Contextual Considerations

 
Population health
A concept of health -- outcomes
 
Health risk factors
 Social/economic
 Environment (geography)
 Health behaviours
 
Health but all is not equal
Health is closely linked to the conditions in which the person lives and works
 Socioeconomic position
 Educational attainment
 Employment opportunities
 Disability status
 Access to health services
 Social supports
 Build and natural environment
 
Disparities
 People living in rural and remote and/or low socioeconomic areas
 People with disability
 Aboriginal and Torres Strait Islander people
 
Socioeconomic groups
Social determinants of health
 Socioeconomic position
 Early life
 Social exclusion
 Employment and work
 Housing and homelessness
 Built environment
 
 
Socioeconomic groups (determinants/outcomes)
Social gradient correlates with health outcomes.
Health risk factors -- lower end of social gradient -- riskier behaviours.
Chronic conditions and mortality -- prevalence rates higher in lower SE group
 Burden of disease
o 1.5 times as high, all causes
o Diabetes 2.3 times
o Lung cancer 2 times
o Anxiety 1.8 times
 
Rural and remote populations
Australian statistical geography standard
 Urban: major urban and other urban (population number dependent: 100,000 or 1000-
99999)
 Rural: bounded locally and rural balance
 Remote (5 classes): relates to relative access to services
  Region: a geographic area of any type
 Health outcomes affected by geographic isolations
 Higher levels of life satisfaction
 
Remoteness and restricted access (determinant)
 Health workforce (except general practitioners)
 Primary health care
o Dental services
o After hours services
o Potentially preventable hospitalisations
 Hospitalisations
o Almost double
 Targeted health care
o Royal flying doctors service
o Telehealth consultations
 
Aboriginal and Torres Strait Islanders
Health status worse than non-Indigenous Australian population
 
People who are culturally and linguistically diverse
 Born overseas, parent born OS, speaks languages other than English
 First-generation, second-generation immigrant
 Migration patterns
 Refugees
 
People who are culturally and linguistically diverse (outcomes)
Almost half of all Australians born elsewhere/ parent born OS
 1 in 4 are first-generation immigrants
 Healthy migrant effect initially (10 years)
 Populations not homogenous
o Dependant on the country of birth
Refugee health
 Impact of trauma
o Mental health-- mental illness
 
People with disability
Survey of disability, ageing and carers
 Asks participants
 Limitations, restrictions, impairment
 At least 6 months, restricts everyday activities
o With severe or profound core activity limitation (self-care, communication, mobility)
o Mild or moderate core activity limitation or restriction
 
People with disability (outcomes)
 1 in 5 or 4.3 million people
o Severe or profound -- 6% or 1.4 million people
o Poor -- fair -- good -- very good -- excellent
 Health service use
o GPs
o Medical specialists
 o Hospitals
o severity related
 
Diverse sex, gender and sexual orientation (LGBTIQ)
Identifying as LGBTIQ depends on
 Age
 Ethnicity
 Socioeconomic position
 Relationships
 
LGBTIQ (outcomes)
Around 3% of the Australian population
 Same-sex couples more likely
o Live in capital cities
o Highly educated
o Employed
o Higher incomes
 Disparities
o Psychological distress
o Sexual health -- HIV risk
o Substance use
 
Veterans
 Former Australian Defence Force (ADF) personnel
 War veterans, any experience with the ADF
 Unique health-related requirement
 Department of defence -- veteran affairs (DVA)
 
Veteran community (determinants/outcomes)
Different cohorts -- different military operations
DVA -- health and welfare of current ADF personnel
 Transition to civilian life
o Medicare, public/private health services, eligible for DVA services
 Determinants
o Type of service, rank, length of service, reason for discharge
 Health outcomes
o Healthy soldier effect
o Transition to civilian life
o Service-related problems
 
Prisoners
A fluid population
 Predominantly males
 Aboriginal and Torres Strait Islanders are over-represented
 
Population characteristics
 Mental illness- 50%
 Illicit drug use- 67%
 Chronic conditions - 30%
 Communicable disease (Hep C)- 30%
  Disability
 Homeless- 25%
 Unemployed- 25%
 Low education level- 67%
 Ageing population
 Accelerated ageing
 
Further considerations
 Age differences
 Sex distribution
 Mental health
 Language (non-English speaking background)
 Comorbidities and polypharmacy
 Living arrangements
 
Age differences
How does the health status change when people is an
 Infant
 Toddler
 Teenager
 Adult
 60 years old
 90 years old
 
Sex differences
 Females live longer than males
 Sex-specific conditions - e.g. cancers
 Lifestyle factors
 
Mental health
Integral component of the bio-psycho-social model of health
 Living with disability impacts mental health
 Mental health can be both a cause and effect of disability
 Limitations of activities of daily life can reach beyond core activities impacting relationships
 
Non-English speaking background
 Enough English language to survive
 Language barrier
o Access to health care
o Employment implications
 
Comorbidity and polypharmacy
Comorbidity
 When one or more additional conditions occur with the primary condition
Polypharmacy
 When five or more medications (i.e. drug, vitamin supplement, herbal preparations) are
taken every day
 
Living arrangements
 Living alone
 Living rough
 Living in an institution