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Journal article: Death, disease and diversity in Australia, 1951 to 2000 There has been a substantial decline in mortality in Australia during the 20th century, with a major improvement in life expectancy. There has been a broad health transition, from a pattern of high mortality from infectious diseases to one of lower overall mortality from non-communicable diseases and injury. From 1951, trends in death rates from major causes were evident, with the rise and partial fall of two epidemics (coronary heart disease and stroke, and lung cancer). This overall picture masks significant inequalities in health for Indigenous people and the socioeconomically disadvantaged. Author: Diana M S Hetzel Published: Medical Journal of Australia 2001; 174(1): 21-24 |
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The relationship between income inequality and mortality has come into question as of late from many within-country studies. This article examines the relationship between income inequality and working-age mortality for metropolitan areas (MAs) in Australia, Canada, Great Britain, Sweden, and the United States to provide a fuller understanding of national contexts that produce associations between inequality and mortality. An ecological cross-sectional analysis of income inequality (as measured by median share of income) and working-age (25-64) mortality by using census and vital statistics data for 528 MAs (population >50,000) from five countries in 1990-1991 was used. When data from all countries were pooled, there was a significant relationship between income inequality and mortality in the 528 MAs studied. A hypothetical increase in the share of income to the poorest half of households of 1% was associated with a decline in working-age mortality of over 21 deaths per 100,000. Within each country, however, a significant relationship between inequality and mortality was evident only for MAs in the United States and Great Britain. These two countries had the highest average levels of income inequality and the largest populations of the five countries studied. Although a strong ecological association was found between income inequality and mortality across the 528 MAs, an association between income inequality and mortality was evident only in within-country analyses for the two most unequal countries: the United States and Great Britain. The absence of an effect of metropolitan-scale income inequality on mortality in the more egalitarian countries of Canada, Australia, and Sweden is suggestive of national-scale policies in these countries that buffer hypothetical effects of income inequality as a determinant of population health in industrialized economies. Authors: Nancy A Ross, Danny Dorling, James R Dunn, Göran Henriksson, John Glover, John Lynch and Gunilla Ringbäck Weitoft Published: Journal of Urban Health 2005 Mar; 82(1): 101-110. Available free online |
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In 1988, in response to an increasing awareness in Australia of the role of social inequality as a key to health inequality, the Social Health Office within the South Australian Health Commission proposed the adoption of a social health strategy. The social health strategy outlined an approach to improving health for all South Australians through a recognition that policies in areas outside of the health sector, such as housing, education, transport etc. can have substantial impact on the health of the general community, and in particular on disadvantaged groups. This is often referred to as a 'social view of health'. Information was seen as having an important part in this strategy, by describing the socioeconomic and health status profiles of the population. The approach chosen to presenting information was through mapping. Maps present data in a way that is accessible to a wide audience, not only those charged with setting policy and undertaking strategic planning, but to consumers and other community advocates who may have limited skills in handling statistical information presented in more traditional ways. The maps describe the geographic distribution of the population by a range of socioeconomic indicators, together with maps showing their health status and use of health services, thereby highlighting the relationships between the indicators of socioeconomic inequality and inequality in health status. These reports have been titled 'social health atlases'. Over the fourteen years since the first social health atlas was released, the range and quality of datasets has improved, allowing for a better understanding of the impact of socioeconomic influences on health. It has also been possible to address changes in the overall levels, and patterns in the distribution, of socioeconomic status and health status and to assess the extent to which the health divide has been addressed. The atlases represent a major initiative in strengthening the public health information infrastructure in Australia and are a major policy tool with which to address health inequality arising from social inequality. Authors: John Glover, Sarah Tennant and Tony Woollacott Published: Serie Geográfica 2004-2005; 12: 103-122 |
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Summary
Objective: To examine the prevalence of major chronic diseases and their risk factors in different socioeconomic groups in the Australian population, in order to highlight the need for public policy initiatives to reduce socioeconomic inequalities in health. Methods: Data were provided by the Australian Bureau of Statistics (ABS) from the 2001 National Health Survey (NHS) for selected chronic diseases and associated risk factors. Conditions selected were those, which form the National Health Priority Area (NHPA) conditions (other than injury, which has not been included in this paper, with its focus on chronic disease); plus other 'serious' chronic conditions, in line with the classification developed by Mathers; and for which sufficient cases were available for analysis by socioeconomic status. Indirectly age-standardised prevalence rates were calculated by broad age group for Australia and for five groups of socioeconomic status; rate ratios were calculated to show variations in prevalence between these groups. Results: Significant socioeconomic inequalities were evident for many of the major chronic diseases; the largest was for diabetes mellitus (at ages 25 to 64 years); and for many diseases, there was also a strong, continuous socioeconomic gradient in the rates. Circulatory system diseases (in particular, hypertensive disease) and digestive system diseases also exhibited a strong differential in the 25 to 64 year age group. In the 65 years and over age group, the strongest inequalities were evident for mental and behavioural problems, diabetes (with a continuous socioeconomic gradient in rates) and respiratory system diseases. A number of risk factors for chronic diseases, namely self-reported smoking, alcohol misuse, physical inactivity and excess weight showed a striking association with socioeconomic status, in particular for people who were smokers and those who did not exercise. Conclusion: This analysis shows that the prevalence of chronic disease varies across the socioeconomic gradient for a number of specific diseases, as well as for important disease risk factors. Therefore, any policy interventions to address the impact of chronic disease, at a population level, need to take into account these socioeconomic inequalities. Authors: John D Glover, Diana MS Hetzel and Sarah K TennantPublished: Australia and New Zealand Health Policy 2004; 1: 8. Available free online |
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Journal article: Unpacking analyses relying on area-based data: are the assumptions supportable Summary Background: In the absence in the major Australian administrative health record collections of a direct measure of the socioeconomic status of the individual about whom the event is recorded, analysis of the association between the health status, use of health services and socioeconomic status of the population relies an area-based measure of socioeconomic status. This paper explores the reliability of the area of address (at the levels typically available in administrative data collections) as a proxy measure for socioeconomic disadvantage. The Western Australian Data Linkage System was used to show the extent to which hospital inpatient separation rates for residents of Perth vary by socioeconomic status of area of residence, when calculated at various levels of aggregation of area, from smallest (Census Collection District) to largest (postcode areas and Statistical Local Areas). Results are also provided of the reliability, over time, of the address as a measure of socioeconomic status. Results: There is a strong association between the socioeconomic status of the usual address of hospital inpatients at the smallest level in Perth, and weaker associations when the data are aggregated to larger areas. The analysis also shows that a higher proportion of people from the most disadvantaged areas are admitted to hospital than from the most well-off areas (13% more), and that these areas have more separations overall (47% more), as a result of larger numbers of multiple admissions. Of people admitted to hospital more than once in a five year period, four out of five had not moved address by the time of their second episode. Of those who moved, the most movement was within, or between, areas of similar socioeconomic status, with people from the most well off areas being the least likely to have moved. Conclusion: Postcode level and SLA level data provide a reliable, although understated, indication of socioeconomic disadvantage of area. The majority of Perth residents admitted to hospital in Western Australia had the same address when admitted again within five years. Of those who moved address, the majority had moved within, or between, areas of similar socioeconomic status. Access to data about individuals from the Western Australian Data Linkage System shows that more people from disadvantaged areas are admitted to a hospital, and that they have more episodes of hospitalisation. Were data to be available across Australia on a similar basis, it would be possible to undertake research of greater policy-relevance than is currently possible with the existing separations-based national database. Authors: John Glover, Diana Rosman, Sarah Tennant Published: International Journal of Health Geographics 2004; 3: 30. Available free online |