Ambulance attendances for drug overdoses

• Unhealthy behaviours contribute significantly to the burden of death and ill-health in NSW. For example:

smoking causes more than  5,200 deaths and just over 44,000 hospitalisations per year

alcohol causes more than 1,220 deaths and just under 448,000 hospitalisations each year.

• Unhealthy behaviours affect people of all ages.

• Among adults in 2010:

18% of men and 13.5% of women are current smokers

60% of men and 48% of women are overweight or obese

while only:

60% of men and 51% of women are adequately physically active

53% of men and 60% of women eat adequate quantities of fruit

7% of men and 12% of women eat adequate quantities of vegetables.

• Of secondary school students aged 12-17 years in 2008:

7% of boys and 8% of girls smoked in the previous week

21% of boys and 20% of girls consumed alcohol in the previous week

26% of boys and 15% of girls were overweight or obese

13% of boys and 12% of girls have used cannabis at least once

and only:

33% of boys and 17%of girls wear a hat in the sun

34% of boys and 53% of girls usually use sunscreen.

• Encouragingly, though:

smoking rates have declined among both men and women since 1977

in 2008, for both sexes, the number of ex-smokers was greater than the number of current smokers

there has been a slight increase in the proportion of adults undertaking adequate physical activity over the last five years

the death rate from heroin overdose has declined steeply since 1999.

Health risk factors and burden of disease

Good health enhances the quality of human life and benefits the community. The opportunity to participate in and contribute to society is maximised in a healthy population. Organisational, economic, and environmental factors have major influences on the health of individuals.

Health-related behaviours also contribute significantly to cardiovascular and respiratory diseases, cancer, and other conditions that account for much of the burden of morbidity and mortality in later life. Some factors have positive effects, and others have negative effects on health. Diets with a high daily intake of fruit and vegetables, or being vaccinated against disease, are factors that protect us against ill health. Risk factors, such as smoking, or being physically inactive increase our risk of ill health (AIHW Cat. no. AUS 122 2010).

Risk factors contribute to almost one-third of Australia’s total burden of death, disease and disability. Tobacco smoking was estimated to contribute the greatest burden (7.8% of the total health burden), followed by high blood pressure (7.6%) and overweight or obesity (7.5%) (AIHW Cat. no. AUS 122 2010). Physical inactivity was responsible for 6.6% of the total burden of disease and injury and low fruit and vegetable consumption for 2.1% (Begg et al. 2007).

These risk factors are major contributors to the development of chronic conditions (such as cancers and cardiovascular diseases), which are the main contributors to the total burden of disease and injury in Australia (AIHW Cat. no. AUS 122 2010).

References

Australian Institute of Health and Welfare. Australia’s health 2010. Australia’s health series no. 12. Cat. no. AUS 122. Canberra: AIHW, 2010. Available at http://www.aihw.gov.au/publication-detail/?id=6442468376

Begg S, Vos T, Barker B. The burden of disease and injury in Australia, 2003. Cat. no. PHE 82 edition. Canberra: AIHW, 2007. Available at http://www.aihw.gov.au/publications/index.cfm/title/10317

• Across Australia, people living in rural and remote areas generally have worse health than those living in cities.

• Reasons for this health differential include geographic isolation, socioeconomic disadvantage, shortage of health care providers, lower levels of access to health services, greater exposure to injury risks, and poor health among Aboriginal people who comprise a significant proportion of the population in rural and remote areas.

• The population of NSW is highly urbanised. Less than 1% of the total population live in areas classified as Remote or Very remote.

• In 2008 around 38,000 residents in NSW lived in Remote or Very remote areas of the state and just under a quarter of these (8,600) were Aboriginal. In Very remote areas Aboriginal people comprise almost one-third of the total population.

• Compared with people who live in Mmajor cities, people who live in Remote or Very remote areas:

can expect to live about five fewer years in Remote areas and eight fewer years in Very remote areas; 

are more likely to die prematurely, and from causes classified as ‘potentially avoidable’; 

report greater difficulties in getting health care when they need it; 

are more likely to be hospitalised for conditions for which hospitalisation can be avoided through prevention and early management; 

are more likely to be overweight and obese; 

are more likely to die in motor vehicle crashes; 

are more  likely to be hospitalised for heart disease.

Definitions

There are five categories of remoteness, that is a distance from service centres, according to the Australian Standard Geographical Classification (ASGC). These categories are: Major cities, Inner regional, Outer regional, Remote and Very remote areas. The term rural and remote is used when referring generally to areas outside Major cities.

Demography

The population of NSW is highly urbanised. Only around 27% of total population live in rural and remote areas of NSW and an estimated 0.5% of the population live in areas classified as Remote or Very remote, according to the ASGC categories. The ASCG categories and ARIA classification are discussed further under Methods tab.

Aboriginal people make up an increasing proportion of the population with increasing remoteness, and comprise just under one-third of the population of Very remote areas and just under a quarter of residents in Remote and Very remote areas combined. However, only around 6% of the total Aboriginal population in NSW live in Remote or Very remote areas, with 43% living in Major cities in NSW.

Burden of disease

Across Australia, people living in rural and remote areas have worse health generally than those living in metropolitan areas. Numerous factors contribute to this differential but many originate in geographic isolation and include socioeconomic disadvantage, shortage of health care providers, lower levels of access to health services and greater exposure to injury risks. The main factor, however, is poorer health among Aboriginal people who comprise a significant proportion of the population in rural and remote areas.

Recent initiatives to improve rural and remote health

NSW Health has worked to improve the provision of health services in rural and remote communities through

• new models of service delivery, such as Multipurpose Services for small communities,

• development of further specialist services in Rural Referral Hospitals,

• establishment of the Centre for Rural and Remote Metal Health with the aims to provide education and training programs, undertake research and evaluate innovative service delivery models in metal health,

• establishment of rural on-site cardiac catheterisation laboratories in regional centres,

• transport initiatives such as the Isolated Patients' Transport and Accommodation Assistance Scheme

• development of health infrastructure

• opening of radiation therapy services in cancer centres

• establishing the NSW Institute of Rural Clinical Services and Teaching to support rural health staff by facilitating the networking of services and clinicians and providing opportunities to undertake rural based collaborative research

• establishing the NSW Rural and Remote Health Priority Taskforce to advise on key rural health issues and monitor the implementation of rural health initiatives

Proposals for Rural Health for Parliamentary Term 2011-2014 and the second NSW Rural Health Plan include, among other:

• centralisation, within NSW Health,  of coordination of service provision at small rural hospitals across the state

• improvements to training of rural health force.

The concept of self-sufficiency

Self-sufficiency was defined as the ratio of public hospital acute inpatient activity provided in an Area Health Service to residents of that Area Health Service, to the total demand for public hospital activity by residents of that Area. A similar concept will be applied to the new structure of Local Health Networks.

Low self-sufficiency indicated residents in a particular health area sought hospital care outside that area. Some of these patient flows should be considered 'natural', such as where a patient living near a border may attend a hospital in another health area, as it is closer to their home. For example, the Australian Capital Territory was located in the middle of the Greater Southern Area Health Service. This was likely to have had a decisive role in the low self- sufficiency result in this health area. Other patient flows, however, were caused by other factors, which might have included referral patterns of general practitioners to specialist services, inadequate infrastructure, inadequate medical workforce, and patient choice.

Useful websites include:

Rural health at the NSW Health Department website http://internal.health.nsw.gov.au/rural

NSW Institute of Rural Clinical Services and Teaching at http://www.ircst.health.nsw.gov.au

Australian Bureau of Statistics at http://www.abs.gov.au

Australian Institute of Health and Welfare at http://www.aihw.gov.au

HealthInsite at http://www.healthinsite.gov.au