Socio-economic
Disadvantage
Prepared by Kim Gilchrist
Epidemiologist
Public Health, MLHD
May 2013
Taking A “Social Determinants” Approach
 Research has shown that the housing, transport, stress,
type of employment or unemployment, social support and
income have as much impact on health and wellbeing as
our genes and behaviours.
 These factors are known as the Social Determinants of
Health are the conditions in which people are born, grow,
live, work, play and age.
Dahlgren and Whitehead's Social Determinants of Health Rainbow
Source: Dahlgren and Whitehead (1991)
Why look at disadvantage
for health planning?
 Poorer people have poorer health
 People in disadvantaged areas have lower life
expectancy and higher illness rates
 Need to identify if and where our District has areas of
Disadvantage
 Identify areas of most need
 Enables targeted services
How do we measure disadvantage?
 Many indicators in the Australian Bureau of Statistics
Census:
– Income
– Disability
– Housing
– Car ownership
– Employment
– Internet access
– Occupation
– Qualifications
– Family characteristics
– English language skills
How do we summarise all those?
 ABS developed summary measures combining many
factors which can indicate economic or social disadvantage
 Australian Bureau of Statistics Socio Economic Indexes for
Areas (SEIFA)
 Main one of interest is the:
Index of Relative Socio-economic Disadvantage
(IRSD)
Index of Relative Socio-economic
Disadvantage (IRSD)
 The ABS divides all Australia into small geographic areas
 They look at the percentage of people in each area in
households with:
– low incomes, no qualifications, low-skilled jobs,
unemployment, poor English, one-parent families,
overcrowded homes etc.
 Each area is given a score
 The areas’ scores are then ranked (ordered) and put into
groups from 1 (most disadvantaged) to 10 (least
disadvantaged).
Index of Relative Socio-economic
Disadvantage (IRSD)
 Each group contains 10 % of all the areas in Australia
 These are called Deciles
Decile 1
Most disadvantaged
5
10
Least disadvantaged
What is relative disadvantage?
 Relative – because this is an index comparing all areas
across Australia relative to each other
 It is not saying that Decile 1 is “absolute poverty” but it has
more households with the disadvantage characteristics and
Decile 2 has less…. Decile 10 the least.
 The disadvantage scores cannot be compared to other
countries or used as a measure of poverty, people in Decile
1 for example could not be said to be destitute or living in
“developing world” conditions.
Geographic Areas of MLHD
 29 local government areas (LGAs) – plus part of Lachlan
Shire (Lake Cargelligo)
 To give more specific detail we can look at:
– ABS statistical areas (SA1s)
– contain an average of 400 people
– mostly within LGA boundaries
– 787 SA1s in MLHD
– Disadvantage scores are calculated at this level
Geographic Areas of MLHD
Disadvantage by LGA
Most disadvantaged
Decile 2
Least disadvantaged
Disadvantage by LGA (cont.)
 Scores are averaged across the SA1s within the LGA
 Gives a good indication for MLHD which LGAs have
relatively high proportion of disadvantaged
 Hay, Murrumbidgee and Narrandera stand out as the most
disadvantaged LGAs
 Conargo shows as least disadvantaged
 However there is significant geographic variation in
disadvantage within LGAs
Disadvantage by Small Areas (SA1s)
 Scores are calculated across Australia at this level of
geography
 Gives a good indication for MLHD of pockets of
disadvantage within LGAs
 Each LGA can be looked at in more detail
 May help target location of certain services
Disadvantage by SA1
Most disadvantaged
Least disadvantaged
Proportion of Disadvantage in LGAs
 ABS also releases data on the proportion of population in
each LGA living in disadvantaged SA1s
 We can interpret this as the proportion of an LGA who are
highly disadvantaged
 Narrandera, Harden and Lachlan Shire (Lake Cargelligo)
have approximately one third of the LGA population living in
highly disadvantaged areas.
Disadvantage by LGA
Most disadvantaged
Least disadvantaged
Population size or Percentage
 There may be a high percentage of population by LGA but
small numbers of actual people – e.g. Lake Cargelligo
 Or the percentage might be small but there are high
numbers of people e.g. Albury, Wagga Wagga
 Also shows where the population is – not just whole LGA
e.g. Murray Shire has three separate locations of
disadvantaged populations
Disadvantage vs Health outcome
 SCATTER PLOTS
 SEIFA disadvantage score for an LGA (the horizontal axis)
has been plotted against the rate of hospitalisation/death
(the vertical axis) for that LGA.
 Each chart has 29 dots, one for each LGA.
 A “line of best fit” has been added to each chart to
demonstrate a linear relationship between disadvantage
and the health indicator.