dr paul jelfs, abs: monitoring and reporting on socioeconomic difference

Health – relationships with

socioeconomic status Dr Paul Jelfs

First Assistant Statistician

Population, Labour and Social Statistics Group

Australian Bureau of Statistics

Drivers of health outcomes

• Economic income and wealth

– Mostly measured as income and SEIFA (IRSD)

• Education/language skills

• Location and access to services

• Occupation

• Environment

• Health beliefs

• Health literacy

Socio-economic measurement

Couldn’t raise $2,000 in a week – Low Inc 33%, LER 43%

Couldn’t pay gas/elect on time – Low Inc 23%, LER 31%

Went without meals – Low Inc 8%, LER 10%

Vulnerable populations

• Low economic resource households (income/wealth)

• Some Aboriginal and Torres Strait Islanders

• Some migrant populations

• Some rural/remote locations & some

urban locations

• Those with a disability or multiple

chronic health conditions

Key data sets that contribute to this

discussion

• Census of population and housing (2011)

• Survey of Income and Housing (2009-10, 2011-12)

• Australian Health Survey – General and Aboriginal

and Torres Strait Islander populations (2011-13)

• Patient Experience Survey (2012-13)

• Survey of Disability, Ageing and Carers (2012)

• Adult Literacy and Life Skills Survey (2006)

Risk factors

• Smoking – Low SES 24%, High SES 10%

• Low exercise – Low SES 76%, High SES 59%

• Obesity* – Females Low SES 64%, Females High SES 50%

• Alcohol risk (lifetime)* – Low SES 16.7%, High SES 22%

Adequate health literacy

Aboriginal and Torres Strait

Islander people

Smoking rates

Non-Indigenous smoking rates – 16.1%

Alcohol – long term risk

Proportion of Aboriginal and Torres Strait Islander people 15

years and over who exceeded alcohol guidelines for lifetime risk,

by remoteness and sex, 2012-13

Overweight and obesity

Health services

Private Health insurance

Access to health services

Barriers to accessing health services

Some people that needed to see a health professional or fill a prescription delayed or did not do so because of the cost:

• GP: 7%

• Medical Specialist: 8%

• Prescription for medication: 9%

• Dentist: 21%

Barriers to accessing health services

• 21% of people delayed or did not see the dentist due to cost – who were they?

Barriers to accessing health services

• 21% of people delayed or did not see the dentist due to cost – who were they?

Health outcomes

• Diabetes – Low SES 8.3%, High SES 5.1%

• Diabetes (Self report) – Low SES 5.4%, High SES 2.5%

• Abnormal cholesterol * – Low SES 29%, High SES 35%

• Abnormal tryglicerides – Low SES 18%, High 11.5%

• Abnormal kidney – Low SES 5.5%, High SES 2.9%

• Arthritis - Low SES 17.2%, High SES 14.2%

• Asthma - Low SES 12.1%, High SES 8.9%

Self assessed Health Status

Disability

• Key health related conditions – Musculoskeletal

(56%), Circulatory (39%), Mental health (35%)

• Year 12 completion rates – with a disability 37%,

without a disability 59%

• Further qualification – with a disability 52%,

without a disability 60%

• Labour participation – with a disability 29.7%

(profound)/60.4%(other), without a disability 82.5%

Key messages

• Socio-economic disadvantage measures are good indicators

of risk and outcome ....but are not always perfect at an individual or small group level

• The relationship between SES and health is not always in a

positive direction

• The relationship of health with SES does not always hold

for all population groups

• There is a cumulative effect of health risk and SES and

therefore a cumulative effect on health outcomes

Key Messages 2

• Australia has some very good data to describe and

unpack the SES/health relationship

• Driving change in health requires continuously

addressing the key elements of education and

income which will have an impact on risk

exposures and capacities to use health services

– Cross sectional and across cohorts