NACCHO Aboriginal Health Report Alert : Distribution of the supply of the clinical health workforce 2014

new-microsoft-word-document-3

 ” 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. “

Download the Report here

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

NACCHO Aboriginal health : #AIHW #AustraliasHealth2016 : What are the health experts saying about the report ?

aus-2016

” The report has also pointed out ongoing areas of health inequality in Australia, driven by socioeconomic factors and social determinants.

Communities suffering socioeconomic disadvantage continued to have systematically poorer health including lower life expectancy, higher rates of chronic disease and higher smoking rates.

Aboriginal and Torres Strait Islander peoples recorded improved health indicators in some areas, including lower rates for smoking and infant mortality.

However, the report found life expectancy was shorter by 10 years than for non-Indigenous Australians, and Aboriginal and Torres Strait Islander peoples continued to suffer higher rates of diseases such as diabetes, coronary heart disease and end-stage kidney disease.

The impact of risk factors such as smoking, physical inactivity, poor nutrition and harmful alcohol use have been emphasised as significant contributors to Australia’s rising rates of chronic disease.

This is an opportunity for health leaders and the Commonwealth Government to heed the report’s message that lifestyle factors and social determinants are significant contributors to ill-health, and to address the issues of health inequality and the importance of reform across all of our care systems “

AHHA Chief Executive Alison Verhoeven

Download the report here australias-health-2016

 #AIHW and Minister Sussan Ley press releases from launch #AustraliasHealth2016 report

Life expectancy gap between Indigenous and non-Indigenous Australians remains about one decade

The life expectancy gap between Indigenous and non-Indigenous Australians remains about one decade, according to new statistics.

The latest report from the Australian Institute of Health and Welfare (AIHW) said that while health outcomes had improved for Aboriginal and Torres Strait Islander people, they still remain below those of non-Indigenous Australians.

The biennial report, published today, shows Indigenous males born between 2010 and 2012 have a life expectancy of 69.1 years, a decade less than their non-Indigenous counterparts.

The gap for women was slightly lower at 9.5 years.

Between 2009 and 2013, 81 per cent of all Indigenous deaths were of people under 75. This is more than twice the rate of non-Indigenous Australians, which stands at 34 per cent.

The latest statistics come 10 years after the establishment of the Closing the Gap campaign, which aims to end the disparity on life expectancies.

Earlier this year, Prime Minister Malcolm Turnbull pledged that the Government would better engage with Indigenous people in “hope and optimism rather than entrenched despair”.

Indigenous sobriety rate higher than non-Indigenous Australians

While smoking rates have been falling nationally, they remain high among Indigenous Australians, with 44 per cent of Aboriginal and Torres Strait Islander people aged 15 and over describing themselves as a current smoker.

The report states that 42 per cent smoke daily, 2.6 times the rate of their non-Indigenous counterparts.

However, Indigenous Australians drink less alcohol than non-Indigenous counterparts — 26 per cent of Aboriginal and Torres Strait Islander people aged 15 and over had not consumed alcohol in past 12 months.

This equates to a sobriety rate 1.6 times that of non-Indigenous Australians.

Potentially avoidable deaths — categorised as deaths that could have been avoided given timely and effective health care — accounted for 61 per cent of deaths of Indigenous Australians aged up to 74 years between 2009 to 2013.

This was 10 per cent more than their non-Indigenous counterparts.

Australians are living longer than ever but with higher rates of chronic disease, the latest national report card shows.

Reports below from the Conversation

According to the Australian Institute of Health and Welfare’s Australia’s Health 2016 report, released today, Australian boys can now expect to live into their 80s (80.3), while the life expectancy for girls has reached the mid-80s (84.4).


A boy born and girl born in 1890 could only expect to live to 47.2 and 50.8 years respectively. AIHW

The single leading cause of death in Australia is coronary heart disease, followed by:

Grouped together, cancer has overtaken cardiovascular disease (heart disease and stroke) as Australia’s biggest killer. Cancer is also the largest cause of illness, followed by cardiovascular disease:


Burden of disease, by disease group, Australia, 2011 AIHW

Chronic diseases are becoming more common, due to population growth and ageing. Half of Australians (more than 11 million) have at least one chronic disease. One quarter have two or more.

The most common combination of chronic diseases is arthritis with cardiovascular disease (heart disease and stroke):


AIHW

Australians have high rates of the biomedical risk factors that increase the risk of heart disease and stroke. Almost a quarter (23%) of Australian adults have high blood pressure and 63% have abnormal levels of cholesterol.


Lifestyle choices

Fron Jackson-Webb, Health + Medicine Editor, The Conversation

The good news is Australians are less likely to smoke and drink at risky levels than in the past.

Australia now has the fourth-lowest smoking rate among 34 OECD countries, at 13% in 2013. This is almost half that of 1991 (24%).


AIHW

The volume of alcohol Australians consume fell from 10.8 litres per person in 2007–08 to 9.7 litres in 2013–14. This is the lowest level since 1962–63. But 16% of Australians are still drinking to very risky levels: consuming 11 or more standard drinks on one occasion in the past 12 months.


AIHW

Around eight million Australians have tried illicit drugs in their lifetime, including 2.9 million in the last 12 months. The most commonly used illicit drugs are cannabis (10%), ecstasy (2.5%), methamphetamine (2.1%) and cocaine (2.1%).

Use of methamphetamine has remained stable in recent years. However, more methamphetamine users are opting for crystal (ice) rather than powder (speed).

The bad news is Australians are still struggling with their weight. Around 63% are overweight or obese, up from 56% in 1995. This equates to an average increase of 4.4kg for men and women. One in four children are overweight or obese.

Junk foods high in salt, fat and sugar account for around 35% of adults’ energy intake and around 39% of the energy intake for children and young people.

Most Australians (93%) don’t consume the recommended five serves of vegetables a day and only half eat the recommended two serves of fruit. Just 3% of children eat enough vegetables, though 70% consume the recommended amount of fruit.

Almost half (45%) of adults aged 18 to 64 and 23% of children aren’t meeting the national physical activity recommendations. These are for adults to accumulative 150 to 300 minutes of moderate intensity physical activity or 75 to 150 minutes of vigorous intensity physical activity each week. Children are advised to accumulate at least 60 minutes of moderate to vigorous physical activity every day.

Lifestyle choices have a huge impact on the risk of chronic disease; an estimated 31% of the burden of disease in Australia could have been prevented by reducing risk factors such as smoking, excess weight, risky drinking, physical inactivity and high blood pressure.

Proportion of the burden attributable to the top five risk factors


AIHW

Preventing chronic disease

Rob Moodie, Professor of Public Health, University of Melbourne

This report outlines a number of positives in Australia’s health – our life expectancy, the health services at our beck and call, major declines in tobacco and road deaths. We’re doing well, it says, but we could do better.

If we took prevention and health promotion far more seriously, we could do a lot better.

The report nominates tobacco use, alcohol, high body mass and physical inactivity as the chief causes of preventable illness and the chief causes of our increasing level of chronic illnesses. Yet national investment in prevention is declining.


Further reading: Focus on prevention to control the growing health budget


Tobacco use is rapidly declining because of really effective measures (plain packaging, advertising bans and increasing price through taxes) that save lives and enormous amounts of money over a lifetime for people who used to smoke.

However, we can’t seem to make any major dent in the commercial, industrial and lifestyle diseases related to junk food and drinks, harmful consumption of alcohol and car dependency.

We’ve known what will work for many years but the power of some of these unhealthy industries is still overwhelming – a situation in which our politicians fear these industries and their associations more than they fear the voters.

Our collective health would have been much better if we’d been able to follow the guidance of our own national task forces and learnt from other countries. The report card should read, “Doing well, but could have done a lot better”.


Inequities

Fran Baum, Matthew Flinders Distinguished Professor and Foundation Director at the Southgate Institute for Health, Society & Equity, Flinders University

Australia’s Health 2016 shows many Australians are not getting a fair go at health. There is a gradient across society whereby the richer the area you live in, the longer you can expect to live. The difference between the highest and lowest is four years.

Deaths by socioeconomic group: 1 = lowest; 5 = highest


AIHW

The gradient is evident from early life. Children most at risk of exclusion – those from poor areas who experience problems with education, housing and connectedness – are most likely to die before they reach 15 years from potentially preventable or treatable causes.


Further reading: Want to improve the nation’s health? Start by reducing inequalities and improving living conditions


Our most glaring inequity is the ten-year life gap between Aboriginal and Torres Strait Islander Australians and others. Indigenous life expectancy is 69.1 years for males and 73.7 years for females.

Compared with the non-Indigenous population, Indigenous Australians are:

  • 3.5 times as likely to have diabetes and four times as likely to be hospitalised with it or to die from it
  • five times as likely to have end-stage kidney disease
  • twice as likely to die from an injury
  • twice as likely to have heart disease.

Australians living outside major cities have higher rates of disease and injury. They also live in environments that make healthy lifestyles choices harder (such as more difficulties buying fresh fruit and vegetables) and so their risk of chronic diseases is increased.


AIHW

The data on who has private health insurance coverage points to the emergence of a two-tiered health system, where those who can afford to pay receive better access and quality of care. Just 26% of those in the lowest socioeconomic group have cover compared to about 80% of the top group.

Coverage with private health insurance and government health-care cards


AIHW

Cost of care

Professor Stephen Duckett, Director of the Health Program at Grattan Institute

Over the last decade, health expenditure grew about 5% each year, above the 2.8% average growth in Gross Domestic Product (GDP). As a result, health took up an increasing share of GDP.

Spending more on health means Australia spent less on other things. This is not necessarily bad, as long as the benefits from that increased expenditure – such as increasing life expectancy or increased quality of life – are worth the increased costs.

But spending above GDP growth cannot continue indefinitely. And the last few years saw an increase in rhetoric about health spending increases being “unsustainable” from so-called “futurists” and politicians.

Informed commentators have generally rejected the unsustainability claim, some labelling it a “myth”, while others take a more nuanced view.

Australia’s Health 2016 shows a slowing of the real growth rate in the most recent two years to about half that of the previous decade – 1.1% from 2011-12 to 2012-13 and 3.1% from 2012–13 to 2013–14.


Annual growth rates in health expenditure AIHW

This suggests the “unsustainability” rhetoric is at least overblown and potentially prompting budget decisions which are counter-productive, such as introducing a co-payment for general practice.

Commonwealth government expenditure was more or less stable over these most recent two years, declining 2.5% initially then increasing 2.4% in the last year.

Health expenditure by area (adjusted for inflation)


AIHW

Savings to the government came from shifting costs to consumers, by slowing the growth in government subsidies to private health insurers, and also by slowing spending on pharmaceuticals.

This latter slowdown was achieved through tighter controls on payments to drug manufacturers and because some big-selling drugs came off patent, resulting in falls in prices.

NACCHO Aboriginal Health Newspaper Next AGM Edition

agm

NACCHO Welcomes Advertising and Articles

NACCHO Aboriginal Health Alert : #AIHW and Minister Sussan Ley launch #AustraliasHealth2016 report

sl

 ” A new snapshot of Australia’s health has found we are living longer than ever before, but the rise of chronic disease still presents challenges in achieving equal health outcomes for Indigenous Australians and people living outside metropolitan areas.

Minister for Health Sussan Ley pictured above with Dr Mukesh Haikerwal

Download the Report Here

australias-health-2016

As well as looking at factors influencing individuals’ health, today’s report also examines the health of particular population groups, and shows considerable disparities.

‘For example, while there have been some improvements overall in the health of Aboriginal and Torres Strait Islander Australians—including falls in smoking rates and infant mortality—Indigenous Australians continue to have a lower life expectancy than non-Indigenous.

Indigenous Australians, at 69.1 years for males and 73.7 for females, more than 10 years shorter than for non-Indigenous Australians,’

Indigenous Australians also continue to have higher rates of many diseases, such as diabetes, end-stage kidney disease and coronary heart disease.”

AIHW Director and CEO Barry Sandison

                     AIHW website Australia’s Health 2016

aus-2016

The Minister today launched the Australian Institute of Health and Welfare’s (AIHW) publication Australia’s health 2016, which provides an update on the health of Australians and the performance of Australia’s health system.

“Australia’s health 2016 shows us that about 85 per cent of Australians rate their health as good, very good or excellent, which is a testament to the significant investment of the Turnbull Government into the health of our nation, with about one-quarter of total government revenue attributed to health spending,” Minister Ley said.

“Our Government’s priority is to ensure the high performance and sustainability of our health system over the long term. This is why the Turnbull Government is working closely with stakeholders to progress a range of health system reforms.”

Total Commonwealth investment in health will grow to more than $71 billion in 2015-16 and this will increase to $79 billion within four years. The Turnbull Government’s investment in Medicare is at $23 billion per year and this will increase by $4 billion over the next four years.

“The report indicates that health outcomes for Australians have improved over time with life expectancy at an all-time high of 80.3 years for males, while a baby girl could expect to live for 84.4 years. Survival rates for cancer are also improving,” Minister Ley said

Minister Ley said that despite plenty of good news on health in the report, managing chronic conditions and their impact on Australia’s health system remained one of our greatest health challenges.

“The report shows that half of Australians have a chronic disease – such as cardiovascular disease, arthritis, diabetes or a mental health disorder – and one-in four have two or more of these conditions,” Minister Ley said.

“This is why our initial investment of almost $120 million in the Health Care Homes initiative is so important. It will help to keep those with chronic conditions healthier and out of hospital. It will give GPs the flexibility and tools they need to design individual care plans for patients with chronic conditions and coordinate care services to support them.

“We recently announced the 10 geographic regions that will deliver Stage One of this important initiative from 1 July next year, and we hope the results will lead more broadly to a better, consumer-focused approach to health care.”

Australia’s health 2016 is available on the Australian Institute of Health and Welfare’s website.

85 out of 100 Australians say they’re healthy—but are we really? AIHW Press Release

Most Australians consider themselves to be in good health, according to the latest two-yearly report card from the Australian Institute of Health and Welfare (AIHW).

The report, Australia’s health 2016 is a key information resource, and was launched today byfederal Health Minister, the Hon. Sussan Ley.

AIHW Director and CEO Barry Sandison said the report provided new insights and new ways of understanding the health of Australians.

‘The report shows that Australia has much to be proud of in terms of health,’ he said.

‘We are living longer than ever before, death rates continue to fall, and most of us consider ourselves to be in good health.’

If Australia had a population of just 100 people, 56 would rate their health as ‘excellent’, or ‘very good’ and 29 as ‘good’.

‘However, 19 of us would have a disability, 20 a mental health disorder in the last 12 months, and 50 at least one chronic disease.’

Mr Sandison said the influence of lifestyle factors on a person’s health was a recurring theme of the report. ‘13 out of 100 of us smoke daily, 18 drink alcohol at risky levels, and 95 do not eat the recommended servings of fruit and vegetables.

‘And while 55 do enough physical activity, 63 of us are overweight or obese.’

Mr Sandison said that while lifestyle choices were a major contributor to the development of many chronic diseases, other factors such as our income, education and whether we had a job—known as ‘social determinants’—all affected our health, for better or worse.

‘As a general rule, every step up the socioeconomic ladder is accompanied by an increase in health.

‘Compared with people living in the highest socioeconomic areas, people living in the lowest socioeconomic areas generally live about 3 years less, are 1.6 times as likely to have more than one chronic health condition, and are 3 times as likely to smoke daily.’

As well as looking at factors influencing individuals’ health, today’s report also examines the health of particular population groups, and shows considerable disparities.

‘For example, while there have been some improvements overall in the health of Aboriginal and Torres Strait Islander Australians—including falls in smoking rates and infant mortality—Indigenous Australians continue to have a lower life expectancy than non-

Indigenous Australians, at 69.1 years for males and 73.7 for females, more than 10 years shorter than for non-Indigenous Australians,’ Mr Sandison said.

Indigenous Australians also continue to have higher rates of many diseases, such as diabetes, end-stage kidney disease and coronary heart disease.

For people living in rural and remote areas, where accessing services can be more difficult, lower life expectancy and higher rates of disease and injury—particularly road accidents— are of concern.

In Australia, health services are delivered by a mix of public and private providers that includes more than 1,300 hospitals and about 385,000 nurses, midwives and medical practitioners.

Of the $155 billion spent on health in 2013–14, $145 billion was recurrent expenditure. Hospitals accounted for 40% of recurrent expenditure ($59 billion), primary health care 38% ($55 billion), with the remaining 22% spent on other health goods and services.

For the first time, the report examines how spending by age for people admitted to hospital has changed over time.

Mr Sandison said the analysis showed that the largest increase in spending between 2004–05 and 2012–13 was for Australians aged 50 and over.

‘This was due to more being spent per person in the population as well as the increased number of people in these age groups.’

Mr Sandison also said that while Australia’s health 2016 provides an excellent overview of Australia’s health at a point in time, there is still scope to expand on the analysis.

New to this edition is information on the changing nature of services provided by publicand private hospitals over the last 10 years; information about how geography affects

Indigenous women’s access to maternal health services; and about the increasing role ofinstitutions such as hospitals and residential aged care in end-of-life care.

‘Good data is essential to inform debate and policy and service delivery decision-making— and improving its quality and availability is at the core of the AIHW’s work.

‘We’re committed to providing meaningful, comprehensive information about Australia’s health and wellbeing—to help create a healthier Australia.’

  • Preliminary material
    • Title and verso pages
    • Contents
    • Preface
    • Acknowledgments
    • Terminology
  • Body section
    • Chapter 1 An overview of Australia’s health
      • Introduction
      • What is health?
      • Australians: who we are
      • How healthy are Australians?
    • Chapter 2 Australia’s health system
      • Introduction
      • How does Australia’s health system work?
      • How much does Australia spend on health care?
      • Who is in the health workforce?
    • Chapter 3 Leading causes of ill health
      • Introduction
      • Burden of disease and injury in Australia
      • Premature mortality
      • Chronic disease and comorbidities
      • Cancer
      • Coronary heart disease
      • Stroke
      • Diabetes
      • Kidney disease
      • Arthritis and other musculoskeletal conditions
      • Chronic respiratory conditions
      • Mental health
      • Dementia
      • Injury
      • Oral health
      • Vision and hearing disorders
      • Incontinence
      • Vaccine preventable disease
    • Chapter 4 Determinants of health
      • Introduction
      • Social determinants of health
      • Social determinants of Indigenous health
      • Biomedical risk factors
      • Overweight and obesity
      • Illicit drug use
      • Alcohol risk and harm
      • Tobacco smoking
      • Health behaviours and biomedical risks of Indigenous Australians
    • Chapter 5 Health of population groups
      • Introduction
      • Health across socioeconomic groups
      • Trends and patterns in maternal and perinatal
      • health
      • How healthy are Australia’s children?
      • Health of young Australians
      • Mental health of Australia’s young people and adolescents
      • Health of the very old
      • How healthy are Indigenous Australians?
      • Main contributors to the Indigenous life expectancy gap
      • Health of Australians with disability
      • Health of prisoners in Australia
      • Rural and remote health
    • Chapter 6 Preventing and treating ill health
      • Introduction
      • Prevention and health promotion
      • Cancer screening
      • Primary health care
      • Medicines in the health system
      • Using data to improve the quality of Indigenous health care
      • Indigenous Australians’ access to health services
      • Spatial variation in Indigenous women’s access to maternal health services
      • Overview of hospitals
      • Changes in the provision of hospital care
      • Elective surgery
      • Emergency department care
      • Radiotherapy
      • Organ and tissue donation
      • Safety and quality in Australian hospitals
      • Specialised alcohol and other drug treatment services
      • Mental health services
      • Health care use by older Australians
      • End-of-life care
    • Chapter 7 Indicators of Australia’s health
      • Introduction
      • Indicators of Australia’s health
  • End matter
    • Methods and conventions
    • Symbols
    • Acronyms and abbreviations
    • Glossary
    • Index

 

 

NACCHO Aboriginal Health Data : Aboriginal and Torres Strait Islander Social Health Atlas released

atlas

The Public Health Information Development Unit (PHIDU) has published an Aboriginal and Torres Strait Islander Social Health Atlas.

This presents a range of demographic, socioeconomic, health outcomes and service use data for Aboriginal and Torres Strait Islander peoples at the Indigenous Area level.

The  2016 release of the atlas includes updated data for the following:

  • Estimate Resident Population (ERP) data for 2015
  • Projected ERP data for 2016
  • Immunisation data for 2015
  • Deaths data now includes data for 2013

And new hospitalisations data for:

  • Hospitalisations by principal diagnosis and age
  • Ambulatory-sensitive hospitalisations

Maps for the Aboriginal and Torres Strait Islander  Atlas can be found at the link below:

http://phidu.torrens.edu.au/current/maps/atsi-sha/atlas.html

For those who prefer the data in a spreadsheet format, the data can be found below:

http://phidu.torrens.edu.au/current/data/atsi-sha/phidu_atsi_data_ia_aust.xls

If you have any questions regarding the Social Health Atlas, our contact details can be found at the link below:

http://phidu.torrens.edu.au/contact-us

 

 

NACCHO Health News : Doctor’s peak bodies speak up about problems with My Health Records

AMA Ley PM

” The Federal Government will drive better patient outcomes for Australians living complex chronic illness as part of its Healthier Medicare reform package, by improving digital heath records and data around health outcomes that will make it easier to co-ordinate their care and measure their progress. “

The Hon. Sussan Ley Minister for Health Press release

Doctors and other health workers need to have access to core clinical information in electronic medical records if the Federal Government’s My Health Record system is to deliver an improvement in patient care

Doctors treating a patient need to be confident that they have access to all relevant information, Shared electronic medical records have the potential to deliver huge benefits by giving health workers ready access to critical patient information when it is needed, reducing the chances of adverse or unwarranted treatments and improving the coordination of care.

AMA President Dr Michael Gannon

Pictured above meeting with the Health Minister and Prime Minister in Perth last week

“There is no question that individuals should have access to their own healthcare data but he believes that basic things need fixing first, such as making it easier for GPs to refer patients.

He says the technology was built by software vendors and NEHTA but has been gathering dust over the last few years and there is still no one secure, integrated system of referring people electronically.

“You start electronically, you finish electronically and everything in between is a mish-mash. You change the business model and then it’s really easy to send data to a national repository.”

Dr Pinskier, who chairs the RACGPs expert committee on e-health and practice systems. See full interview below

The AMA Position Statement on Shared Electronic Medical Records 2016 can be found here

Releasing the AMA’s updated Position Statement, Shared Electronic Medical Records 2016, AMA President Dr Michael Gannon said that giving patients the ability to block or modify access to critical information such as medications, allergies, discharge summaries, diagnostic test results, blood pressure and advance care plans compromised the clinical usefulness of shared electronic medical records loaded on the My Health Record system.

“But, if patients are able to control access to core clinical information in their electronic medical record, doctors cannot rely on it.

“Giving patients such control, as the My Health Record system does, is a big handicap to the clinical usefulness of shared electronic medical records.”

The Federal Government launched My Health Record earlier this year to replace Labor’s troubled Personally Controlled Electronic Health Record (PCEHR) system, and trials of its opt-out arrangements are due to commence in mid-July.

But the system, like the PCEHR, gives patients the power to control what goes on the health record, and who can view it.

The AMA said giving patients such control meant the My Health Record would never realise the full benefits of a national electronic health record system.

“All shared electronic health records must include core clinical information that is not subject to patient controls,” the AMA Position Statement said. “Certainty that shared electronic health records contain predictable core clinical information which is not affected, conditioned or qualified by the application of access controls, is critical to the achievement of the legislated objectives of the My Health Record.”

Like its predecessor, the My Health Record system has generated little interest among patients or doctors – in April just 798 health providers had uploaded a shared health summary to the system.

An AMA survey of 658 medical practices, undertaken last month, found GPs were reluctant to take part because of lack of confidence in the reliability of information it contained, combined with little patient demand and an absence of support for practices undertaking the task of creating shared health summaries.

Dr Gannon said the AMA encouraged individuals to take responsibility for their health and strongly supported the idea of a national shared health summary system, but it had to be the right one – one that supports clinical care.

“All health care workers involved in providing clinical care to a patient should have access to core clinical information,” he said. “Where specific information, other than core clinical information, is not made generally available, this should be made clear to treating doctors with a flag on the medical record.”

The AMA added that in ‘break glass’ emergency situations, implied consent must sometimes be assumed to allow access to the full medical record.

The Association said the system should also provide protections for doctors who acted in good faith but missed or were unable to locate critical data “because it is buried in a sea of electronic documents”.

Dr Gannon said shared electronic medical records should not be treated as a replacement for a patient’s medical record, and should not be treated as the single and definitive source of ‘truth’ regarding clinical information about a patient.

But he said it was an extra source of information, accessible at the point of care, that may otherwise have not been available.

My Health Record: Medics speak up

As the new trials of the My Health Record roll out in Queensland, NSW, WA and Victoria, Government News asks clinicians what might help – or hinder – the progress of the revamped national individual electronic health record.

A bit of history

The idea of a national individual electronic health record has been around for decades, routinely popping up in report recommendations from government health agencies.

It was an idea former Prime Minister John Howard helped spread and one the National Electronic Health Transition Authority (NEHTA) was set up to drive in 2005.

Labour introduced the Personally Controlled Electronic Health Record (PCEHR) in 2012 after two years of GP trials.

But from its inception, the electronic health record has been dogged with problems and fraught with complexities and it still has not had the uptake needed to fulfil the vision of a concise patient record available in an emergency.

Academic Dr Helen Cripps compared the Australian e-health experience to that of Slovenia in her 2011 research paper The Implementation of electronic health records: a two country comparison, and found Australia was making much slower progress.

In it, she lists a whole host of reasons for Australia’s sluggish progress in e-health: the country’s complex health care system, with state and federal involvement and a large private health sector; uneven adoption by clinicians;  problems securely sharing data electronically between GPs and other clinicians; the proliferation of different electronic health record formats and systems; fears about data protection and patient privacy; a lack of national direction; the cost of infrastructure, maintenance and training and a disconnect between government-led implementation and software vendors.

The new Australian Digital Health Agency opened its doors on July 1, and appointed ts first CEO UK digital whizz Tim Kelsey. It is a clear sign that e-health is seriously back on the government’s agenda but what about the clinicians the government is relying on to make the record valuable?

Both Dr Nathan Pinskier, Chair of the Royal Australian College of General Practitioners (RACGP) and Dr Tony Bartone, Vice President of the Australian Medical Association (AMA), have weathered the vicissitudes of the electronic health record over the years.

They spoke to Government News about what pitfalls should be avoided this time around and where the road to success lies.

Dr Pinskier, who chairs the RACGPs expert committee on e-health and practice systems, says there is no question that individuals should have access to their own healthcare data but he believes that basic things need fixing first, such as making it easier for GPs to refer patients.

At the moment, when doctors want to refer patients, for example to specialists, physios and hospitals, they must wrestle with a number of different electronic systems (including Argus, HealthLink and MEDrefer), as well as using fax machines, scanners, emails and letters.

He says the technology was built by software vendors and NEHTA but has been gathering dust over the last few years and there is still no one secure, integrated system of referring people electronically.

“You start electronically, you finish electronically and everything in between is a mish-mash. You change the business model and then it’s really easy to send data to a national repository.”

Prescription for change  

Data quality

Both clinicians say that the value of My Health Record will not be fully realised until there is decent data quality and coverage so that health providers can feel confident using the information.

Dr Pinskier says there are currently eight sources of data within the My Health Record and patients can also add their own data. Instead, he suggests homing in on the most vital pieces of information: bad reactions to medicines, current medications and allergies.

He recalls a hospital doctor searching through a jumble of sometimes conflicting records to find out what medication an out-of-town patient was on. The doctor eventually gave up and phoned the patient’s pharmacist.

“What’s the value if you have all these lists for providers to spend hours trawling through the records?” he asks.

Dr Pinskier says it is worth looking at alternatives, citing international examples such as Boston Open Notes, where local records of healthcare providers are made available to consumers. The patient sees exactly what the healthcare provider sees, which can also help reinforce medical advice, for example about how to take medication.

He says Scotland’s Emergency Care Summary is a good example of how local records work, calling it “simple, effective and functional.” The summary lists essential details such as a person’s name, age and GP and their medications, allergies and bad reactions to medicines, extracting the information from GP records.

“There is one source of truth, which is highly accurate and repeatedly uploaded to a national system. That is certainly regarded as a preferred model,” Dr Pinskier says.

Dr Bartone, Vice President of the nation’s peak body for GPs, agrees that the success of the individual electronic health record relies on good data and not just from GPs, who he says have always been “ahead of the curve” and early adopters of e-health.

The record also relies on getting good information from allied health providers, pharmacies and hospitals, amongst others, in order to get a useful medical summary. This could include pathology results, diagnostic imaging, immunisation, Medicare and Pharmaceutical benefit claims, organ donation, medication and advanced care directives.

He says records are not expected to be as detailed as those held by GPs, but a reliable, secure and useful summary.

“All of these things go into making up the record but at the moment we have got a situation where some hospitals’ IT platforms won’t allow them to upload information. For example, in Victoria whereas some hospitals were able to upload data right now,” Dr Bartone says.

“It’s about an emergency situation where the patient is unknown to the doctor who needs to get some information on them in a hurry. It’s never going to replace the GPs file … it’s not designed to be that.

“You don’t need all these details. Other providers need a snapshot of medications, tests and conditions; then they will move on.”

A Department of Health spokesperson said that the quality of information uploaded to the My Health Record system reflected the quality of the records kept in local clinical information systems.

“It is the responsibility of healthcare providers and is part of their professional standards that they keep accurate and up-to-date records about their patients,” said the spokesperson. “It is anticipated that records which are accessible by both patients and other healthcare providers treating that patient will see an improved quality over time.”

Getting clinicians on board

Dr Bartone believes the work needs to be clinically-led and the scheme’s practical implications for clinicians, such as cost and increased workload, properly thought through and addressed.

He says there has been a lack of engagement with clinicians, caused by “too many people with various agendas pushing different methodologies and ideas” holding the process back so that it failed to deliver enough value to consumers.

Although medics were consulted initially under the PCEHR, Dr Bartone believes this fell by the wayside when the project was delivered, with little thought to how it would actually work on the ground.

“They expected patients to be registered by doctors in their waiting rooms. That’s a cumbersome and difficult process and these are busy places,” he says.

“There was no awareness that this would impose a workload, red tape and duplication. There was lots of money but it wasn’t going to the right people.”

The results so far have been questionable in terms of outcomes and performance.

“The need to have a robust and reliable individual electronic health record is without question,” Dr Bartone says. “The issues thus far have been in terms of scope and implementation: how and who is controlling it and how it would be rolled out.”

But he says offering GPs payments to register a certain number of patients (which has been announced as policy) and making the scheme opt-out for patients, rather than opt-in (which has not, as yet), were both be good ideas.

The My Health Record trials have been a mixture of opt-in and opt-out, to test the public’s response. While the Nepean and Queensland trials were opt-out, two earlier trials in Western Australia and Ballarat, Victoria were opt-in.

Dr Bartone says it is imperative that the back-end of the system is easy for doctors to navigate and does not involve duplication of effort – which he says had only recent been possible through new software – so it does not impose an additional burden on doctors.

“There’s been lots of good will invested over the last four or five years. That will run thin if there are any further problems,” he says.

Another discouragement for doctors to use My Health Record has been anxiety that they may be prosecuted under privacy legislation for accessing or sharing information, a fear which Dr Bartone says resulted in disillusionment, even for rusted-on fans of electronic health records.

Government News put these concerns to the federal Department of Health.

A departmental spokesperson said the My Health Records Act 2012 specifically authorised the collection, use and disclosure of health information in the My Health Record so that there would be no breach of the Privacy Act 1988.

“This means that treating healthcare providers can access and use an individual’s My Health Record for healthcare purposes,” the spokesperson said.

The spokesperson said the penalties for unauthorised collection, use or disclosure of data – which can be up to $540,000 or two years’ imprisonment – did not apply to accidental misuse. Patients are also able to restrict or remove documents in their My Health Record.

“For example, if a healthcare provider inadvertently or accidentally accesses an individual’s My Health Record – they are not liable for a civil or criminal penalty,” said the spokesperson.

Healthcare providers can use their judgement about what they upload onto an individual’s My Health Record.  There is nothing in the My Health Records Act 2012 that requires them to upload if they choose not to.

Dr Pinskier says that some of the difficulty getting a national e-health record off the ground stems from earlier efforts to appease everybody, patients and multiple healthcare providers, ending in an extremely complex system.

The national individual electronic health record became a hybrid of a clinical and consumer record, without quite meeting the requirements of either, he says.

“I think we need to go back to basics and ask what we want to achieve – what’s its core purpose?

“We are not addressing the questions of utility and functionality. There is still a really good opportunity to see what is it we’re trying to achieve, how best to achieve it and the steps needed to do it.”

He is emphatic about how this should be done.

“This is not a technological questions, it needs to be clinically led,” Dr Pinskier says. “We need to start again but we need the key clinical stakeholders involved and the clinical community needs to be listened to.”

My Health Record trials

Opt-in trials began in July in Ballarat, Vic and Western Australia. The Ballarat Health Service help patients register when they are admitted to hospital and their discharge summaries are uploaded to My Health Record.

In Western Australia, the trial involves helping chronically-ill patients register at selected practices and modifying chronic disease management software. This will give treating healthcare providers, including specialists and allied health professionals, access to patients’ My Health Records using connected software.

Opt-out trials are underway in the Nepean Blue Mountains area and Northern Queensland.

The Department of Health says the trials are being conducted to gauge consumer reaction to an opt-out system of participation, as well as looking at healthcare provider use and how much clinical information is uploaded to the My Health Record when most patients have a My Health Record.

Federal Health Minister Sussan Ley announced last month that the number of My Health Records in Australia had surpassed four million, with an average of 2,200 new registrations every day in the preceding four weeks.

“With changes to the General Practice Incentive, healthcare providers are increasingly contributing and viewing on-line health information about their patients,” Ley said. “We are now seeing one upload of clinical health information from a healthcare provider every 21 seconds.”

Ley says that every day, one in five GPs saw a patient for whom they have little or no information but My Health Record would change that.

“This may be a Medicare claim or pharmacy prescription, or clinical information uploaded by other healthcare providers such as a specialist, hospital and pharmacy,” Ms Ley says.

“With a My Health Record, both a patient and their healthcare professional can gain immediate access to important health information on-line.

“This can improve co-ordinated care outcomes, reduce duplication and provide vital information in emergency situations.

Ley says My Health Record puts the power in the hands of health consumers to decide who they shared their health information with.

Patients can register through MyGov for a My Health Record online and then link the two.

NACCHO Aboriginal Health :Report : Perils of place: identifying hotspots of health inequality

image

Hospitalisation rates for diabetes, tooth decay and other conditions that should be treatable or manageable out of hospital show how Australia’s health system is consistently failing some communities.

Perils of place: identifying hotspots of health inequality

Download report here : NACCHO download Perils-of-Place

Places such as Frankston and Broadmeadows in Victoria and Mount Isa and Palm Island in Queensland have had potentially preventable hospitalisation rates at least fifty percent above the state average in every year for a decade.

Place

The problem can be addressed, but only if governments come up with targeted solutions for individual places. Australia is not a uniform country and a one-size-fits-all approach will not work. Local, tailored policy responses are required.

Reducing potentially preventable hospitalisations in hot spots in Victoria and Queensland — the two states the report studied – would save a total of at least $15 million a year. Indirect savings should be significantly larger.

The report introduces a method of identifying small areas where health inequalities are entrenched and, without intervention, are likely to endure.

To build up the limited evidence of what works in reducing place-based health problems, the report recommends that government combine with Primary Health Networks and local communities to run three- to five-year trials of tailored programs in selected places.

Rigorous evaluation is critical, so that the lessons from successful trials can be applied across the country.

Because persistent hotspots are rare, targeting them alone will not substantially reduce the growing burden of potentially preventable hospitalisations, but it’s an important first step.

Government and Primary Health Networks must ensure that all communities get a fair go. The government will save money and, more importantly, some of the most disadvantaged Australians will get the chance to lead healthier, more productive lives.

 

 

NACCHO #Aboriginal Health : #AIHW releases specific Measures tool Item 715 MBS Health checks

GetChecked-Txt

All Aboriginal and Torres Strait Islander people are eligible for an annual Indigenous-specific health check: item 715 on the Medicare Benefits Schedule (MBS).

AIHW Press Release 21 July 2016

Medicare Health Assessment for Aboriginal and Torres Strait Islander People (MBS Item 715) – PDF 322 KB

See update 22 July For Aboriginal Health Workers
The aim of this MBS health assessment item is to help ensure that Aboriginal and Torres Strait Islander people receive primary health care matched to their needs, by encouraging early detection, diagnosis and intervention for common and treatable conditions that cause morbidity and early mortality.

For the purpose of this item, a person is an Aboriginal or Torres Strait Islander person if they, or their parent or carer, identify them as being of Aboriginal or Torres Strait Islander descent.

The MBS health assessment for Aboriginal and Torres Strait Islander people covers the full age spectrum, and should be used for health assessments for the following age groups:

  • Aboriginal and Torres Strait Islander children who are less than 15 years old
  • Aboriginal and Torres Strait Islander adults who are aged fifteen years and over but under the age of 55 years
  • Aboriginal and Torres Strait Islander older people who are aged 55 years and over

Indigenous specific measures tool 5th release (dynamic data display)

This tool shows numbers and usage rates of the checks at various geographic areas. Charts and tables in the tool can be customised to show different time periods and, where possible, disaggregations by age and sex.

The Australian Institute of Health and Welfare has released a new web product on 21 July, 2016:

Indigenous specific measures tool 5th release (dynamic data display)

1.The Indigenous health check (MBS 715) data tool provides information on use of MBS-rebated health checks for Aboriginal and Torres Strait Islander people displayed using SAS Visual Analytics.

2 The tool shows; numbers and rates of health check uptake at national, jurisdiction, Medicare Local and peer group, and Primary Health Network levels.

3 .This update adds national and jurisdiction data up to December 2015, updated from 30 June 2014.

The page can be viewed at this link: http://www.aihw.gov.au/indigenous-australians/indigenous-health-check-data-tool/

Source data: Excel download (1.5MB XLS)

Helpline: 1800 223 919 or nidisc@aihw.gov.au.

Components of the Health Assessment

The health assessment includes an assessment of the patient’s health, including their physical, psychological and social wellbeing. It also assesses what preventive health care, education and other assistance should be offered to the patient to improve their health and wellbeing. It complements existing services already undertaken by a range of health care providers. This health assessment must include:

  • information collection, including taking a patient history and undertaking examinations and investigations as required;
  • making an overall assessment of the patient;
  • recommending appropriate interventions;
  • providing advice and information to the patient;
  • keeping a record of the health assessment, and offering the patient a written report about the health assessment, with recommendations about matters covered by the health assessment; and
  • offering the patient’s carer (if any, and if the medical practitioner considers it appropriate and the patient agrees) a copy of the report or extracts of the report relevant to the carer.

As part of a health assessment, a medical practitioner may develop a simple strategy for the good health of the patient. The strategy should identify any services the patient needs and the actions the patient, or parent or carer, should take. It should be developed in collaboration with the patient, or parent or carer, and documented in the written report on the assessment that is offered to the patient, and/or patient’s carer.

NACCHO’s new Baseline Profiles to demonstrate extent, experience and value of the ACCHO Sector to policy makers

NACCHO-Member-Services-2015-11-1024x939

“NACCHO will use the Baseline Profile to demonstrate the extent, experience and value of the ACCHO Sector to policy makers in government and those developing new programmes and budgets.

NACCHO is developing Baseline Profiles for its Member Services in 300 locations coordinated by 140 NACCHO Member Services as a first step in getting health and related data back in the hands of the Member Service ACCHOs and their communities.”

ACCHOs are a critical component of Australia’s primary health care system; the Baseline Profiles and Member Service’s localised profiles will re-enforce this fact “

Matthew Cooke Chair NACCHO

NACCHO delivers Map-Based Decision Support Services – Our Data in Our Hands for more info

NACCHO Baseline Profiles – putting data to work is from NACCHO Aboriginal Health Newspaper Page 10 April edition : Download 24 pages here

In these times of changing Federal policies, cut backs in areas of funding and overall fiscal constraints, ACCHOs are faced with providing broad ranging evidence of their performance to justify existing budgets and staffing levels, as well as justifying applications for new funding for the expansion of services into identified areas of need.

Challenges are also arising as an increasing number of programmes are being funnelled through the newly formed Primary Health Networks.

A new approach for determining funding allocations being used by the government and PHNs is referred to as “market testing”. This approach will potentially require ACCHOs to compete with state and territory health departments, other NGOs and for-profit practices and corporations for the provision of basic services and for the delivery of new programmes.

Mapping the service delivery footprint of ACCHOs service areas is important to demonstrate their role and significance as unique providers of comprehensive primary health care in over 300 locations coordinated by 140 NACCHO Member Services. ACCHOs are working with many of the new PHNs to build an understanding of the actual range of services provided to the population in their communities and the geographic extent of their service delivery. PHNs are required by the Department of Health to develop Health Needs Assessments and associated planning.

The ACCHO Sector has over 320,000 clients with over 3.7million client contacts delivered in 2013-2014. In comparison, the number of Emergency Department presentations in public hospital emergency departments in all states and territories was 7,195,903 (2013-2014) and RFDS undertook 292,523 client (patient) contacts in the same period.

NACCHOs Baseline Profiles, based on publicly available data, are being created for each Member Service. The profiles form a template to enable Member Services to add data from their own information systems. These localised templates will then be available for use in reports for Service planning and to provide evidence of performance, as well as for communications with community, funding bodies and policy makers.  A critical aspect of planning is “access to services”, for both existing services and for identifying areas where there is no access i.e. gaps.

The Baseline Profiles are using drive times (the time it takes to drive to an ACCHO) as a way of determining accessibility to health services, building on the work of the Australian Institute of Health and Welfare (AIHW) and the Queensland Aboriginal and Islander Health Council (QAIHC).

SEE Koori Mail for 2 and 3 below :The graphic shows example panels from the Baseline Profile for the Geraldton Regional Aboriginal Medical Service in the electorate of Durack and Country WA PHN.

Map 1

1.Maps showing the 60 minute drive time area from Geraldton, age-gender pyramid of the population and service delivery area for the Geraldton Regional Aboriginal Medical Service (GRAMS)
2.Heat map showing areas with a high density of Aboriginal people and the area included in a 60 minute drive time. Aboriginal population within the 60 minute drive-time of Geraldton is 3,382 with 4,727 in the larger service delivery area (ABS Census 2011) 3.Age-gender pyramid of the Aboriginal population in the 60minute drive time area.

Service delivery area with GRAMS fixed and mobile clinic serviced locations.