[PPT] - in Health Care Planning Dr Danielle Butler Robert Graham PowerPoint Presentation

SLIDE 1

Social Determinants of Health in Health Care Planning

Dr Danielle Butler Robert Graham Centre/Australian Primary Health Care Research Institute Visiting Fellowship 2009

SLIDE 2

Acknowledgements

 APHCRI  Support, guidance and time from Robert

Graham Staff

The research in this presentation is a project of the Australian Primary Health Care Research Institute, which is supported by a grant from the Australian Government Department of Health and Ageing, under the Primary Health Care Research, Evaluation and Development Strategy. The information and

pinions containing in it do not necessarily reflect the view or policy of the

APHCRI or the Australian Government Department of Health and Ageing

SLIDE 3

Background and Policy Context

 Increasing health and health care access inequity

across social gradients between and within countries

 Need for some measure of this in health

planning and resource allocation

 Australian Health reform

 Access and equity  Primary health care/preventative care  Data collection/dissemination/monitoring

SLIDE 4

Small area measures of social deprivation

 Captures personal and contextual components  UK, NZ, Aust/US  Domains

 Employment, income, social capital, education/skills, barriers

to housing and services

 Use in primary care policy and public health

 Inherent premise: social deprivation predicts poor health

utcomes and health care access. Targeting services to these

areas will improve inequity

 Incentives/funding, benchmarking, public health monitoring

 Limitations:

 Ecological fallacy, populations do not always behave as

determined by administrative boundaries

SLIDE 5

Determining need in Australia Current Strategies

 Workforce shortage and maldistribution a

significant concern

 Current workforce distribution programs based

n geographical definitions only (RA)

 Complex and generous

 Shortage areas for IMGs only  Outer metro for GP trainees

SLIDE 6

Determining need in Australia The Evidence

 Utilisation and access to primary health care services

relates to:

 Rurality, age, socioeconomic deprivation, indigenous status

and health outcomes

 Inequity exists along social and remoteness gradients

 Rural access index for Victoria (McGrail and Humphreys, 2009)

 Includes measures of GP supply, geographical distance,

mobility, health need and socioeconomic disadvantage

 Significant heterogeneity within remoteness areas

 Reliance of geographical definitions alone fails to

recognise the diversity of need and inequity of access within areas

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GIS and Health in Australia

 Use of spatial relationships and maps – a powerful tool

for understanding health care service issues

 Enhances understanding of community health needs  Immediate visualisation of solutions  A common platform for discussion between stakeholders-

academia, policy and decision makers, clinician and community

 Public health information development unit (PHIDU)  Practice Health Atlas  Rural Access Index  HealthLandscape: created an Australian health mapping

tool through collaborative fellowship

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SLIDE 9

Inner regional Sydney- Medical workers per 10,000

Yass

Orange Bathurst Lithgow Katoomba

SLIDE 10

Inner regional Sydney- Index of Relative Disadvantage

Orange Bathurst Lithgow Katoomba

Yass

SLIDE 11

Sydney-Urban and Outer Metropolitan- Medical Workers per 10,000

Liverpool Campbelltown Sutherland Fairfield Blacktown Parramatta

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Sydney-Urban and Outer Metropolitan-Index of Relative Disadvantage

Fairfield Parramatta Blacktown Liverpool Campbelltown Sutherland

SLIDE 13

Top End Australia

Index of Relative Disadvantage Medical Workers per 10,000

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Quintile of disadvantage Major Cities Inner Regional Outer Regional Remote Very Remote Total 1

3,482,411 27.83 (n=115) 374,710 8.32 (n=21) 38,944 1.99 (n=6) 4,054 1.12 (n=1) 5,652 2.44 (n=2) 3,905,771 19.96 (n=145)

2

2,882,745 23.04 (n=86) 789,242 17.53 (n=45) 183,508 9.36 (n=17) 50,722 14.04 (n=12) 28,132 12.15 (n=6) 3,934,349 20.11 (n=166)

3

2,298,363 18.37 (n=63) 1,089,246 24.20 (n=62) 440,715 22.47 (n=55) 85,170 23.57 (n=227) 10,566 4.57 (n=8) 3,924,060 20.05 (n=215)

4

1,915,032 15.31 (n=49) 1,368,176 30.39 (n=74) 523,323 26.68 (n=69) 95,938 26.55 (n=24) 32,141 13.89 (n=13) 3,934,610 20.11 (n=229)

5

1,933,264 15.45 (n=46) 880,317 19.56 (n=25) 774,686 39.50 (n=101) 125,418 34.71 (n=38) 154,953 66.95 (n=100) 3,868,638 19.77 (n=337)

Total

12,511,815 100.00 (n=359) 4,501,691 100.00 (n=254) 1,961,176 100.00 (n=248) 361,302 100.00 (n=102) 231,444 100.00 (n=129) 19,567,428 100.00 (n=1,092)

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Access/Health need score for Australia

 Constructed score

 Physician score 1-5

 Value of 5 =1:1282-no physicians

 Rural score 1-5  Disadvantage score 1-5  Combine 3-15

 Assumed equal weighting  Factor analysis confirmed this assumption  Relationship likely more complex than this

 requires further investigation

 validation

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Composite Deprivation score Physician Score Dis- advantage score Rural Score Avoidable Death rate per 100,000 Risk rate per 1000 Diabetes rate per 1000 Percent Indigenous Composite Deprivation score 1.0000

1091

Physician score 0.8219

1091

1.0000

1112

Disadvantage score 0.8538

1091

0.5282

1106

1.0000

1107

Rural score 0.5554

1091

0.2053

1097

0.3167

1092

1.0000

1114

Avoidable Death rate per 100,000

0.5275

1037

0.2706

1056

0.5397

1052

0.4257

1043

1.0000

1057

Risk rate per 1000

0.7784

955

0.5191

967

0.8168

967

0.3728

957

0.6576

940

1.0000

969

Diabetes rate per 1000 0.4240

952

0.2710

964

0.5311

964

0.0833

952

0.4888

938

0.5100

964

1.0000

965

Percent Indigenous 0.3505

1091

0.1490

1112

0.2568

1107

0.5042

1098

0.7687

1057

0.4047

967

0.3767

964

1.0000

1113

Total Population

0.1885

1091

0.0201*

1112

0.0937

1107

0.4539

1098

0.1902

1057

0.0964

967

0.0767

964

0.1989

1113

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Summary

 Health and health care access vary along social gradients  Small area measures of socioeconomic deprivation used

internationally

 This study has created a national composite measure of

deprivation predictive of health outcomes and health risk behaviours

 Can be mapped to enable visualisation of need and hence

target resources where needed most

 Adds to the growing body of evidence of the valuable

role of GIS in primary health care research, policy and planning

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 Questions?

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References



WHO, 2008, Commission on Social Determinants of Health Final Report



http://www.wnmeds.ac.nz/academic/dph/research/socialindicators.html



http://www.communities.gov.uk/communities/neighbourhoodrenewal/depr ivation/deprivation07/



http://www.abs.gov.au/websitedbs/D3310114.nsf/home/Seifa_entry_page



Krieger et al., (2003) Race/Ethnicity, Gender and Monitoring Socioeconomic Gradients in Health: A comparison of Socioeconomic Measures-The Public Health Disaparities Geocoding Project. American J. Public Health 93(10)1655- 1671



Wang, F., and Luo, W, (2004) Assessing spatial and nonspatial factors for health care access: towards an integrated approach to defining health professional shortage areas. Health and Place 11:131-146



McGrail, M, and Humphreys, H., (2009) The index of rural access” an innovative integrated approach for measuring primary care access. BMC Health Services Research 9:124



Field, K, (2000) Measuring the need for primary health care: an index of relative disadvantage. Applied Geography 20: 305–332

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Field, 2000