Lesley Barclay, USYD: Social Determinants of Health in Regional and Remote Australia

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Professor Lesley Barclay AO, Professor and Director, Centre for Rural Health, University of Sydney and Chair, National Rural Health Alliance delivered this presentation at the 2013 Social Determinants of Health conference. The conference brought together health, social services and public policy organisations to discuss how social determinants affect the health of the nation and to consider how policy decisions can be targeted to reduce health inequities. The agenda facilitated much needed discussion on new approaches to manage social determinants of health and bridge the gap in health between the socially disadvantaged and the broader Australian population. For more information about the event, please visit the conference website: http://www.informa.com.au/social-determinants.

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  • Being pregnant south of Halls Creek Case studyYou are not sure but think you might be pregnant but your family do not want you to marry this boy and you have not told anyone; your mum notices though Finally and takes you up the aid post when the flying doctor visits. Your are16, you have not been at school for 3 years, you can only go to early high school in your own community, and did not want to travel to the coast 12 hours drive to stay in a boarding house and study more. There is no work so you help your mother with the other younger childrenYou are flown to Halls Creek on small plane for antenatal care but you cannot have the baby there. At 18 weeks flown to Halls Creek then put on the bus for 4 hours to go to Kununurra for ultrasound dating. Met by community midwife who seems friendly but it is still very frighteningYou return home the next day after staying by yourself in a hostel only 30 dollars for food12 weeks later journey is repeated for birth when you wait 16 nights in the hostel, being humbugged, with no one to talk to as the other women in the hostel keep changing You keep going to the ED as you are frightened and you get small pains. They say you are not in labour but after you do this 4 times they put a needle in your arm and examine you . It hurts but they say they baby will come nowYou are even more frightened as the pain that now come hurts you more- you have no one with you. You do not see the same person as they keep changingThey keep feeling you inside but the baby is not coming quickly enough so they say you need an operationYou go to sleep- just wanting to die by this time and not caring about the baby anymore. You wake up and it still hurts but this time it does not stop for a few days. The baby comes and goes and cries a bit but does settles quickly when you feed himA week later they put you on the bus and 4 hours later you get to halls creekYou stay overnight in the hospital and people talk to you but it is still scaryYou catch the small plane home the next dayIt is wonderful to see your mother and grandmothers and
  • Lesley Barclay, USYD: Social Determinants of Health in Regional and Remote Australia

    1. 1. University Centre for Rural Health Lesley Barclay AO PhD Professor and Director SCHOOL OF PUBLIC HEALTH
    2. 2. Definitions ‘Health’ is a very broad notion, affected by a wide range of individual characteristics, behaviours and contextual factors. Those contextual factors that fall within social, economic and environmental domains are usually referred to as the ‘social determinants of health’
    3. 3. Context that affects a person’s health  How much education they have  Where they live  Whether they have a job  What kind of work they do  The quality of their food, home life and recreation 3
    4. 4. Characteristics of poorer health  Lower incomes, lower levels of education and employment are linked to poorer access to health services  These are more prevalent in rural and remote Australia 4
    5. 5. Associated factors  Common risk factors for ill-health with higher rates in rural and remote Australia     higher rates of smoking obesity greater rates of disability lower rates of physical activity 5
    6. 6. Consequences  These factors lead to excess mortality  Living with greater levels of morbidity  diabetes and renal disease in Aboriginal populations 6
    7. 7. Most important contributor  Factor most closely allied to health status is income  Income is less outside major cities 7
    8. 8. Lower income in rural/remote Australia Exacerbated by:  Cost of living is higher  ↑ fuel, food, transport  Educational achievements lower-influences income  Private health insurance less 8
    9. 9. Access to health services  prevent/minimise illness less available  E.g. minimising antenatal care  GP, pharmacist, allied health, nurse  very few private practitioners  diagnosis or advice, education limited  treatment/s also less available  not just acute treatments, falls prevention, home medication review for complex medication 9
    10. 10. Access/closures  Access to health services in rural and remote areas  closures; small hospitals  services; e.g. birthing  surgical services  accident and emergency 10
    11. 11. Services not there  private practitioners, insufficient volume or people who can pay for care e.g. dentistry. GPs (no hospital income to ‘prop up’ practices) private practitioners, insufficient volume or people who can pay for care e.g. dentistry  private hospitals private hospitals 11
    12. 12. Focus on urban  Effects of urbanisation on health care services  concentration of skills and expertise  in some cases advantageous, in others detrimental  devalues rural expertise and makes it less attractive for practice  Makes services difficult to get to- increases transport and accommodation costs header 12
    13. 13. Transport 13
    14. 14.  Redesign of small rural hospitals  High end aged care and MPS  Salaried services that are not dependant on a small business model when this is not sustainable  Medicare Local supported and managed  Locally services when possible- e.g dialysis at home  Better and more efficient skills mix; salaried nurse practitioners and midwives  Community oriented services and support  Provision of affordable and accessible means of transport and accommodation for acute care treatments 14
    15. 15. References The Determinants of Health in Rural and Remote Australia. Fact Sheet 28. May 2011.

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