Prepared by Kim GilchristEpidemiologist

Public Health, MLHDMay 2013

Socio-economic Disadvantage

Taking A “Social Determinants” Approach

Research has shown that the housing, transport, stress, type of employment or unemployment, social support and income have as much impact on health and wellbeing as our genes and behaviours.

These factors are known as the Social Determinants of Health are the conditions in which people are born, grow, live, work, play and age.

Dahlgren and Whitehead's Social Determinants of Health Rainbow Source: Dahlgren and Whitehead (1991)

Why look at disadvantage for health planning?

Poorer people have poorer health

People in disadvantaged areas have lower life expectancy and higher illness rates

Need to identify if and where our District has areas of Disadvantage

Identify areas of most need

Enables targeted services

How do we measure disadvantage?

– Income– Housing– Employment– Occupation– Qualifications– Family characteristics– English language skills

– Disability– Car ownership– Internet access

Many indicators in the Australian Bureau of Statistics Census:

How do we summarise all those?

ABS developed summary measures combining many factors which can indicate economic or social disadvantage

Australian Bureau of Statistics Socio Economic Indexes for Areas (SEIFA)

Main one of interest is the:

Index of Relative Socio-economic Disadvantage (IRSD)

Index of Relative Socio-economic Disadvantage (IRSD)

The ABS divides all Australia into small geographic areas

They look at the percentage of people in each area in households with:– low incomes, no qualifications, low-skilled jobs,

unemployment, poor English, one-parent families, overcrowded homes etc.

Each area is given a score

The areas’ scores are then ranked (ordered) and put into groups from 1 (most disadvantaged) to 10 (least disadvantaged).

Index of Relative Socio-economic Disadvantage (IRSD)

Each group contains 10 % of all the areas in Australia

These are called Deciles

Decile 1 5 10

Most disadvantaged Least disadvantaged

What is relative disadvantage?

Relative – because this is an index comparing all areas across Australia relative to each other

It is not saying that Decile 1 is “absolute poverty” but it has more households with the disadvantage characteristics and Decile 2 has less…. Decile 10 the least.

The disadvantage scores cannot be compared to other countries or used as a measure of poverty, people in Decile 1 for example could not be said to be destitute or living in “developing world” conditions.

Geographic Areas of MLHD

29 local government areas (LGAs) – plus part of Lachlan Shire (Lake Cargelligo)

To give more specific detail we can look at:– ABS statistical areas (SA1s)

– contain an average of 400 people– mostly within LGA boundaries– 787 SA1s in MLHD– Disadvantage scores are calculated at this level

Geographic Areas of MLHD

Disadvantage by LGA

Most disadvantaged Least disadvantaged

Decile 2

Scores are averaged across the SA1s within the LGA

Gives a good indication for MLHD which LGAs have relatively high proportion of disadvantaged

Hay, Murrumbidgee and Narrandera stand out as the most disadvantaged LGAs

Conargo shows as least disadvantaged

However there is significant geographic variation in disadvantage within LGAs

Disadvantage by LGA (cont.)

Scores are calculated across Australia at this level of geography

Gives a good indication for MLHD of pockets of disadvantage within LGAs

Each LGA can be looked at in more detail

May help target location of certain services

Disadvantage by Small Areas (SA1s)

Disadvantage by SA1Most disadvantaged Least disadvantaged

ABS also releases data on the proportion of population in each LGA living in disadvantaged SA1s

We can interpret this as the proportion of an LGA who are highly disadvantaged

Narrandera, Harden and Lachlan Shire (Lake Cargelligo) have approximately one third of the LGA population living in highly disadvantaged areas.

Proportion of Disadvantage in LGAs

Disadvantage by LGA

Most disadvantaged Least disadvantaged

Population size or Percentage

There may be a high percentage of population by LGA but small numbers of actual people – e.g. Lake Cargelligo

Or the percentage might be small but there are high numbers of people e.g. Albury, Wagga Wagga

Also shows where the population is – not just whole LGA e.g. Murray Shire has three separate locations of disadvantaged populations

Disadvantage vs Health outcome

SCATTER PLOTS

SEIFA disadvantage score for an LGA (the horizontal axis) has been plotted against the rate of hospitalisation/death (the vertical axis) for that LGA.

Each chart has 29 dots, one for each LGA.

A “line of best fit” has been added to each chart to demonstrate a linear relationship between disadvantage and the health indicator.