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Korda RJ, Biddle N, Lynch J, Eynstone-Hinkins J, Soga K, Banks E, Priest N, Moon L, Blakely T. Education inequalities in adult all-cause mortality: first national data for Australia using linked census and mortality data. Int J Epidemiol 2021; 49:511-518. [PMID: 31581296 PMCID: PMC7266531 DOI: 10.1093/ije/dyz191] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2019] [Indexed: 12/16/2022] Open
Abstract
Background National linked mortality and census data have not previously been available for Australia. We estimated education-based mortality inequalities from linked census and mortality data that are suitable for international comparisons. Methods We used the Australian Bureau of Statistics Death Registrations to Census file, with data on deaths (2011–2012) linked probabilistically to census data (linkage rate 81%). To assess validity, we compared mortality rates by age group (25–44, 45–64, 65–84 years), sex and area-inequality measures to those based on complete death registration data. We used negative binomial regression to quantify inequalities in all-cause mortality in relation to five levels of education [‘Bachelor degree or higher’ (highest) to ‘no Year 12 and no post-secondary qualification’ (lowest)], separately by sex and age group, adjusting for single year of age and correcting for linkage bias and missing education data. Results Mortality rates and area-based inequality estimates were comparable to published national estimates. Men aged 25–84 years with the lowest education had age-adjusted mortality rates 2.20 [95% confidence interval (CI): 2.08‒2.33] times those of men with the highest education. Among women, the rate ratio was 1.64 (1.55‒1.74). Rate ratios were 3.87 (3.38‒4.44) in men and 2.57 (2.15‒3.07) in women aged 25–44 years, decreasing to 1.68 (1.60‒1.76) in men and 1.44 (1.36‒1.53) in women aged 65–84 years. Absolute education inequalities increased with age. One in three to four deaths (31%) was associated with less than Bachelor level education. Conclusions These linked national data enabled valid estimates of education inequality in mortality suitable for international comparisons. The magnitude of relative inequality is substantial and similar to that reported for other high-income countries.
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Affiliation(s)
- Rosemary J Korda
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra ACT, Australia
| | - Nicholas Biddle
- Centre for Social Research and Methods, Research School of Social Sciences, Australian National University, Canberra ACT, Australia
| | - John Lynch
- School of Public Health, University of Adelaide, Adelaide, Australia.,Population Health Sciences, Bristol Medical School, Bristol, UK
| | - James Eynstone-Hinkins
- Health and Vital Statistics Section, Australian Bureau of Statistics, Brisbane, Australia
| | - Kay Soga
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra ACT, Australia
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra ACT, Australia
| | - Naomi Priest
- Centre for Social Research and Methods, Research School of Social Sciences, Australian National University, Canberra ACT, Australia
| | - Lynelle Moon
- Australian Institute of Health and Welfare, Canberra, Australia
| | - Tony Blakely
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
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2
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Carson SL, Kentatchime F, Sinai C, Van Dyne EA, Nana ED, Cole BL, Godwin HA. Health Challenges and Assets of Forest-Dependent Populations in Cameroon. ECOHEALTH 2019; 16:287-297. [PMID: 31114945 DOI: 10.1007/s10393-019-01411-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 03/27/2019] [Accepted: 04/01/2019] [Indexed: 05/25/2023]
Abstract
Indigenous populations often have poorer health outcomes than the general population. Marginalization, colonization, and migration from traditional lands have all affected traditional medicine usage, health access, and indigenous health equity. An in-depth understanding of health for specific populations is essential to develop actionable insights into contributing factors to poor indigenous health. To develop a more complete, nuanced understanding of indigenous health status, we conducted first-person interviews with both the indigenous Baka and neighboring Bantu villagers (the reference population in the region), as well as local clinicians in Southern Cameroon. These interviews elucidated perspectives on the most pressing challenges to health and assets to health for both groups, including access to health services, causes of illness, the uses and values of traditional versus modern medicine, and community resilience during severe health events. Baka interviewees, in particular, reported facing health challenges due to affordability and discrimination in public health centers, health effects due to migration from their traditional lands, and a lack of culturally appropriate public health services.
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Affiliation(s)
- Savanna L Carson
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California, Los Angeles, 650 Charles E Young Dr S, Los Angeles, CA, 90095, USA.
| | - Fabrice Kentatchime
- Higher Institute of Environmental Sciences - IBAY Sup, Nkolbisson, Yaounde, Cameroon
| | - Cyrus Sinai
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California, Los Angeles, 650 Charles E Young Dr S, Los Angeles, CA, 90095, USA
| | - Elizabeth A Van Dyne
- Department of Pediatrics, Mattel Children's Hospital, University of California, Los Angeles, Los Angeles, CA, USA
| | - Eric Djomo Nana
- Higher Institute of Environmental Sciences - IBAY Sup, Nkolbisson, Yaounde, Cameroon
| | - Brian L Cole
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California, Los Angeles, 650 Charles E Young Dr S, Los Angeles, CA, 90095, USA
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Hilary A Godwin
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California, Los Angeles, 650 Charles E Young Dr S, Los Angeles, CA, 90095, USA
- Center for Tropical Research, Institute of the Environment and Sustainability, University of California, Los Angeles, Los Angeles, CA, 90039, USA
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3
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Hofer A, McDonald M. Continuity of care: why it matters and what we can do. Aust J Prim Health 2019; 25:214-218. [PMID: 31196382 DOI: 10.1071/py19041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 04/20/2019] [Indexed: 11/23/2022]
Abstract
Continuity of care matters; however, expansion and specialisation of the health system tends to fragment care. Continuity of care is accompanied by a range of patient benefits, including reduced all-cause mortality; lower rates of hospital presentation and preventable admission; and improved patient satisfaction. Potential concerns have been raised about some aspects of continuity of care, but these are outweighed by the perceived benefits. There are many barriers to achieving continuity, especially in rural and remote settings. Some practical solutions have been proposed that include adapting clinic procedures, utilising a small team approach, improving staff retention and ongoing advocacy.
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Affiliation(s)
- Alexandra Hofer
- Torres and Cape Hospital and Health Service, 163 Douglas Street, Thursday Island, Qld 4875, Australia; and Corresponding author
| | - Malcolm McDonald
- Australian Institute for Tropical Health and Medicine, James Cook University, Cairns Campus, PO Box 6811, Cairns, Qld 4870, Australia
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4
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Wapau H, Jans D, Hapea E, Mein J, Curnow V, McDonald M. Coming to town: Reaching agreement on a thorny issue. Aust J Rural Health 2018; 26:416-421. [PMID: 30450678 DOI: 10.1111/ajr.12430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2018] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To describe the process of gaining consensus across regional organisations in formulating measures to improve coordination of care for people from remote Far North Queensland communities coming to town (Cairns) to access health care. DESIGN This is a descriptive study that includes survey data from workshop participants. SETTING Coming to town for health care poses great challenges, especially for Indigenous Australians from remote communities. Numerous organisations are involved, communications are fragmented and there is no central coordinating body. The system frequently fails to deliver necessary services. This generates preventable cost burdens through missed flights, missed appointments, missed treatment opportunities and extra administration. Workshop organisers invited key service providers from across Far North Queensland. MAIN OUTCOME MEASURES Using real-case scenarios, the task was to identify and prioritise the central issues and explore ways to address them. Participants jointly crafted the final recommendations and also posted suggestions on a 'wish-list' board. A participant assessment survey was conducted at the end of the workshop, followed by an online survey 6 weeks later. RESULTS There were 32 participants. The concluding survey indicated the workshop was well received and people valued the collaboration. There were six primary recommendations plus numerous wish-list suggestions. The best-supported recommendation was establishment of a coming to town Hub with a local coordinating team and community-based representatives. CONCLUSION Implementation of the workshop recommendations and support of all key service providers should be culturally acceptable and resource-efficient with better health outcomes for travellers, their families and communities.
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Affiliation(s)
- Hylda Wapau
- Apunipima Cape York Health Council, Bungalow, Queensland, Australia
| | - Diana Jans
- Apunipima Cape York Health Council, Bungalow, Queensland, Australia
| | - Emily Hapea
- Mookai Rosie Bi-Bayan Aboriginal and Torres Strait Islander Corporation, Edmonton, Queensland, Australia
| | - Jacki Mein
- Wuchopperen Health Service, Manoora, Queensland, Australia
| | - Venessa Curnow
- Aboriginal and Torres Strait Islander Health Management Unit, Cairns and Hinterland Hospital and Health Services, Queensland Health, Cairns, Queensland, Australia
| | - Malcolm McDonald
- Apunipima Cape York Health Council, Bungalow, Queensland, Australia.,Centre for Chronic Disease Prevention, James Cook University, Smithfield, Queensland, Australia
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McDonald MI, Lawson KD. Doing it hard in the bush: Aligning what gets measured with what matters. Aust J Rural Health 2017; 25:246-251. [PMID: 28205339 DOI: 10.1111/ajr.12336] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2016] [Indexed: 01/22/2023] Open
Abstract
What gets measured gets managed. Funding of health services is substantially determined by operational activity and specific outcome indicators. In day-to-day clinical decision-making, surrogate markers, such as glycosylated haemoglobin and blood pressure, are commonly used to modify risks of 'hard' outcomes that include kidney failure, ischaemic cardiac events, stroke and all-cause mortality. In many settings, surrogates are all we have to go on. As a consequence, current health funding models heavily rely on surrogate-based key performance indicators [KPIs]. While surrogates are convenient and provide immediate information, there is an obligation to ensure that they are appropriate, reliable and validated in context. In contrast, hard outcomes, the real consequences of illness, are usually realised over an extended timeframe. Additionally, and for a host of reasons, hard endpoints have the greatest social, emotional and economic impact for people at the far end of the health system; those in rural and remote settings - 'in the bush' - especially Indigenous Australians. We propose a health service assessment approach that aligns short-term decision-making with patient-centred and longer term hard outcomes, one that takes into account community, cultural and environmental factors, especially remoteness. Communities should have a major say in determining what health indicators are measured and managed.
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Affiliation(s)
- Malcolm I McDonald
- Apunipima Cape York Health Council, Cairns, Queensland, Australia.,Centre for Chronic Disease Prevention, Cairns Campus, James Cook University, Cairns, Queensland, Australia
| | - Kenny D Lawson
- Centre for Chronic Disease Prevention, Cairns Campus, James Cook University, Cairns, Queensland, Australia.,Centre for Health Research, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
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6
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Chondur R, Li SQ, Guthridge S, Lawton P. Does relative remoteness affect chronic disease outcomes? Geographic variation in chronic disease mortality in Australia, 2002-2006. Aust N Z J Public Health 2013; 38:117-21. [DOI: 10.1111/1753-6405.12126] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
| | - Shu Qin Li
- Health Gains Planning Branch, Department of Health, Northern Territory
| | - Steven Guthridge
- Health Gains Planning Branch, Department of Health, Northern Territory
- Centre for Remote Health, Flinders University and Charles Darwin University
- Centre of Research Excellence in Rural and Remote Primary Health Care
| | - Paul Lawton
- Menzies School of Health Research, Northern Territory
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Sosa-Rubí SG, Walker D, Serván E, Bautista-Arredondo S. Learning effect of a conditional cash transfer programme on poor rural women's selection of delivery care in Mexico. Health Policy Plan 2011; 26:496-507. [PMID: 21278371 PMCID: PMC9109227 DOI: 10.1093/heapol/czq085] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2010] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND The Mexican programme Oportunidades/Progresa conditionally transfers money to beneficiary families. Over the past 10 years, poor rural women have been obliged to attend antenatal care (ANC) visits and reproductive health talks. We propose that the length of time in the programme influences women's preferences, thus increasing their use not only of services directly linked to the cash transfers, but also of other services, such as clinic-based delivery, whose utilization is not obligatory. OBJECTIVE To analyse the long-term effect of Oportunidades on women's use of antenatal and delivery care. METHODOLOGY 5051 women aged between 15 and 49 years old with at least one child aged less than 24 months living in rural localities were analysed. Multilevel probit and logit models were used to analyse ANC visits and physician/nurse attended delivery, respectively. Models were adjusted with individual and socio-economic variables and the locality's exposure time to Oportunidades. Findings On average women living in localities with longer exposure to Oportunidades report 2.1% more ANC visits than women living in localities with less exposure. Young women aged 15-19 and 20-24 years and living in localities with longer exposure to Oportunidades (since 1998) have 88% and 41% greater likelihood of choosing a physician/nurse vs. traditional midwife for childbirth, respectively. Women of indigenous origin are 68.9% less likely to choose a physician/nurse for delivery care than non-indigenous women. CONCLUSIONS An increase in the average number of ANC visits has been achieved among Oportunidades beneficiaries. An indirect effect is the increased selection of a physician/nurse for delivery care among young women living in localities with greater exposure time to Oportunidades. Disadvantaged women in Mexico (indigenous women) continue to have less access to skilled delivery care. Developing countries must develop strategies to increase access and use of skilled obstetric care for marginalized women.
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Affiliation(s)
- Sandra G Sosa-Rubí
- Health Economics Division, Mexican School of Public Health/National Institute of Public Health (INSP), Cuernavaca, Mexico and Reproductive Health Division, Mexican School of Public Health/National Institute of Public Health (INSP), Cuernavaca, Mexico
| | - Dilys Walker
- Health Economics Division, Mexican School of Public Health/National Institute of Public Health (INSP), Cuernavaca, Mexico and Reproductive Health Division, Mexican School of Public Health/National Institute of Public Health (INSP), Cuernavaca, Mexico
| | - Edson Serván
- Health Economics Division, Mexican School of Public Health/National Institute of Public Health (INSP), Cuernavaca, Mexico and Reproductive Health Division, Mexican School of Public Health/National Institute of Public Health (INSP), Cuernavaca, Mexico
| | - Sergio Bautista-Arredondo
- Health Economics Division, Mexican School of Public Health/National Institute of Public Health (INSP), Cuernavaca, Mexico and Reproductive Health Division, Mexican School of Public Health/National Institute of Public Health (INSP), Cuernavaca, Mexico
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8
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Zhao Y, You J, Guthridge SL, Lee AH. A multilevel analysis on the relationship between neighbourhood poverty and public hospital utilization: is the high Indigenous morbidity avoidable? BMC Public Health 2011; 11:737. [PMID: 21951514 PMCID: PMC3203263 DOI: 10.1186/1471-2458-11-737] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Accepted: 09/27/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The estimated life expectancy at birth for Indigenous Australians is 10-11 years less than the general Australian population. The mean family income for Indigenous people is also significantly lower than for non-Indigenous people. In this paper we examine poverty or socioeconomic disadvantage as an explanation for the Indigenous health gap in hospital morbidity in Australia. METHODS We utilised a cross-sectional and ecological design using the Northern Territory public hospitalisation data from 1 July 2004 to 30 June 2008 and socio-economic indexes for areas (SEIFA) from the 2006 census. Multilevel logistic regression models were used to estimate odds ratios and confidence intervals. Both total and potentially avoidable hospitalisations were investigated. RESULTS This study indicated that lifting SEIFA scores for family income and education/occupation by two quintile categories for low socio-economic Indigenous groups was sufficient to overcome the excess hospital utilisation among the Indigenous population compared with the non-Indigenous population. The results support a reframing of the Indigenous health gap as being a consequence of poverty and not simplistically of ethnicity. CONCLUSIONS Socio-economic disadvantage is a likely explanation for a substantial proportion of the hospital morbidity gap between Indigenous and non-Indigenous populations. Efforts to improve Indigenous health outcomes should recognise poverty as an underlying determinant of the health gap.
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Affiliation(s)
- Yuejen Zhao
- Health Gains Planning Branch, Northern Territory Department of Health, PO Box 40596, Casuarina NT 0811, Australia.
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9
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Daniel M, Lekkas P, Cargo M. Environments and cardiometabolic diseases in aboriginal populations. Heart Lung Circ 2010; 19:306-15. [PMID: 20356789 DOI: 10.1016/j.hlc.2010.01.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2009] [Accepted: 01/05/2010] [Indexed: 10/19/2022]
Abstract
This review establishes the relevance and frames the relationship of environmental factors to cardiometabolic risk factors and disease in Aboriginal populations. Environmental factors operate at the level of communities or populations. They include contextual measures of places and compositional measures of populations which together constitute "risk conditions" affecting individual risk factors. Environmental factors have been implicated by contrasting Aboriginal and non-Aboriginal populations in cardiometabolic risk factors and outcomes, or by geographic contrasts of Aboriginal populations in remote, rural and urban regions. It is unclear whether heterogeneity in contextual or compositional factors between and within Aboriginal populations is associated with heterogeneity in cardiometabolic risk factors and outcomes. Empirical literature that links environmental factors and cardiometabolic outcomes in Aboriginal populations is critically reviewed for three postulated pathways of influence: (1) behaviour; (2) psychosocial factors; and (3) stress response axes. These pathways, represented as interdependent, can explain how and why environments are associated with cardiometabolic outcomes. The need remains, however, to develop a robust quantitative evidence base in cardiometabolic research aimed at enhancing knowledge of the specific environmental factors related to the cardiometabolic health of Aboriginal populations as well as explicating the underlying mechanisms by which environmental risk conditions 'get under the skin'.
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Affiliation(s)
- Mark Daniel
- Sansom Institute, University of South Australia, Adelaide, Australia.
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10
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Clark RA, Driscoll A. Access and quality of heart failure management programs in Australia. Aust Crit Care 2009; 22:111-6. [PMID: 19586780 DOI: 10.1016/j.aucc.2009.06.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Accepted: 06/04/2009] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND/AIM In response to the high burden of disease associated with chronic heart failure (CHF), in particular the high rates of hospital admissions, dedicated CHF management programs (CHF-MP) have been developed. Over the past five years there has been a rapid growth of CHF-MPs in Australia. Given the apparent mismatch between the demand for, and availability of CHF-MPs, this paper has been designed to discuss the accessibility to and quality of current CHF-MPs in Australia. METHODS The data presented in this report has been combined from the research of the co-authors, in particular a review of the inequities in access to chronic heart failure which utilised geographical information systems (GIS) and the survey of heterogeneity in quality and service provision in Australian. RESULTS Of the 62 CHF-MPs surveyed in this study 93% (58) centres had been located areas that are rated as Highly Accessible. This result indicated that most of the CHF-MPs have been located in capital cities or large regional cities. Six percent (4 CHF-MPs) had been located in Accessible areas which were country towns or cities. No CHF-MPs had been established outside of cities to service the estimated 72,000 individuals with CHF living in rural and remote areas. 16% of programs recruited NYHA Class I patients and of these 20% lacked confirmation (echocardiogram) of their diagnosis. CONCLUSION Overall, these data highlight the urgent need to provide equitable access to CHF-MP's. When establishing CHF-MPs consideration of current evidence based models to ensure quality in practice.
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Affiliation(s)
- Robyn A Clark
- Sanson Institiute, City East Campus, University of South Australia, Adelaide, SA, Australia.
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11
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Speldewinde PC, Cook A, Davies P, Weinstein P. A relationship between environmental degradation and mental health in rural Western Australia. Health Place 2009; 15:865-72. [PMID: 19345135 DOI: 10.1016/j.healthplace.2009.02.011] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2008] [Revised: 01/21/2009] [Accepted: 02/22/2009] [Indexed: 10/21/2022]
Abstract
Australia is currently experiencing a process of escalating ecosystem degradation. This landscape degradation is associated with many outcomes that may directly or indirectly impact on human health. This study used a Bayesian spatial method to examine the effects of environmental degradation (measured as dryland salinity) on the mental health of the resident rural population. An association was detected between dryland salinity and depression, indicating that environmental processes may be driving the degree of psychological ill-health in these populations.
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Affiliation(s)
- Peter C Speldewinde
- Centre of Excellence in Natural Resource Management, University of Western Australia, Albany, Western Australia 6332, Australia.
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12
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Turrell G, Kavanagh A, Draper G, Subramanian SV. Do places affect the probability of death in Australia? A multilevel study of area-level disadvantage, individual-level socioeconomic position and all-cause mortality, 1998-2000. J Epidemiol Community Health 2007; 61:13-9. [PMID: 17183009 PMCID: PMC2465593 DOI: 10.1136/jech.2006.046094] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND In Australia, studies finding an association between area-level socioeconomic disadvantage and mortality are often based on aggregate-ecological designs which confound area-level and individual-level sources of socioeconomic variation. Area-level socioeconomic differences in mortality therefore may be an artefact of varying population compositions and not the characteristics of areas as such. OBJECTIVE To examine the associations between area-level disadvantage and all-cause mortality before and after adjustment for within-area variation in individual-level socioeconomic position (SEP) using unlinked census and mortality-register data in a multilevel context. Setting, participants and DESIGN The study covers the total Australian continent for the period 1998-2000 and is based on decedents aged 25-64 years (n = 43,257). The socioeconomic characteristics of statistical local areas (SLA, n = 1317) were measured using an index of relative socioeconomic disadvantage, and individual-level SEP was measured by occupation. RESULTS Living in a disadvantaged SLA was associated with higher all-cause mortality after adjustment for within-SLA variation in occupation. Death rates were highest for blue-collar workers and lowest among white-collar employees. Cross-level interactions showed no convincing evidence that SLA disadvantage modified the extent of inequality in mortality between the occupation groups. CONCLUSIONS Multilevel analysis can be used to examine area variation in mortality using unlinked census and mortality data, therefore making it less necessary to use aggregate-ecological designs. In Australia, area-level and individual-level socioeconomic factors make an independent contribution to the probability of premature mortality. Policies and interventions to improve population health and reduce mortality inequalities should focus on places as well as people.
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Affiliation(s)
- Gavin Turrell
- School of Public Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Brisbane, Queensland, Australia.
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13
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Abstract
OBJECTIVE To identify areas of relative need and inform future planning of health workforce and health services in discrete Indigenous communities. METHOD Descriptive analysis of relevant variables from the 1999 Community Housing and Infrastructure Needs Survey (CHINS), including all discrete Indigenous communities in Australia. RESULTS Almost 90% of the Indigenous population of the Northern Territory live in discrete communities. The corresponding figure for Queensland, South Australia and Western Australia is around 25%, for New South Wales 8% and Victoria 1%. Just over 4000 people (5% of the population surveyed) live 100 kilometres or more from the nearest community health centre and almost 60,000 (54%) live 100 kilometres or more from the nearest hospital. Approximately 4000 Indigenous people (6% of population surveyed) have little or no access to a registered nurse or a doctor in their community. Access to Indigenous health workers is also limited, with more than 26,000 people (40%) having almost no access to a male Indigenous health worker and about 10,400 (16%) having almost no access to a female Indigenous health worker. More than 13,000 people (20%) have no access to a dentist and many thousands (30-50%) have no access to allied health or mental health care workers. An obstetrician or ENT/respiratory physician never visited the communities of almost 40,000 people (55% and 59%, respectively) and about 24,000 people (36%) have no access to an ophthalmologist. CONCLUSION CHINS data provide a unique source of information to monitor the status of health services and the workforce in discrete Indigenous communities.
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14
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Armfield JM. Socioeconomic inequalities in child oral health: a comparison of discrete and composite area-based measures. J Public Health Dent 2007; 67:119-25. [PMID: 17557684 DOI: 10.1111/j.1752-7325.2007.00026.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study aims to examine the relationship between child caries prevalence and six discrete area-based measures of socioeconomic status (SES). Comparisons were also made of the discrete SES measures and the Socio-Economic Index for Areas (SEIFA) composite index in explaining child caries experience. METHODS Oral health data were electronically captured for 58,463 4- to 16-year-old children enrolled in the School Dental Service of South Australia in 2001. Socioeconomic measures for the same year were extracted from Basic Community Profiles for postcodes available from the Australian Bureau of Statistics. RESULTS There were generally consistent linear relationships between caries prevalence and SES with children having poorer oral health residing in areas of greater socioeconomic disadvantage. This was evident across all SES measures, although some variations were shown for some measures. Children from more socioeconomically disadvantaged areas had higher odds of having either one or more decayed, missing, or filled teeth or four or more decayed, missing, or filled teeth. Most discrete SES measures explained a significant amount of the variance in oral disease beyond that accounted for by the composite SEIFA index. CONCLUSIONS Pervasive social inequality in child oral health exists in Australia. Specific area-based measures of SES are valuable in documenting these inequalities and may be more meaningful than composite area-based indices of SES.
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Affiliation(s)
- Jason M Armfield
- Send correspondence and reprint requests to Jason AIHW Dental Statistics and Research Unit, Australian Research Centre for Population Oral Health, The University of Adelaide, South Australia 5005, Australia.
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15
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Turrell G, Kavanagh A, Subramanian SV. Area variation in mortality in Tasmania (Australia): the contributions of socioeconomic disadvantage, social capital and geographic remoteness. Health Place 2006; 12:291-305. [PMID: 16546695 DOI: 10.1016/j.healthplace.2004.08.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2004] [Indexed: 11/22/2022]
Abstract
This study investigated the association between socioeconomic disadvantage, social capital, geographic remoteness and mortality in the Australian state of Tasmania. The analysis is based on death rates among persons aged 25-74 years in 41 statistical local areas (SLA) for the period 1998-2000. Multilevel binomial regression indicated that death rates were significantly higher in disadvantaged areas. There was little support for an association between social capital and mortality, thereby contesting the often held notion that social capital is universally important for explaining variations in population health. Similarly, we found little evidence of a link between geographic remoteness and mortality, which contrasts with that found in other Australian states; this probably reflects the small size of Tasmania, and limited variation in the degree of remoteness amongst its SLA.
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Affiliation(s)
- Gavin Turrell
- School of Public Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Brisbane, Queensland, 4059 Australia.
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Stephens C, Porter J, Nettleton C, Willis R. Disappearing, displaced, and undervalued: a call to action for Indigenous health worldwide. Lancet 2006; 367:2019-28. [PMID: 16782493 DOI: 10.1016/s0140-6736(06)68892-2] [Citation(s) in RCA: 193] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
"What sets worlds in motion is the interplay of differences, their attractions and repulsions. Life is plurality, death is uniformity. By suppressing differences and peculiarities, by eliminating different civilisations and cultures, progress weakens life and favours death. The ideal of a single civilisation for everyone implicit in the cult of progress and technique, impoverishes and mutilates us. Every view of the world that becomes extinct, every culture that disappears, diminishes a possibility of life!"
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Affiliation(s)
- Carolyn Stephens
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
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Tracy SK, Sullivan E, Dahlen H, Black D, Wang YA, Tracy MB. Does size matter? A population-based study of birth in lower volume maternity hospitals for low risk women. BJOG 2006; 113:86-96. [PMID: 16398776 DOI: 10.1111/j.1471-0528.2005.00794.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To study the association between volume of hospital births per annum and birth outcome for low risk women. DESIGN Population-based study using the National Perinatal Data Collection (NPDC). SETTING Australia. PARTICIPANTS Of 750,491 women who gave birth during 1999-2001, there were 331,147 (47.14%) medically 'low risk' including 132,696 (40.07%) primiparae and 198,451 (59.93%) multiparae. METHODS The frequency of each birth and infant outcome was described according to the size of the hospital where birth took place. We investigated whether unit size (defined by volume) was an independent risk factor for each outcome factor using public hospitals with greater than 2000 births per annum as a reference point. MAIN OUTCOME MEASURES Rates of intervention at birth and neonatal mortality for low risk women in relation to hospitals with <100, 100-500, 501-1000, 1001-2000 and >2001 births per annum. RESULTS Neonatal death was less likely in hospitals with less than 2000 births per annum regardless of parity. For multiparous low risk women in hospitals of 100 and 500 births per annum compared with hospitals of >2000 births per annum the adjusted odds of neonatal mortality [adjusted odds ratio (AOR) 0.36; 99% confidence interval (CI) 0.14-0.93]. For low risk primiparous women in hospitals with less than 100 births per annum, there were lower rates of induction of labour (AOR 0.62; 99% CI 0.54-0.73); intrathecal analgesia/anaesthesia (AOR 0.34; 99% CI 0.28-0.42); instrumental birth (AOR 0.80; 99% CI 0.69-0.93); caesarean section after labour (AOR 0.59; 99% CI 0.49-0.72) and admission to a neonatal unit (AOR 0.15; 99% CI 0.10-0.22) and for low risk multiparous women in hospitals with less than 100 births per annum: induction (AOR 0.69; 99% CI 0.62-0.76); intrathecal analgesia/anaesthesia (AOR 0.32; 99% CI 0.29-0.36); instrumental birth (AOR 0.52; 99% CI 0.41-0.67); caesarean section after labour (AOR 0.41; 99% CI 0.33-0.52); and admission to a neonatal unit (AOR 0.09; 99% CI 0.07-0.12). CONCLUSIONS In Australia, lower hospital volume is not associated with adverse outcomes for low risk women.
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Affiliation(s)
- Sally K Tracy
- Australian Institute of Health and Welfare (AIHW), National Perinatal Statistics Unit, University of New South Wales, Sydney, Australia
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Murray G, Judd F, Jackson H, Fraser C, Komiti A, Hodgins G, Pattison P, Humphreys J, Robins G. The Five Factor Model and Accessibility/Remoteness: Novel evidence for person–environment interaction. PERSONALITY AND INDIVIDUAL DIFFERENCES 2005. [DOI: 10.1016/j.paid.2005.02.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Murray G, Judd F, Jackson H, Fraser C, Komiti A, Hodgins G, Pattison P, Humphreys J, Robins G. Rurality and mental health: the role of accessibility. Aust N Z J Psychiatry 2004; 38:629-34. [PMID: 15298585 DOI: 10.1080/j.1440-1614.2004.01426.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The absence of an agreed definition of "rural" limits the utility of existing research into a possible relationship between rurality of residence and mental health. The present study investigates the bipolar dimension accessibility/remoteness as a possible correlate of mental health. METHOD A continuous area of non-metropolitan Australia was selected to provide a range of scores on the Accessibility/Remoteness Index of Australia (ARIA). A questionnaire measuring demographics, the five-factor model of personality and three aspects of mental health (distress, disability and wellbeing) was mailed to 20 000 adults selected randomly from electoral rolls. RESULTS Responses were received from 7615 individuals (response rate = 40.5%; 57.1% female). ARIA was not associated with either distress or disability measures, but a small negative association was found between accessibility and two measures of wellbeing. Individuals residing in locales with better access to services and opportunities for interaction reported higher levels of satisfaction with life (SWL) and positive affect (PA). Adjusting statistically for a range of demographic and personality correlates did not alter the effect of ARIA on SWL. The effect on PA remained significant after adjusting for demographics, but not once personality correlates entered the model. CONCLUSIONS By sampling across a single proposed parameter of rurality, a novel profile of correlations was identified. In accord with existing data, accessibility was not associated with distress or disability. In contrast, accessibility was positively associated with the wellbeing aspect of mental health. Further attention to the measurement of rural place and the exploration of accessibility as a parameter with mental health relevance, is warranted.
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Affiliation(s)
- Greg Murray
- School of Social and Behavioural Sciences, Swinburne University of Technology, Hawthorn, Victoria 3122, Australia
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Carson BE, Bailie RS. National health workforce in discrete Indigenous communities. Aust N Z J Public Health 2004. [DOI: 10.1111/j.1467-842x.2004.tb00482.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Page A, Morrell S, Taylor R. Suicide differentials in Australian males and females by various measures of socio-economic status, 1994-98. Aust N Z J Public Health 2002; 26:318-24. [PMID: 12233951 DOI: 10.1111/j.1467-842x.2002.tb00178.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To investigate Australian suicide differentials in males and females by three area-based measures of socio-economic status (SES). METHODS Suicide data for 1994-98 were used to investigate area-based gradients of SES for the Index of Relative Socio-Economic Disadvantage (IRSED) (an overall measure of SES), the Index of Economic Resources (IER), and the Index of Education and Occupation (IEO), using Poisson regression models adjusting for age, country-of-birth and urban-rural residence. RESULTS After adjusting for age, country-of-birth and urban-rural residence, significant increasing linear trends in suicide risk from high to low quintiles of SES were evident in males for the IRSED (an average multiplicative increase in suicide risk of 8% per quintile), IER (9% increase) and IEO (5% increase). For females, there was no evident SES gradient for the IRSED after adjusting for age, country-of-birth and urban-rural residence, but a significant positive linear trend from high to low quintiles of SES was found for the IER (6% increase per quintile). A significant decreasing linear trend (increasing suicide risk with increasing SES) was evident for the IEO (30% per quintle). CONCLUSION Male suicide is positively associated with all three measures of SES examined. Female suicide is significantly associated with the IER (positive association) and IEO (negative), and because of this is not associated with the overall measure of SES. These findings partly explain why female suicide has been found to be poorly correlated with area-based measures of SES. IMPLICATIONS Specific components of area-based socio-economic status provide a clearer picture of socio-economic suicide differentials in Australian females, with implications for population-based preventive strategies.
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Affiliation(s)
- Andrew Page
- School of Public Health, University of Sydney, New South Wales
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