” This index is used to look at the geographic supply of the clinical health workforce in seven key professions with particular relevance to Indigenous Australians, and to identify areas in Australia that face particular supply challenges.

The professions considered were general practitioners, nurses, midwives, pharmacists, dentists, psychologists and optometrists. “

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aihw-distribution-of-the-supply-of-clinical-health-workforce

The poorer health status of Aboriginal and Torres Strait Islander Australians, compared with that of non-Indigenous Australians, is evident throughout the life course.

Aboriginal and Torres Strait Islander babies are more likely to be exposed to smoking while in utero, are more likely to be born pre-term and with low birthweight, and are more likely to die before their first birthday than are non-Indigenous babies.

These inequalities continue throughout childhood and adulthood and are evident in indicators such as poor health, lower life expectancy and higher levels of chronic disease (AIHW 2015b).

The factors underpinning these differences are complex and interrelated, and include:

• higher levels of social disadvantage

• greater exposure to environmental risk factors (such as inadequate and overcrowded housing)

• sociocultural and historical factors

• poorer nutrition, higher rates of smoking and risky alcohol consumption

• poorer access to health services.

Access to health services is compounded by the fact that Aboriginal and Torres Strait Islander people are more likely than non-Indigenous Australians to live outside cities.

This population distribution is important because distance often poses substantial challenges for workforce recruitment and health service delivery, particularly in areas where populations are widely dispersed or isolated.

Access to health services and health professionals will not on its own eliminate the differences in health status between Indigenous and non-Indigenous Australians.

However, having access to appropriate, high-quality and timely health care can help to improve health and wellbeing.

For a start, it improves health literacy and self-management of chronic disease; it also provides links to services within and outside the health system, and improves screening and treatment of acute and chronic illnesses.

Thus, the extent to which there are gaps in the geographic distribution of the health workforce in professions with particular relevance for Aboriginal and Torres Strait Islander people is a critical policy issue.

This report looks at the geographic supply of the clinical health workforce in seven key professions with particular relevance to Indigenous Australians—general practitioners (GPs), nurses, midwives, pharmacists, dentists, psychologists and optometrists—to identify areas in Australia that face particular supply challenges.

Traditional measures of workforce supply (such as provider-to-population ratios) have shortcomings in that they do not take into account differences between areas in terms of their geographic size, location of service providers, and the location of populations across areas. These factors directly affect the capacity of providers to supply services, and the ability of the population to access those services.

To overcome these issues, a new Geographically-adjusted Index of Relative Supply (GIRS) was developed to indicate the supply of professionals in one area compared with another. The GIRS takes data on hours worked in clinical roles and on main practice location from the 2014 National Health Workforce Data Set (NHWDS)—combined with data on population size, geographic size and drive time to services—to create a score ranging from 0 to 8 for each of the seven professions in each Statistical Area level 2 (SA2) in Australia.

The area-level GIRS scores are combined with information on the spatial distribution of the Indigenous population. This is done for two reasons: firstly, to calculate the number of Indigenous Australians who live in areas with each of the GIRS scores and, secondly, to identify those areas with relative supply challenges for each profession individually and with challenges across multiple professions.

This work builds on previous Australian Institute of Health and Welfare (AIHW) reports focusing on access to GPs relative to need (AIHW 2014a), spatial variation in Aboriginal and Torres Strait Islander people’s access to primary health care (AIHW 2015a) and to maternal and child health services (AIHW 2016a).

Notes

This report uses a new measure developed by the Australian Institute of Health and Welfare—the Geographically-adjusted Index of Relative Supply (GIRS).

The GIRS scores were compared with the distribution of the Indigenous population to assess the extent to which Indigenous people live in areas with lower relative levels of supply.

The GIRS was developed to overcome limitations in using relatively simple provider-to-population ratios to compare areas with vastly different geographic characteristics. The GIRS takes data on hours worked in clinical roles and on main practice location from the 2014 National Health Workforce Data Set; it then adjusts it for three other factors—land size, population dispersion, and drive time to services—to create a score ranging from 0 to 8 for each of the seven professions in each Statistical Area level 2 (SA2) in Australia. Areas with lower GIRS scores are more likely to face workforce supply challenges than those with higher GIRS scores.

The report’s findings are as follows:

• GIRS scores of 0 or 1 (most likely to face supply challenges) occur most often for midwives, optometrists and psychologists, and least often for nurses.
  • Over 19,000 Aboriginal and Torres Strait Islander women of child-bearing age (15–44 years) live in 120 SA2s with a low relative supply of midwives.
  • Over 85,000 Aboriginal and Torres Strait Islander people live in 56 SA2s with a low relative supply of optometrists.
  • Over 76,000 Aboriginal and Torres Strait Islander people live in 49 SA2s with a low relative supply of psychologists.
• For each profession, a higher proportion of Aboriginal and Torres Strait Islander people than non-Indigenous people live in areas with lower GIRS scores.
• While relative supply challenges are more common in remoter parts of Australia, the findings show that there is considerable variation in regional and remote areas.
• There were 155 SA2s out of 2,091 (8%) with a GIRS score of 0–1 in at least one profession. Nearly 20% of Aboriginal and Torres Strait Islander people live in these areas, compared with 3% of the non-Indigenous population.
• Over 72,000 Aboriginal and Torres Strait Islander people live in the 39 SA2s where at least four of the seven professions (that is, over half the professions) have GIRS scores of 0 or 1. Over 30,000 of these people live in the 13 SA2s where at least six of the seven professions have GIRS scores of 0 or 1.

The GIRS is an important resource for policy discussions on improving the supply of health services. It has limitations, however. In particular, it does not take into account outreach services and the distribution of the workforce supply within SA2s is unknown.

As well, it cannot take into account the adequacy of services, whether the services are financially or culturally accessible, or the extent to which they meet the needs of the populations within each area.

Future work could build on the GIRS by including these other factors.

Publication table of contents

• Preliminary material
  • Contents
  • Acknowledgments
  • Abbreviations
  • Summary
• Body content
  • 1 Introduction
    • Structure of this report
  • 2 Methods
    • Calculation of the GIRS
    • Data sources
    • Putting it all together
  • 3 General practitioners
    • GP GIRS scores
    • Population distribution
    • Discussion
  • 4 Nurses
    • Nurse GIRS scores
    • Population distribution
    • Discussion
  • 5 Midwives
    • Midwife GIRS scores
    • Population distribution
    • Discussion
  • 6 Pharmacists
    • Pharmacist GIRS scores
    • Population distribution
    • Discussion
  • 7 Dentists
    • Dentist GIRS scores
    • Population distribution
    • Discussion
  • 8 Psychologists
    • Psychologist GIRS scores
    • Population distribution
    • Discussion
  • 9 Optometrists
    • Optometrist GIRS scores
    • Population distribution
    • Discussion
  • 10 Conclusion
    • Discussion
• End matter
  • Appendix A: Selection of geographic scale
  • Appendix B: Detailed data sources and methods
    • Workforce data
    • Other data sources
    • Geocoding of service locations
    • Population centroids
    • Manual adjustment of area centroids
    • Calculating drive times from population centroid to service locations
    • Proportion of SA2 population within a 1 hour drive of nearest service location
  • Appendix C: Constructing the GIRS for GPs
  • Appendix D: Additional tables
  • References
  • List of tables
  • List of figures