from an and/or Torres Strait Islander background Number of services that indicated that they would like more information, training and/or resources for this group ( and/or Torres Strait Islander people) Melbourne Moonee Valley Moreland Yarra Total % % % Source: INWMML (2012). Allied Health Survey. 69 This is likely to reflect the role of the VAHS Medical Service within the catchment. 70 AIHW. (2011). Access to health services for and Torres Strait Islander people. 71 AIHW. (2011). Access to health services for and Torres Strait Islander people. 72 Australian DoHA. (2012). and Torres Strait Islander Health Performance Framework, 2012 Report p128. Closing the Gap in Inner North West Melbourne February 2013 Local Service System and Service Use 23

28 Local Service System and Service Use 6Data on the use of MBS funded allied health items by people in the NWMML catchment is not available. In 2012, an INWMML survey of allied health providers in the catchment had a response rate of 43% of the 529 allied health services. Table 19 outlines the findings of the survey, and shows that 13% of surveyed allied health services reported that they have providers who specialise in providing care to patients, 28.7% have capacity to see more clients or patients from an background, and 15.31% would like information, training and/or resources for people. 6.6 SERVICE PROVIDER PERSPECTIVE The Inner North West Primary Care Partnership (INW PCP) is currently leading a project called the Inner North West Primary Care Partnership Closing the Health Gap Wellbeing Project. The project, funded by the Victorian Government, is led by INWPCP but is overseen by a number of key agencies in the catchment. The aim of the project is to develop and implementation best evidence practice health screening and evidenced based responses focused on a life stages approach. The rationale for the project is that people generally delay accessing adequate health care. By providing early access to the right services at the right time and supporting people to remain well, will impact on the on the health gap between and non- people. A key deliverable of the project work thus far has been the production of Closing the Health Gap Inner North West Region: Profile Report (2012). The report highlights a range of findings from the stakeholders in the region and recommends a number of key enablers that require further work within the catchment. These include: 1 Cultural awareness/responsiveness staff training 2 Asking the Question staff training and resolution of database problems 3 Raising the awareness of, and access to, Liaison staff and support for this workforce 4 Developing welcoming environments. A further grant from the Victorian government will allow a subsequent work to be undertaken by the partnership group in 2013/14. INWMML will continue to work collaboratively with the INWPCP and partner agencies to support this work. 6.7 CONSUMER AND STAKEHOLDER FEEDBACK. As a part of the Inner North West Primary Care Partnership Closing the Health Gap Wellbeing Project the partnership commissioned Merri Community Health to undertake a project to: Gain a better understanding of peoples experiences in accessing health services in the Inner North West Metropolitan Region (INWMR), and provide insights and recommendations into how services should be best structured and delivered to support and engage people in the INWMR. Twenty-six residents participated in the project either via an interview or group discussion. The project identified three key factors influencing the likelihood of people accessing services within the INWM region: cultural competence, reputation and access to services. The report The Inner North West Metropolitan Region: and Torres Strait Islander Peoples Health Consumer Report (2013) is currently being finalised and will guide the partnership work in region further. KEY ISSUES: Victorian Hospital admissions for communities are, to a large degree, influenced by chronic health issues, injuries and poisonings and mental health use of hospital EDs in the region for Category 4 5 were not very different from non- ED use Little is known about catchment screening rates for populations, which given some of the identified health issues and benefits of early detection, should be recorded and potentially used as an indicator of service system improvements Difficulties in mapping the use of related MBS items were identified through a lack of catchment data More INWMML GPs should be encouraged to sign up for the IHI PIP Almost 70% of pharmacies had signed with the Closing the Gap Co-Payment measure and many others requested information concerning this Very few Allied health services (13%) identified they specialised in populations, but over a quarter identified they had the capacity to work with clients. Fifteen percent identified they would like further information and/or training in working well with this group There is currently significant work occurring to strengthen and improve the service system for people living in the catchment. This work is being led by the INWPCP The consumer perspective suggests the service system can be strengthened through building cultural competence, establishing a reputation for delivering culturally safe services, and through the employment of staff in liaison roles. 24 Closing the Gap in Inner North West Melbourne February 2013 Local Service System and Service Use

29 Gap Analysis and Priorities The population living in the catchment is unique, in that people are slightly older, more likely to be employed, more likely to live alone or in group households, earn a higher income, and are more likely to have a higher education qualification than the average for people across Victoria. The INWMML service system is also unusual as it is home to a number of large and small Community Controlled Organisations, as well as to a range of specific programs delivered by mainstream organisations. It also benefits from a relatively large pool of dedicated positions, working out of its community health services, local government and hospitals. A key strength is the aged care service system within the catchment, where unlike other parts of Victoria, people have access to specific and mainstream residential aged care, packaged care and HACC funded services. In addition, resources are being channelled to address key health issues such as tackling smoking, and into maternity services, and service system reform through initiatives such as the CCSS program and the INWPCP s project. The lack of catchment specific and LGA level data hampers INWMML s ability to fully understand and assess the health and wellbeing needs of its residents. However, almost every indicator suggests there are significant inequalities between Victorians and non- Victorians, and where available, data suggests the inequalities are replicated within the INWMML catchment. Time constraints in preparing this report have limited the amount of consultation undertaken with key catchment stakeholders. The essential next step for INWMML is to validate the findings and priority actions in this report with key agencies providing care to people in the catchment; enhance partnerships; and develop co-operative activities to build on the robust work already being enacted within the catchment. Priorities for action INWMML is committed to closing the health and life expectancy gap between and non- Australians. After consideration of the data, catchment research and the existing capacity of the service system, the following priorities for action have been identified within key areas. 7 Health and lifestyle Chronic disease management, with a focus on improving screening rates, and building capacity for better self-management Working to improve mental health outcomes through increasing early identification and mapping of culturally sensitive services Working to reduce preventable hospitalisations of people in the catchment through further analysis of hospital admission data and service usage of programs such as HARP Sexually Transmissible Infections, with a focus on awareness raising, prevention and building capacity for better self-management Promoting healthy lifestyles including the importance of physical activity, healthy eating, being a healthy weight, harm minimisation in the consumption of alcohol and drugs, and tobacco use. Children and families Perinatal and early years, in particular promoting breastfeeding, immunisation and antenatal checkups, with a focus on raising awareness about the importance of not smoking during pregnancy, and the risks associated with low birth weight babies Working to reduce the incidence and impact of child protection and family violence. Service system education and support Raise awareness amongst INWMML s GPs, pharmacies and allied health services, about the availability of specific MBS items, with a view to achieving an up-take of services which reflects the demographic profile of the community in the catchment. In particular, the INWMML can capitalise on the interest expressed by pharmacies and allied health services through their recent survey, for more information about how to support people Increase the number and percentage of general practices registered for the Practice Incentive Program (PIP), Indigenous Health Incentive (IHI). The initial focus should be on increasing registration for the IHI in the Cities of Moreland, Melbourne and Yarra Support the service system improvement project work being led by the INWPCP, in relation to improving the identification of clients, cultural awareness training, etc. Gap Analysis and Priorities Data collection in the service system Work with agencies to collect, record and share information on service utilisation by people, to establish a more robust evidence base about the use of local services by people. Closing the Gap in Inner North West Melbourne February 2013 Gap Analysis and Priorities 25

30 Appendix A: Policy Context Appendices This section of the report sets out the key policies and frameworks underpinning the Australian governments commitments to improving the health status of people and to Closing the Gap in life expectancy. STATEMENT OF INTENT National Strategic Framework for and Torres Strait Islander Health In July 2008, all Australian governments endorsed the National Strategic Framework for and Torres Strait Islander Health [NSFATSIH). The key goal of NSFATSIH is to ensure that and Torres Strait Islander peoples enjoy a healthy life equal to that of the general population that is enriched by a strong living culture, dignity and justice. A new National and Torres Strait Islander Health Plan is currently being developed, and is due to be finalised in mid National Statement of Intent The National Statement of Intent is a national commitment between the Government of Australia and the people of Australia, and outlines the pledge across Australia to Close the Gap in life expectancy. The National Statement of Intent stipulates that Australian governments and people will work together to achieve equality in health status and life expectancy between and Torres Strait Islander peoples and non-indigenous Australians by the year The National Statement of Intent was signed on 20 March 2008 following the National Apology to the Stolen Generations and the National Indigenous Health Equality Summit (March 2008) where the Close the Gap Indigenous health equality targets were presented. Victorian Statement of Intent In Victoria, the national apology led to the Victorian Government and a coalition of non-government organisations, led by the Victorian Community Controlled Health Organisation (VACCHO), committing support to the Victorian Statement of Intent in The signatories to the Victorian Statement of Intent, committed to: Developing a comprehensive, long-term plan of action, that is targeted to need, evidence-based and capable of addressing the existing inequities in health services, in order to achieve equality of health status and life expectancy between people and non- Australians by 2030 Ensuring primary health care services and health infrastructure for people, which are capable of bridging the gap in health standards by 2018 Ensuring the full participation of people and their representative bodies in all aspects of addressing their health needs Working collectively to systematically address the social determinants that impact on achieving health equality for people Building on the evidence base and supporting what works in health, and relevant international experience. To supporting and developing community-controlled health services in urban, rural and remote areas in order to achieve lasting improvements in health and wellbeing Achieving improved access to, and outcomes from, mainstream services for people Respect and promote the rights of people, including by ensuring that health services are available, appropriate, accessible, affordable, and of good quality Measure, monitor, and report on [their] joint efforts, in accordance with benchmarks and targets, to ensure that [they] are progressively realising [their] shared ambitions. The Victorian Statement of Intent committed the Victorian Government to the Closing the Health Gap strategy which was informed and shaped by regional Closing the Health Gap committees. The Victorian Statement of Intent was re-signed by the Premier of Victoria the Hon. Ted Ballieu, in March NATIONAL INDIGENOUS REFORM AGREEMENT In December 2007 the Council of Australian Governments (COAG) endorsed the National Indigenous Reform Agreement. This is a partnership agreement between all levels of government and commits all parties to work with communities to Close the Gap on disadvantage. The National Indigenous Reform Agreement was signed in 2008 and reaffirmed in The National Indigenous Reform Agreement has six identified targets. These are to: 1 Close the gap in life expectancy within a generation (by 2031) 2 Halve the gap in mortality rates for children under five within a decade (2018) 3 Ensure all four year olds in remote communities have access to early childhood education within five years (by 2013) 4 Halve the gap in reading, writing and numeracy achievements for children within a decade (2020) 5 Halve the gap for students in Year 12 equivalent attainment by Halve the gap in employment outcomes between and non- Australians within a decade (2018). 26 Closing the Gap in Inner North West Melbourne February 2013 Appendices

31 A COAG also identified seven building blocks that need to be addressed in a coordinated fashion if the targets above are to be achieved. The building blocks reflect the need for a whole of government approach, and emphasise the influence that social, economic and environment factors have on overall health outcomes. The building blocks are: Early childhood Education and supporting school attendance Access to primary health care Economic participation and active welfare Healthy home environments Safety and freedom from violence Leadership and governance. A number of key partnership agreements were made to support the NIRA. The two most relevant for health in Victoria are the: National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes National Partnership Agreement on Indigenous Early Childhood Development. National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes The partnership to Close the Gap in health outcomes addresses two of the NIRA s six targets: 1 To close the gap in life expectancy within a generation 2 To halve the gap in mortality rates for children under five within a decade. The National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes, with funding of $1.6 billion over four years to June 2013, outlines five priority areas, which all states and territories must address as part of their Closing the Gap agenda. These priority areas are: Tackling smoking Primary health care services that deliver Fixing the gaps in the patient journey Healthy transition to adulthood Making health everyone s business. In response to the National Partnership Agreement on Closing the Health Gap, Victoria produced the Implementation Plan: National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes ( ) which outlined how Victoria will address each of the priority areas. Victoria s approach was to engage with the community at a regional level, through the establishment of regional Closing the Gap Committees, and empowering these committees to develop a four year regional Closing the Gap Plan (see section 2.6 of this report). National Partnership Agreement on Indigenous Early Childhood Development The National Partnership Agreement on Indigenous Early Childhood Development with funding of $564 million over six years (to June 2014) seeks to address the needs of children in their early years. The Indigenous Early Childhood and Development National Partnership tackles target number two which is to halve the gap in mortality rates for Indigenous children under five within a decade. In Victoria, the Departments of Education and Early Childhood Education (DEECD) and Department of Health (DH) are responsible for implementing strategies to address this target through the following initiatives: Increased access to, and use of, maternal and child health services by families Increased access to antenatal care, pre-pregnancy, and teenage sexual and reproductive health services. NATIONAL HEALTHCARE AGREEMENT In 2008, COAG also signed the National Healthcare Agreement committing $60.5 billion over five years. This affirmed the agreement of all governments that Australia s health system should: Be shaped around the health needs of individual patients, their families and communities Focus on the prevention of disease and injury, and the maintenance of health, not simply the treatment of illness Support an integrated approach to the promotion of healthy lifestyles, prevention of illness and injury and diagnosis and treatment of illness across the continuum of care Provide all Australians with timely access to quality health services based on their needs, not their ability to pay, regardless of where they live in the country. VICTORIAN ADVISORY COUNCIL ON KOORIE HEALTH VACKH Victorian Advisory Council on Koorie Health (VACKH) was established in 1996 under the Victorian Agreement on and Torres Strait Islander Health. VACKH provides a forum for the Victorian and Commonwealth Governments and the Community Controlled sector to work collaboratively to improve the health and wellbeing of people in Victoria. VACKH members are representatives nominated by the Victorian Community Controlled Health Organisation (VACCHO), the Victorian Government Department of Human Services (DHS) and the Australian Government Department of Health and Ageing (DoHA). Appendices Closing the Gap in Inner North West Melbourne February 2013 Appendices 27

32 A Appendices Victorian Health Plan The Victorian Health Plan was developed by VACKH in The Victorian Health Plan sets out key health priorities and potential actions to assist in Closing the Health Gap between and non- people in Victoria. The Plan determines that action to Close the Gap will be progressed through three key areas: Social determinants of health Health promotion and prevention Health sector action. KEY VICTORIAN POLICIES, FRAMEWORKS AND PLANS Victorian Affairs Framework The most recent Victorian Government Framework aims to build and expand on the previous work completed regarding Affairs with a focus on six strategic action areas to improve outcomes for Victorians. These include: Maternal and early childhood health and development Education and training Economic participation Health, housing and wellbeing Safe families and communities and equitable justice outcomes Strong culture, engaged people and confident communities. Victorian Indigenous Affairs Framework (VIAF) The previous Victorian Indigenous Affairs Framework (VIAF), Victoria s whole-of-government framework underpinning efforts to raise life expectancy and quality of life for Victorians, is aligned with the NIRA and is incorporated into a bilateral plan between Victoria and the Commonwealth for the delivering the NIRA. The VIAF includes areas for action regarding improving health and provides the platform for major Victorian strategies to close the gaps in areas such as education, employment, economic development and justice. Victorian Health Priorities Framework The Victorian Health Priorities Framework : Metropolitan Health Plan includes a commitment to progress the Strategic Directions in health as part of Victoria s response to Closing the Gap, with a particular focus on increasing life expectancy and reducing child mortality rates for children under five as a critical focus of Victoria s future health planning. Koolin Balit: Victorian Government Strategic Directions for Health Koolin Balit outlines the Victorian Government s strategic directions for health in Victoria over the next ten years. It sets out what the Department of Health, together with communities, and other parts of government and mainstream service providers, will do to achieve the government s commitment to improve health. Koolin Balit sets objectives for improving health in Victoria. It details six key priorities for work to achieve these objectives, and three enablers to support these priorities. Key Priorities Key Stages of Life A healthy start to life A healthy childhood A healthy transition to adulthood Caring for older people Continuum of Care Addressing risk factors Managing illnesses better with effective health services Key Enablers Improving data and evidence Strong organisations Cultural responsiveness Other Relevant Documents A range of other policies, frameworks and plans have been developed in recent years, to support Victoria s activity to Close the Gap, they include: Dardee Boorai: Victorian Charter of Safety and Wellbeing for Children and Young People Wannik: Educational Strategy for Koori Students Balert Booron: The Victorian Plan for Children Victorian Suicide Prevention and Response Action Plan Koorie Alcohol Action Plan. Source: Department of Health. Koolin Balit: Victorian Government Strategic Directions for Health May 2012 p Closing the Gap in Inner North West Melbourne February 2013 Appendices

33 A NORTH AND WEST REGION CLOSING THE HEALTH GAP PLAN North and West Region Closing the Health Gap Committee In 2009, all regions across Victoria were allocated four years of funding to implement actions to Close the Gap. Closing the Gap advisory committees were established in all regions, and tasked with conducting extensive community consultation to develop a Regional Closing the Health Gap Plan. This ensured that each region had a local and tailored approach to Close the Gap, within the parameters of the five Closing the Health Gap priority areas. In the North and West Metropolitan Region (NWMR), a Closing the Health Gap Advisory Committee was established. The Committee comprised representatives from: Victorian Health Service; VACSAL; Western Suburbs Indigenous Gathering Place; Aborigines Advancement League; Onemda; VACCA; VACSAL; Community Elders Service; VACCHO; Department of Health, Department of Human Services and a representative from each of the following mainstream agencies: Council, Community Health Service; hospital and Northern Division of General Practice. In considering the available evidence the NWMR Closing the Gap Advisory Committee concluded that it would: Adopt three priority areas for action (systems reform) over the four years: 1 Screening for health issues (early, every time, everywhere) amongst vulnerable children, youth, adults and the elderly in the N&WMR 2 Engagement of people to assist understanding and acceptance of screening and the need for the follow-up of the health issues identified 3 Assist people to navigate the N&WMR health system, once issues are identified and the need for more complex help is recognised Focus action across the life span, responding to vulnerable children, youth, adults and the elderly. In 2010, the region produced the North and West Region Closing the Gap Strategic Plan, outlining goals, strategies and outcomes linked to the Closing the Health Gap priorities. In 2012, the NWMR Closing the Gap Advisory Committee determined that the last two years of funding would be targeted at developing and implementing an Family Centred Model of Care. The rationale for this refocusing of their approach was outlined by the Committee as follows. The service system can be complex and confusing, with families having to navigate from service to services themselves, rather than experiencing seamless support. At times a lack of focus on long-term solutions that assist families to move permanently out of disadvantage can lead to families becoming dependant on the system. The Family Centred Care Model intends to address these issues, by adopting a systems approach and by capacity building the workforce. While there are parts of the service system which are well integrated and the care of vulnerable families is well coordinated, the Advisory Committee believes that further integration and improvement can be achieved. The Project will build on, and strengthen intake, assessment, care planning, referral and care coordination for vulnerable families, initially through the functional integration of ACCO/ACCHOs in the NWMR, and over time between the service system and mainstream services. North and West Governance Group In addition to the NWMR Closing the Gap Advisory Committee, the region has an Governance Group. This group comprises senior representatives from the Department of Human Services (DHS) and the Department of Health (DH), and the CEOs of the nine Community Controlled Health Organisations (ACCHOs) and Community Controlled Organisations (ACCOs) based in the region. The Governance Group identified nine priority areas to guide its work. The nine priorities are: 1 Homelessness, in particular youth homelessness 2 Mental health including Koorie Kids 3 Suicide 4 Alcohol and drugs 5 Children at risk/vulnerable young people 6 Disability 7 Culture 8 Holistic health including early intervention / prevention and incorporating all people not just those in crisis or at risk 9 Strengthening ACCOs in particular infrastructure and workforce. Inner North West PCP Closing the Gap Project Late in Year 3 ( ) of the N&WMR Closing the Health Gap strategy, the Inner North West Primary Care Partnership (INWPCP) received funding to undertake the Inner North West Men s and Women s Wellbeing Service Partnership Project until June In December 2012, the project was extended until June 2014 with additional funding allocated. The aim of the project is to develop and implementation best evidence practice health screening and evidenced based responses focussed on a life stages approach for the People living in the Cities of Moreland, Moonee Valley, Yarra and Melbourne. The rationale for the project is that people generally delay accessing adequate health care. Providing early access to the right services at the right time to support people to remain well, will impact on the health gap between and non- people. Appendices Closing the Gap in Inner North West Melbourne February 2013 Appendices 29

34 BAppendix B: LGA Demographic Profiles CITY OF MOONEE VALLEY Appendices Table 17: ABS census data for the City of Moonee Valley Total population 317 people live in the City of Moonee Valley, and comprise of 0.29% of the total population living in the City of Moonee Valley. Population by sex Language spoken at home Australian Traditional Religion Median age Median total personal income ($ weekly) Median total household income ($ weekly) Median rent ($ weekly) Average number of persons per bedroom Average household size Proportion of dwellings that need one or more bedrooms (%) Unpaid assistance to a person with a disability aged 15 years and over Households Percentage unemployed 156 (49%) males and 161 (51%) females live in the City of Moonee Valley. 284 people reported that they spoke English only at home, and 11 people indicated that they speak an Australian Indigenous Language at home. Three (3) people living in Moonee Valley practice an Australian Traditional Religion. people living in the City of Moonee Valley are younger than the general population. The median age of persons living in the City of Moonee Valley is 26 years, compared to 38 years for non- persons. The median total personal income for people living in the City of Moonee Valley is $589, compared to $628 for non- persons. The median total household income for households is $1,381, which is slightly higher than the median total household income of $1,377 for non- households. The median rent is $300 for both and non- households. There is an average of 1.2 persons per bedroom in the City of Moonee Valley, compared to an average of 1.1 persons per bedroom for non- households. 2.6 households, 2.5 non- households. 11.1% of dwellings need one or more bedrooms, compared to 3.4% non- households. There are 33 people in the City of Moonee Valley providing unpaid assistance to a person with a disability. There are 182 households in the City of Moonee Valley, of these 120 are family households, 37 are lone person households, and 25 are group households. The level of unemployment is slightly higher for people living in the City of Moonee Valley, with 6.9% of males and 4.5% of females reporting they were unemployed, compared to 5% of non- males and 4.4% of non- females. Graph 2. population by age and sex: City of Moonee Valley Males Females Total years 5 14 years years years years 65 years and over 30 Closing the Gap in Inner North West Melbourne February 2013 Appendices

35 B Graph 3. status by sex: City of Moonee Valley Males Females Total Source: 2011 Census of Population and Housing. Appendices 0 Torres Strait Both and Total Islander Torres Strait Islander(a) Graph 4. population by highest year of school completed: City of Moonee Valley Males Females Total Year 12 or Year 11 or Year 10 or Year 9 or Year 8 Did not go equivalent equivalent equivalent equivalent or below to school Graph 5. Total personal income (weekly) Indigenous persons aged 15 years and over: City of Moonee Valley Negative/ $1 $199 $200 $299 $300 $399 $ $600 $799 $800 $999 $1,000 Personal Nil income or more income not stated Closing the Gap in Inner North West Melbourne February 2013 Appendices 31 31

36 B Appendices CITY OF MORELAND Table 18: ABS census data for the City of Moreland Total population 702 people live in the City of Moreland, making up 0.47% of the total population of Moreland. Population by sex Language spoken at home Australian Traditional Religion Median age Median total personal income ($ weekly) Median total household income ($ weekly) Median rent ($ weekly) Average number of persons per bedroom Average household size Proportion of dwellings that need one or more bedrooms (%) Unpaid assistance to a person with a disability aged 15 years and over Households Percentage unemployed 359 (51%) males and 343 (49%) females live in the City of Moreland. 652 people reported that they spoke English only, and 8 indicated that they speak an Australian Indigenous Language at home. 9 people living in the City of Moreland practice an Australian Traditional Religion. The median age of people living in the City of Moreland is 26 years, compared to 35 years non- persons. The median total personal income for people living in the City of Moreland is $439, compared to $552 for non- persons. The median total household income for households in the City of Moreland is $1,151, compared to $1,215 for non- households. The median rent paid by households in Moreland is $270, compared to $310 for non- households. The average number of persons per bedroom is the same for and non- households 1.2 persons per bedroom. The average household size for households in Moreland is 2.7, which is slightly higher than the average of 2.5 persons in non- households. 7.3% of households, 5.6 non- households. 60 people are providing unpaid assistance to a person with a disability. There are 383 households in the City of Moreland, of these 262 are family households, 72 are lone person households, and 49 are group households. 11.5% of males and 14.3% of females living in the City of Moreland were unemployed, compared to 6% of non- males and 5.5% of non- females. Graph 7. population by age and sex: city of Moreland Males Females Total years 5 14 years years years years 65 years and over 32 Closing the Gap in Inner North West Melbourne February 2013 Appendices

37 B Graph 8. status by sex: City of Moreland Males Females Total Source: 2011 Census of Population and Housing. Appendices 0 Torres Strait Both and Total Islander Torres Strait Islander(a) Graph 9. population by highest year of school completed: City of Moreland Males Females Total Year 12 or Year 11 or Year 10 or Year 9 or Year 8 Did not go equivalent equivalent equivalent equivalent or below to school Graph 10. Total personal income (weekly) Indigenous persons aged 15 years and over: City of Moreland Negative/ $1 $199 $200 $299 $300 $399 $ $600 $799 $800 $999 $1,000 Personal Nil income or more income not stated Closing the Gap in Inner North West Melbourne February 2013 Appendices 33 33

38 B Appendices CITY OF YARRA Table 19. ABS census data for the City of Yarra Total population 321 people live in the City of Yarra, making up 0.44% of the total population living in the City of Yarra. Population by sex Language spoken at home Australian Traditional Religion Median age Median total personal income ($ weekly) Median total household income ($ weekly) Median rent ($ weekly) Average number of persons per bedroom Average household size Proportion of dwellings that need one or more bedrooms (%) Unpaid assistance to a person with a disability aged 15 years and over Households Percentage unemployed 162 (50.5%) males and 159 (49.5%) females live in the City of Yarra. 288 people speak English only, and 15 people speak an Australian Indigenous Language at home. 3 people practice an Australian Traditional Religion. The median age of residents is 31 years, slightly lower than the median age of 34 years for non- persons. Yarra has the highest median age of persons in the INWMML catchment. The median total personal weekly income for residents in Yarra is $479, which is notably lower than the $867 per week for non- persons in Yarra. Median total household income for families is $1,125, which is notably lower than the $1,684 for non- households. people pay a median rent of $270 per week in the City of Yarra. This is notably lower than the $370 paid by non- households. The average number of persons per bedroom is 1.1 in households and 1.2 for non- households in the City of Yarra. The average household size is 2.4 persons in households, and 2.2 non- households. 8.1% of dwellings, 4.4% non- dwellings need 1 or more bedrooms. 25 people are providing unpaid assistance to a person with a disability. There are 212 households in the City of Yarra, of these 93 are family households, 66 are lone person households, and 53 are group households. 9.1% of males and 13.3% of females reported they were unemployed, compared to 5% of non- males and 4.4% of non- females living in Yarra. Graph 12. population by age and Sex: City of Yarra Males Females Total years 5 14 years years years years 65 years and over 34 Closing the Gap in Inner North West Melbourne February 2013 Appendices

39 B Graph 13. status by sex: City of Yarra Males Females Total Source: 2011 Census of Population and Housing. Appendices 0 Torres Strait Both and Total Islander Torres Strait Islander(a) Graph 14. population by highest year of school completed: City of Yarra Males Females Total Year 12 or Year 11 or Year 10 or Year 9 or Year 8 Did not go equivalent equivalent equivalent equivalent or below to school Graph 15. Total personal income (weekly) Indigenous persons aged 15 years and over: City of Yarra Negative/ $1 $199 $200 $299 $300 $399 $ $600 $799 $800 $999 $1,000 Personal Nil income or more income not stated Closing the Gap in Inner North West Melbourne February 2013 Appendices 35 35

40 B Appendices CITY OF MELBOURNE Table 20. ABS census data for the City of Melbourne Total population 262 people live in the City of Melbourne, making up 0.28% of the total population living in the City of Melbourne. Population by sex Language spoken at home Australian Traditional Religion Median age Median total personal income ($ weekly) Median total household income ($ weekly) Median rent ($ weekly) Average number of persons per bedroom Average household size 163 (62.2%) males and 99 (37.8%) females live in the City of Melbourne. 226 people speak English only, and 5 people speak an Australian Indigenous Language at home. 3 people practice an Australian Traditional Religion. The median age of residents is 27 years, similar to the median age of 28 years for non- persons. The median total personal weekly income for residents in Melbourne is $581, which is notably lower than the $711 per week for non- persons in Melbourne. Median total household income for families is $1,702, which is notably higher than the $1,351 for non- households. people pay a median rent of $339 per week in the City of Melbourne. This is lower than the $400 paid by non- households. The average number of persons per bedroom is 1.3 in households and 1.2 for non- households in the City of Melbourne. The average household size is 2.2 persons for both and non- households. Proportion of dwellings that need one or more bedrooms (%) Unpaid assistance to a person with a disability aged 15 years and over Households Percentage unemployed 10.6% of dwellings, 8.2% non- dwellings need 1 or more bedrooms. 27 people are providing unpaid assistance to a person with a disability. There are 152 households in the City of Melbourne, of these 69 are family households, 45 are lone person households, and 36 are group households. 11.8% of males and 12.8% of females reported they were unemployed, compared to 7.6% of non- males and 8.6% of non- females living in Melbourne. Graph 17. population by age and sex: City of Melbourne Males Females Total years 5 14 years years years years 65 years and over 36 Closing the Gap in Inner North West Melbourne February 2013 Appendices

41 B Graph 18. status by sex: City of Melbourne Males Females Total Source: 2011 Census of Population and Housing Appendices 0 Torres Strait Both and Total Islander Torres Strait Islander(a) Graph 19. population by highest year of school completed: City of Melbourne Males Females Total Year 12 or Year 11 or Year 10 or Year 9 or Year 8 Did not go equivalent equivalent equivalent equivalent or below to school Graph 20. Total personal income (weekly) Aborignal persons aged 15 years and over: City of Melbourne Negative/ $1 $199 $200 $299 $300 $399 $ $600 $799 $800 $999 $1,000 Personal Nil income or more income not stated Closing the Gap in Inner North West Melbourne February 2013 Appendices 37 37

42 CAppendix C: Services in the Catchment Appendices ABORIGINAL COMMUNITY CONTROLLED HEALTH ORGANISATIONS There are a number of Community Controlled organisations located within the INWMML catchment. In addition, a range of other services are located in Darebin, and surrounding areas. Victorian Health Service The Victorian Health Service (VAHS) was established in Fitzroy in Today, VAHS is a comprehensive primary health care provider with a holistic approach to health, wellbeing and healing. VAHS provides a range of services, including: Clinical Programs, providing a large medical clinic, oral health, allied health services, pharmacy and healthy for life programs Community Programs, providing health support to Elders in the home, centre based allied health, and group based exercise activities Family Counselling Programs, providing family, mental health and drug and alcohol diagnosis and support services to the community at a local and state wide level for children, youth and adults. These include, psychological services, and psychiatric support, adult mental health, adolescent/ youth programs, family therapy, Koori Kids program, Justice/Court support, family well-being support, family violence counselling and a men s group Financial Wellbeing Program, which provides a range of services including financial counselling, problem gambling counselling, social support and housing support Women s and Children s Programs, including maternal and child health, maternity and enhancement services, paediatric and gynaecology services, in-home support, audiology, and nursing services Men s Health, providing group activities, men s health programs, and health promotion programs. Victorian Child Care Agency The Victorian Child Care Agency (VACCA) is a state-wide child and family welfare agency based in Brunswick. VACCA provides assistance and support to children and families who are experiencing social and economic problems which may contribute to a breakdown in the family structure. VACCA also receives funding from the OATSIH to deliver the Victorian Link-Up Program which assists the Stolen Generations to identify and reunite with family members. VACCA services available in the north and west metropolitan region of Melbourne include: Integrated Family Services including Strong Families, playgroups, Cultural Support, ChildFIRST Liaison Officers, and Family Restorations Out-of-home-care programs including foster care and residential care Lakidjeka ACSASS, which provides specialist cultural advice to Child Protection Link-Up Victoria Family Violence services. Community Elders Service The Victorian Community Elders Service (ACES) based in East Brunswick provides services for elders, other frail aged and people with disabilities who are in need of care and support in culturally appropriate and safe environments. ACES was initially established by the community to care for elders previously isolated in hospitals and other institutions. The ACES provides the following services: A 24-bed hostel in East Brunswick designed and operated in accordance with cultural principles Community Aged Care packages in the community across metropolitan Melbourne A Planned Activity Group program. Melbourne Youth, Sport and Recreation Melbourne Youth, Sport and Recreation (MAYSAR) is an community gym, located in Collingwood. MAYSAR provides the following services: Youth Services Health Promotion Education/Training Physical/Sporting Groups Health Education Community Support Public Meeting Place. Access Services for Koories Access Services for Koories (ASK) based in Collingwood is an outreach care coordination service, delivered through a partnership between VAHS and the Northern Division of General Practice (now known as Infiniti Health Solutions). ASK staff facilitate a culturally appropriate response between clients and health care providers including specialists, general practitioners, psychologists, practice nurses and allied health professionals. 38 Closing the Gap in Inner North West Melbourne February 2013 Appendices

43 C Victorian Community Controlled Health Organisation The Victorian Community Controlled Health Organisation (VACCHO) is the peak body for Health in Victoria, representing Health Services (VACCHO Member Organisations) throughout Victoria, each member is an Community Controlled Health Organisation delivering primary health services to their local community. VACCHO s role is to advocate, educate and promote the philosophy of community control and to develop policy and strategies which promote Health Rights, Community Control and physical, spiritual and emotional wellbeing. The Victorian and federal governments formally recognise VACCHO as the peak representative organisation on Health in Victoria. Family Violence Prevention and Legal Service Victoria The Family Violence Prevention and Legal Service Victoria (FVPLS Victoria) was established in October 2002 to provide assistance to victims of family violence and sexual assault and to work with families and communities affected by violence. FVPLS Victoria is funded through a number of sources including the Commonwealth Attorney General s Department, Victoria Legal Aid and Department of Justice Victoria. Services include: Legal services Community legal education Counselling services. Connecting Home Connecting Home Ltd (previously known as Stolen Generations Victoria) was registered on the 17 March, This organisation was established in response to the recommendations arising from the Stolen Generations Taskforce Report of April 2003 commissioned by the Victorian Government. The Taskforce identified the need for an independent, community controlled Stolen Generations Organisation for Victoria. Connecting Home delivers a number of programs that are designed to directly support people affected by the Government s past policies of forcible removal including healing and case management. Local Indigenous Networks A Local Indigenous Network (LIN) is made up of people who work together to provide a voice for their community, identify local issues and priorities and plan for the future. Across Victoria LINs meet regularly. Each LIN is expected to develop a local community plan that identifies their strengths, resources and describes the vision, aspirations and priorities of their local community. LINs are involved in many activities including community events and gatherings, building relationships with local service providers and organisations, linking with local government planning, working with Local Education Consultative Groups, increasing youth participation, planning and supporting community initiatives such as men s groups, homework centres and cultural identity projects. Hostels Limited Hostels Limited provides: Temporary accommodation to people. A network of hostels across Australia and currently operates its own hostels and funds community hostels. Affordable accommodation for people under the following categories: Multipurpose Accommodation Secondary Education Tertiary Education and Training Indigenous Youth Mobility Program (IYMP) Medical and Renal Treatment Substance Abuse Rehabilitation. Housing Victoria The Housing Board of Victoria was established in 1981 to develop and manage housing assistance to the community. Housing Victoria (as it is now known) is a non-profit, non-government housing organisation dedicated to the provision of safe, secure and affordable housing for Victorians. Services include: Housing Emergency housing Information Support Home maintenance. Appendices Koorie Heritage Trust The Koorie Heritage Trust is based in Melbourne. Its purpose is to preserve, protect and promote the culture of South Eastern Australia and in doing so, bridge the cultural gap between Koories and the wider community. Closing the Gap in Inner North West Melbourne February 2013 Appendices 39

44 C Appendices Iibijerri Theatre Group Based in North Melbourne the Ilbijerri is the longest running Theatre company in Australia and the only one in Victoria. ILBIJERRI s plays explore a range of complex and controversial issues from a uniquely perspective. Our work possesses the power to reach out and remind audiences of every person s need for family, history and heritage. organisations located geographically near INWMML Margaret Tucker hostel Fairfield Elizabeth Hoffman House Fairfield Bert Williams Centre Thornbury Male Centre Preston Yappera Children s Service Thornbury William T Onus Hostel Northcote Aborigines Advancement League Thornbury. ABORIGINAL SPECIFIC POSITIONS IN MAINSTREAM SERVICES Hospital networks There are Liaison Officers located in the following hospitals in the INWMML catchment or just outside the catchment: St Vincent s Hospital Royal Melbourne Hospital Northern Hospital, plus a HACC Liaison Officer (HALO) position Royal Children s Hospital Royal Victoria Eye and Ear Hospital Western Hospital (Western Health) Maroondah Hospital (Eastern Health) Royal Women s Hospital, which also has an Women s Health Unit. Improving Care for Patients Program The Victorian Department of Health established the Improving Care for Patients (ICAP) program in 2004 in recognition that many people are reluctant to attend hospitals, and under identification of patients. ICAP is underpinned by a 30% loading on health service funding for inpatients. To demonstrate the provision of quality care for patients, health services are required to report progress against four key result areas in their annual quality of care reports: Relationships with communities Culturally aware staff Discharge planning Primary care referrals. Councils The City of Melbourne s Indigenous Unit s work focuses on: Monitoring and reporting on the City of Melbourne s Reconciliation Action Plan Ensuring the City of Melbourne s and Torres Strait Islander Statement of Commitment is recognised and supported through the organisation s strategies and actions Advising the City of Melbourne on issues, interests and culture Being the contact point for the community Raising awareness and promoting Melbourne s history, culture, issues and achievements through funded events and initiatives. The Moonee Valley City Council Moonee Valley Council has a Reconciliation Policy , and develops an annual Reconciliation Plan. 40 Closing the Gap in Inner North West Melbourne February 2013 Appendices

45 C Moreland City Council Council is committed to reconciliation with Australians, particularly the Wurundjeri people the traditional owners of the land we now call Moreland. To demonstrate this, Moreland Council: Flies the flag and the Australian flag at Council buildings Invites Wurundjeri Elders (traditional land owners) to do Welcome to Country to open significant civic events Helps community organisations include Welcome to Country and other activities and performers in their community events Provides a program of cultural awareness and activities within Moreland schools during Reconciliation Week each year between 27 May 3 June Develops appreciation of art through various exhibitions at the Counihan Gallery in Brunswick Gives access to music, books and films through our libraries Organises cultural awareness and appreciation sessions Appoints and supports trainees in the Council workforce, and helps non groups and organisations engage with groups and organisations. Moreland also has a Reconciliation Advisory Committee. The Moreland Reconciliation Advisory Committee s objectives are to: Provide advice to Council on access, equity and justice for people Identify, advocate, and promote understanding on issues affecting Australians Promote understanding of culture through collaborative effort Oversee and assist with the implementation of Council s strategies for Reconciliation Make the most of all opportunities to further Reconciliation within Council, the community, business and with other spheres of government. Moreland Council also has a Reconciliation Policy and Action Plan The Council is committed to working towards two main goals as outlined in the Reconciliation Policy and Action Plan: Strengthen recognition of people as the First Nation peoples of Australia Reduce the disadvantage of people through closing the negative social and health gaps between and non- people. Recently Council reaffirmed its commitment to reconciliation and endorsed the Apology to Australia s Indigenous Peoples. The Yarra City Council has two specific positions: Community Planner Partnerships Coordinator Community Advocacy. In addition, Yarra Council has an Advisory Group. This Advisory Group enables on-going consultation between the community and Council. The Group s membership includes Elders, community members, and representatives of organisations in Yarra including: MAYSAR, VAHS, VALSV, VACSAL and representatives of Affairs Victoria and the Federal Department of Family and Community Services and Indigenous Affairs. The Group meets monthly to actively work on a broad range of issues such as health, housing, legal matters, sport and recreation, culture, heritage, environment, employment, and training. The Group also: provides Council with strategic advice regarding issues pertinent to the Wurundjeri people and issues pertaining to social justice for Australians assists Council in its on-going role in regards to issues affecting local Australians oversees the development and implementation of Council s Partnerships Plan. Other services with specific positions There are Liaison Officers located in the following services within the INWMML catchment: Diabetes Australia Victoria The Cancer Council of Victoria Omenda VicHealth Koori Health Unit Community Health. Appendices Closing the Gap in Inner North West Melbourne February 2013 Appendices 41

46 References D Australian Bureau of Statistics. (ABS; 2012). Births Australia Births of and Torres Strait Islander References peoples, Summary Victoria 2006 to Australia: ABS. Retrieved from Australian Bureau of Statistics. (ABS; 2012) Census of Population and Housing. and Torres Strait Islander Peoples (Indigenous) Catalogue number Australia: ABS. Retrived from Australian Bureau of Statistics. (ABS; 2013) Census of Population and Housing. and Torres Strait Islander Peoples (Indigenous) Profile: Melbourne (C) (LGA ). Catalogue number Australia: ABS. Retrived from Australian Bureau of Statistics. (ABS; 2013) Census of Population and Housing. and Torres Strait Islander Peoples (Indigenous) Profile: Moonee Valley (C) (LGA 25060). Catalogue number Australia: ABS. Retrived from Australian Bureau of Statistics. (ABS; 2013) Census of Population and Housing. and Torres Strait Islander Peoples (Indigenous) Profile: Moreland (C) (LGA 25250). Catalogue number Australia: ABS. Retrived from Australian Bureau of Statistics. (ABS; 2013) Census of Population and Housing. and Torres Strait Islander Peoples (Indigenous) Profile: Yarra (C) (LGA 20607). Catalogue number Australia: ABS. Retrived from Australian Bureau of Statistics. (ABS; 2012) Estimating the Homeless: Census (note LGA rates analysed by INWMML epidemiologist). Australia: ABS. Retrieved from Australian Department of Health and Ageing. (DoHA; 2012). and Torres Strait Islander Health Performance Framework, 2012 Report. Australia: Australian Department of Health and Ageing. Retrieved from Australian Indigenous HealthinfoNet. (2012). Summary of Australian Indigenous health, Indigenous HealthInfoNet. Australia: HealthinfoNet. Retrieved from Australian Institute of Health and Welfare. (AIHW; 2011). Access to health services for and Torres Strait Islander people. Cat. No. IHW 46. Canberra: AIHW. Retrieved from Australian Institute of Health and Welfare. (AIHW; 2013). Indigenous Australians data website: Canberra: AIHW. Retrieved from Australian Institute of Health and Welfare. (AIHW; 2011). Eye health in and Torres Strait Islander people. Australia: AIHW. Retrieved from Australian Institute of Health and Welfare. (2011). The Health and Welfare of Australia s and Torres Strait Islander People. Canberra: AIHW. Retrieved from Australian Institute of Health and Welfare. (AIHW; 2011). Contribution of chronic disease to the gap in adult mortality between and Torres Strait Islander and other Australians. Canberra: AIHW. Retrieved from Australian Institute of Health and Welfare. (AIHW; 2010). Australian Mothers and Babies 2010, Canberra: AIHW. Retrieved from Dental Health Services Victoria. (2010). Oral Health Plan Victoria: DHSV. Retrieved from Inner North West Melbourne Medicare Local (INWMML; 2012). Allied health survey. Melbourne: INWMML. Inner North West Melbourne Medicare Local (INWMML; 2012). General practice survey. Melbourne: INWMML. Inner North West Melbourne Medicare Local (INWMML; 2012). Pharmacy survey. Melbourne: INWMML. Inner North West Primary Care Partnership. (2013). Inner North West Metropolitan Region: &Torres Strait Islander Peoples Health Consumer Perspectives Project. Melbourne: INWPCP. Retrieved from -%20Final%20Report% pdf Inner North West Primary Care Partnership. (2012). Closing the Health Gap, Inner North West Region: Profile Report. Melbourne: INWPCP. Retrieved from ReportFINAL_ pdf Kulunga Research Network. (2010). Working together: and Torres Strait Islander mental health and wellbeing principles and practice. Western Australia: Centre for Research Excellence. Retrieved from Medical Benefits Scheme (MBS; 2012). Division of General Practice MBS data report. Retrieved from 42 Closing the Gap in Inner North West Melbourne February 2013 References

47 D National Aborginal Community Controlled Health Organisation. (NACCHO; 2012). Definitions webpage. Australia: NACCHO. Retrieved from National Health Performance Authority. (NHPA; 2013) Healthy communities: Immunisation rates for children in Sydney: NHPA. Retrieved from HC_ImmRates_ _FINAL_ pdf Public Health Development Information Unit. (PHIDU; 2012). Social Health Atlas of Australia: Statistical Local Area and Local Government Area. Adelaide: PHIDU. Retrieved from Public Health Development Information Unit. (PHIDU; 2011). Social Health Atlas of Australia: Statistical Local Area and Local Government Area. Adelaide: PHIDU. Retrieved from Thorpe, S. & Browne, J. (2009). Closing the nutrition & physical activity gap in Victoria: Victorian nutrition & physical activity strategy. Melbourne: Victorian Community Controlled Health Organisation. URBIS. (2011). Closing the Gap in health outcomes in Victoria: Baseline report May Retrieved from in%20health%20outcomes%20in%20victoria%20baseline%20report%20may% pdf URBIS. (2012). Closing the Health Gap: Evaluation Progress Report June Retrieved from VicHealth. (2012). Health in Victoria: Research Summary Identifying the determinants of physical and mental health. Melbourne: VicHealth. Retrieved from VicHealth. (2012). Mental Health Impacts of racial discrimination in Victorian Communities: Experiences of racism Survey,2011. Retrieved from Victorian Health Service. (VAHS; 2011). Evidence Report for the Melbourne Metropolitan Mental Health Redevelopment Project. Melbourne: VAHS. Victorian Department of Community and Planning Development (DCPD; 2012). workforce participation and skill development. Victoria: Victorian Department of Community and Planning Development. Retrieved from vic.gov.au/ data/assets/pdf_file/0005/110975/-workforce-participation-and-skill-development-july-20.pdf Victorian Department of Community and Planning Development (DCPD; 2011). Victorian Government Indigenous Affairs Framework Victoria: Victorian Department of Community and Planning Development. Retrieved from data/assets/pdf_file/0004/63832/dpcd-report-lr-part1.pdf Victorian Department of Community and Planning Development (DCPD; 2012). Victorian Affairs Framework Victoria: Victorian Department of Community and Planning Development. Retrieved from data/assets/pdf_file/0005/127535/doc-central_n _v1_aat_-_vaaf_-_final_ web_version_november_2012.pdf Victorian Department of Education and Early Childhood Development. (DEECD; 2009). The State of Victoria s Children 2009: children and young people in Victoria. Victoria: DEECD. Retrieved from Victorian Department of Health: North and West Metropolitan Region. (2009). Closing the Gap in Indigenous Health: Baseline Report October Victoria: Victorian Department of Health Victorian Department of Health. (DoH; 2012). Koolin Balit: Victorian Government Strategic Directions for Health Victoria: Victorian Department of Health. Retrieved from Victorian-Government-Strategic-Directions-for--Health Victorian Department of Health. (DoH; 2012). Koori health counts! Victorian hospital data Victoria: Victorian Department of Health. Retrieved from doc/7296e8a6def87671ca fd68/$file/ _koori_health_counts_7.pdf Victorian Department of Health. (DoH; 2011). The health and wellbeing of Victorians: Victorian Population Health Survey 2008 Supplementary report. Victoria: Victorian Department of Health. Retrieved from Survey-2008-Supplementary-report Victorian Department of Health. (DoH; 2012). Koori Maternity Service. Developmental Review. Victoria: Victorian Department of Health Williams, S., Jamieson, L., MacRae, A., & Gray, C. (2011) Review of Indigenous oral health. Retrieved from References Closing the Gap in Inner North West Melbourne February 2013 References 43 43

48