Analysis of Health Priorities - Health & Wellbeing

Priority Area 1: Healthy Lifestyle – Eating and Exercise

Eating patterns and physical activity are key determinants of obesity and can lead to chronic disease such as diabetes. The prevalence of overweight and obese individuals in Australia has been steadily increasing over the last 30 years with the number of overweight and obese adults increasing from 4.6 million in 1989–90 to 7.4 million in 2004–05.  According to the Victorian Population Health Survey (2003), the average of adults in the Barwon South West Region who were overweight or obese was higher than the average for Victoria as a whole (DHS 2003, NPHT 2008).

The relationship between moderate levels of physical activity and improved health and wellbeing is well established. Research has shown that physical activity is one of the major modifiable risk factors in reducing the risk of and complications from chronic diseases. Chronic disease not only increases the burden on the health care system but can significantly diminish economic productivity. People with chronic disease are less likely to participate full-time in the labour force and are nearly twice as likely to not be in the labour force as those without chronic disease (AIHW 2009, DHS 2005).

Diabetes

Diabetes is widely recognised as one of the most serious health problems across the world in the 21st century. Diabetes is one of several key chronic diseases (others can include heart disease, stroke, cancer, osteoporosis, arthritis, depression, asthma) that together account for 80% of the disease burden in Victoria (DHS 2008, The Allen Consulting Group 2008). This is not only due to the considerable adverse health and economic costs of the existing problem but the rapidly accelerating rate of disease in most countries over the last 20 years.
Corio Norlane has a diabetic incidence of 6.76% compared to the Victorian State rate of 4.04% and the National rate of 3.98%. More than 20% of all diabetics in the greater Geelong region are treated in Corio Norlane. Diabetics have a significantly increased morbidity and mortality from a range of medical conditions. In Australia, diabetes is identified as the 6th most common cause of death, the most common reason for kidney dialysis, the most common cause of blindness in those under 60 years of age and the most common cause of non-traumatic lower limb amputation. Diabetes is also associated with reductions in life expectancy.

Nutrition

In Corio Norlane, a significant number of children face challenges associated with poor nutrition, lack of physical exercise and poor oral health. Almost 10% of children born between 1999 and 2000 weighed less than 2,500 grams (low birth weight); and a higher proportion of children were not fully immunised when compared to other communities in Geelong. Their parents are also struggling with a range of health related issues such as stress and diabetes (NDSS 2009).
Victorians with low socioeconomic status have significant levels of food insecurity, described as ‘irregular access to nutritionally adequate, culturally acceptable, safe foods through local non-emergency services’, with nearly a quarter reporting that within the last 12 months they ran out of food and couldn’t afford to buy more. In Corio Norlane, a Food Security Rapid Assessment Project found that the majority of participants indicated that the main barriers to food security include limited: public transport; income; skills and knowledge; and local food supplies (The Allen Consulting Group 2008, Wood 2008).
The inability to access nutritious food is cause for short-term health issues such as constant hunger, anxiety related to food shortage and a lack of energy. Long term health issues can arise due to food insecurity as foods of poorer quality that are high in fat, salt, and sugar, are selected as they are believed to be the ‘cheaper’ option. These ‘cheaper’ options can contribute to range of chronic diseases (The Allen Consulting Group 2008).

Priority Area 2: Improve Access to Health Services

In 2000, a health needs assessment was conducted by Deakin University on behalf of the Department of Human Services in Corio Norlane. As a result, community members identified the following health service needs:

• more local general practitioner, dental and allied health services located in the area;
• action to address the barriers to accessing services including: location, distance, transport, cost, knowledge, eligibility, outreach, and the co-location of services;
• early intervention, prevention and health education; and
• integration between providers to ensure continuity of care.

In 2002, consultations conducted by Barwon Health took place to identify the needs of the community with respect to the redevelopment of the community health services. Identified needs include:

• space for social activity and community networking;
• increased capacity for basic community health services;
• co-location of GP services and provision of visiting specialist services;
• services to meet areas of concern (Asthma, Diabetes, General Health, Occupational Heath, Pain management, Parenting, Refugees, Chronic Condition, Sleep disorders);
• clinical support to Wathaurong health services; and
• increased capacity for community participation in public health, disease prevention and health promotion activities and strategies (Barwon Health 2002).

Access to Integrated Diabetes Management Services

Optimal management of diabetes can greatly diminish the health and economic consequences of diabetes. Optimal management involves a comprehensive team approach to health management in which the patient engages with a range of health professionals on a regular basis throughout each year. These professionals include family doctors, diabetes educators, dieticians, podiatrists and optometrists or ophthalmologists. In disadvantaged areas such as Corio Norlane access to such services is often problematic due to the need to see different health workers in different locations and at different times. Limited access to public or private transport and the high costs of attending so many different practitioners have traditionally resulted in far less than recommended management of diabetes in Corio Norlane.

In response to this identified community need, an innovative integrated diabetes service has been established in Corio Norlane. The service is provided out of a building located adjacent to a large family medical centre. A range of public and private health practitioners provide diabetic services coordinated so that diabetics are often able to access many service providers during the one visit. This is subsidised in various ways so that it is at no cost to the patients. The health providers all use shared health records to improve coordination of the delivery of their service. Since this centre has been established, regular attendance at consultations with the health providers has increased and for many patients there have been significant improvements in the control of their diabetes and management of their related medical conditions. It is intended to further expand both the range of services available and the number of sessions in which they are provided as determined by community need.

Health Literacy

In disadvantaged communities there is a direct correlation between those who have low literacy levels and a poorer understanding of health prevention and treatment strategies. People with low literacy levels often report poorer overall health and ultimately reduced life expectancy. People with low literacy are:

• less likely to make use of screening services such as Pap Smears and mammography;
• are more likely to present in later stages of disease;
• are more likely to be hospitalised;
• are less likely to adhere to medical regimens, including immunisation and breast feeding; and
• less likely to have their children participate in health maintenance activities.
  

New trends in healthcare are moving towards a system in which patients’ are encouraged to participate in the care and management of their own health. This shift is an example of the importance of not only health literacy but literacy in general. Patients now find themselves more often actively:

• involved in management of their chronic conditions e.g. diabetes, asthma, arthritis, osteoporosis;
• using screening programs e.g. breast, prostate, bowel, pap smears;
• using decision aids to help decide on options e.g. graphs, tables;
• using the Internet to seek health information; and
• needing to be kept informed of the changing Adult and Child Immunisation Programs, e.g. meningococcal, cervical cancer, measles, mumps and rubella vaccination.

Poor literacy levels reduce the capacity of individuals to understand and participate in managing their own health.

Oral Health

Poor oral health has the greatest impact on the most vulnerable members of the community, the health and wellbeing of children. The Barwon South West Region has consistently higher averages of dental decay in children than the Victorian average. In Corio Norlane waiting times to visit a dentist peak at 31 months, the highest of all Barwon Health services. In addition, children in Corio Norlane in the 4-5 years and 12-16 years age groups consistently experience higher rates of decayed ‘missing or filled’ and ‘teeth needing fillings’ than the average of the Barwon South West Region and Metropolitan Melbourne.
The impacts of oral disease on an individual’s health include: poorer nutritional status; peptic ulceration; poorer cardiovascular health; poor appearance; low self-esteem; speech difficulties; decreased employment opportunities; and decreased quality of life. Oral disease also becomes a burden on the health system with increasing general practitioner visits and hospital admissions. In addition, there are economic costs including decreased productivity and days lost from work or school (Barwon Primary Care Forum 2004, Dental Health Services Victoria 2006, The Allen Consulting Group 2008).
In June 2009, fluoride was introduced into the water supply in Geelong. Fluoridation reduces the socioeconomic disadvantages in oral health. At present, fluoridated areas of Victoria have a 36% lower rate of dental cavities in 6 year olds (and 22% lower rate in 12 year olds) than in non-fluoridated areas such as Corio Norlane. The introduction of fluoride into Geelong’s water supply is one example of the CN DAB and the Health and Wellbeing Sub Committee (HWBSC) working together with its partners to identify and address health priorities in Corio Norlane. This initiative is supported by National and State peak bodies who agree that the most equitable and cost effective intervention to improve dental health is fluoridation.

Priority Area 3: Reduce the Misuse of Drugs and Alcohol

Smoking

Tobacco remains the leading cause of preventable deaths and hospitalisation in Australia. Victorians of low socioeconomic status and Indigenous Victorians smoke at higher rates than other sub-groups. In Victoria, 19.9% of the population are currently smoking. Of Indigenous Victorians, 34% are currently smoking. Of Victorians of a low socioeconomic status, 32.7% currently smoke. Smoking has both immediate and longer-term effects on a person’s health. Short term effects include breathing problems while longer term adverse health effects include an increased risk of developing: respiratory problems; emphysema; coronary disease; and numerous cancers including lung, throat, mouth, bladder, kidney, cervical and stomach (The Allen Consulting Group 2008, VicHealth 2001).
In 2005, Colac Area Health established a Smoking Cessation Clinic based on the model established by The Royal Prince Alfred Hospital, Sydney, and promoted by The Alfred Hospital, Melbourne. The Clinic was the first of its kind in Victoria producing 12 month abstinence rates of 33%.  A study assessing the success of the Smoking Cessation Clinic found that: the model provided was a success in rural communities; and that low socioeconomic conditions do not affect residents accessing the services. In fact, the study found that residents living in the Colac Neighbourhood Renewal area constituted 32% of the client base, a number much greater than expected. This Smoking Cessation model is currently being implemented at the Corio Medical Clinic.
In Corio Norlane, recent community consultations at the Cloverdale’s Plant, Meet and Eat Day and Rosewall’s Going Potty Garden and Arts Festival suggests that the community continue to believe that smoking is the ‘biggest problem’ in Corio Norlane.

Alcohol

Alcohol consumption accounts for 3.2% of the total burden of disease and injury in Australia. The annual cost to the Australian community from harmful drinking is estimated to be almost $11 billion. Much of this cost is borne outside the health system e.g. the loss of productivity in the workplace ($3.5 billion); the impact of drinking by parents and/or other adults on children; and 13% of Australian children aged two years or less are exposed to an adult who is a regular binge drinker.

Priority Area 4: Promote Sexual Health

Cancer of the cervix is the second most common cancer in women across the World but a national screening program in Australia has helped to reduce its incidence in this country to the 13th most common cancer. The National Cervical Screening Program commenced in 1991 and its main objective is to reduce incidence and death from cervical cancer. The Program depends on the use of organised regular screening using the Pap test to identify treatable pre-cancerous lesions as well as cervical cancer. The Program targets all Australian women aged 20–69 years. The National policy for this program currently recommends routine screening for all sexually active women from the age of 20 (or 1 to 2 years after first having sexual intercourse, whichever is later) repeated every two years until the age of 69. More frequent testing is required for women with previous abnormalities or symptoms or history suggestive of disease affecting the cervix.
It is now recognised that cervical cancer is a rare outcome of infection with certain strains of human papillomavirus (HPV). Because HPV infection is necessary for the development of cervical cancer, risk factors for cervical cancer include having multiple sexual partners and becoming sexually active at a young age. Smoking has also been identified as a risk factor for the development of cancer of the cervix.
In 2006-2007, 61.5% of Australian women in the targeted age group participated in Pap Smear screening at the recommended two yearly screening rate (AIHW & DHA 2009a). In 2005-2006, when figures were last available for participation according to socioeconomic status, the rate of participation across Australia was 64.6% ranging from 71.5% participation in the highest socioeconomic quintile to 57.3% in the lowest socioeconomic quintile (AIHW & DHA 2009).
The rate of participation in Corio Norlane is approximately 50% and improving this rate has been identified as a significant priority given the extra risk factors for development of cervical cancer in the Corio Norlane area from early sexual activity and high smoking rates. Work is underway to identify barriers to participation in cervical cancer screening and alternative health promotion strategies aimed at reducing risk factors for cervical cancer.

Priority Area 5: Mental Health and Wellbeing

Mental ill health is one of the top three leading causes of burden of disease and injury in Australia. In 2003, mental disorders accounted for 13% of the total disease burden in Australia and 24% of the non-fatal burden. The National Health Survey, Australia indicates that:

• the rates of mental and behavioural problems and psychological distress were highest for males and females who were unemployed and those who were not in the labour force; and
• those people from the most disadvantaged socioeconomic areas (those in lowest SEIFA quintiles) were more likely to have a higher prevalence of mental and behavioural problems (12.3%) compared with 8.1% of people from the least disadvantaged socioeconomic areas (ABS 2001).

The Victorian Population Health Survey (2003) indicates that 14% of men and 23% of women participating in the survey had been told by their doctor that they had depression or anxiety (DHS 2005). Further, the Survey results indicated that adults more likely to be categorised as experiencing psychological distress were:

• persons with lower education levels;
• unemployed or not in the labour force;
• those in non-professional occupations;
• smokers;
• those with doctor-diagnosed high blood pressure;
• told by a doctor that they had depression or anxiety;
• those self-reporting poor health status;
• those not having private health insurance; and
• in households having lower income levels (DHS 2005).

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