Environmental Health Branch, Health Protection NSW and Centre for Epidemiology and Evidence, NSW Ministry of Health.
The denominator for the Safety: Gas criteria may differ to the other criteria as not all houses had gas connected.
Survey data and graphs present:
Projects are counted within the time-period in which survey-fix 2 is completed.
The Housing for Health program aims to improve the health status of Aboriginal people, particularly children, by assessing, and repairing or replacing health hardware so that houses are safe and the occupants have the ability to carry out “Healthy Living Practices” (HLPs). Housing for Health has been delivered to Aboriginal communities across NSW since 1997. Between 1997 and 2018, 118 community Housing for Health projects have been delivered.
The program made significant improvements to house function, in particular electrical safety, structural safety and access, fire safety, working showers, laundry services, drainage and flush toilets.
In 2010, NSW Health published an evaluation of the program that assessed health outcomes from 1998 to 2008. This evaluation, called Closing the Gap: 10 Years of Housing for Health in NSW, provides evidence of a 40% reduction in hospitalisation with infectious diseases among residents of houses that received Housing for Health, compared to the rest of the rural NSW Aboriginal population.
The Housing for Health program used a defined methodology. Following a feasibility study and community agreement to a project, an initial baseline survey and fix was undertaken. Teams consisting of trained community members led by qualified team leaders, tested and recorded over 250 items in each house using a standardised data collection tool, and carried out minor repairs. Licenced trades followed behind repairing items identified by the teams.
The first survey used the standard data collection tool to identify problems in key areas of safety (electrical, gas, structural and fire) and Healthy Living Practices (HLPs) (including facilities for washing people, washing clothes, removing sewage and waste and improving nutrition). Simple or urgent repairs were carried out on-the-spot before an upgrade works program addressed larger or more complex problems.
Following the upgrade works, a second survey-fix was undertaken approximately six to twelve months apart. This used the same data collection tool and process as the first and assessed any changes in house function. Again, any urgent works were repaired by the licenced trades. As items were repaired the house function data was updated so that survey data and graphs presented here show:
Each HLP comprises a number of criteria and a house must pass all of these criteria to be considered acceptable for that HLP. Occasionally, criteria are beyond the scope of the program funding conditions. For example, Improving Nutrition: store, prepare and cook food has 15 criteria including adequate cooking facilities, bench space and cool storage. While the program addresses most of these criteria (repairing stoves and kitchen taps etc) it is not able to address all criteria (such as replacing a refrigerator). Therefore, whilst the average criteria score for this HLP were improved only modest overall gains were possible for this HLP.
In Safety: structure and access, some houses required major repairs and engineering works that were beyond the funding capacity of this program. For Safety: fire, all houses were upgraded to current standards for smoke detection, but in some houses egress (escape) was not possible from all windows as they had security screens permanently fixed to the windows.
Projects are being continuously rolled out. Projects which had the second survey-fix completed in the two-year period are included in the data set. The first survey may have been undertaken prior to this period.
For more information
NSW Department of Health.Closing the Gap: 10 Years of Housing for Health in NSW.NSW Department of Health 2010
Australian Institute of Health and Welfare. Indigenous housing needs 2005- a multi-measure needs model Canberra: AIHW, 2005. Available at www.aihw.gov.au/publications/index.cfm/title/10166..
Pholeros P, Rianow S, Torzillo P. Housing for Health: Towards a Health Living Environment for Aboriginal Australia. Healthabitat: Newport Beach, 1993.
Department of Family and Community Services. National Indigenous Housing Guide (3nd edition) Canberra: Commonwealth of Australia, 2008.
NSW Department of Health. Aboriginal Communities Development Program-Housing for health. Sydney: NSW Department of Health, 2004.
• Social factors such as income, socioeconomic status, employment status, educational attainment and crime rates are associated with inequalities in health.
• In 2016, four of the five most socioeconomically disadvantaged local government areas of NSW were in remote or very remote parts of the state (Brewarrina, Central Darling, Walgett and Coonamble). Fairfield Local Government Area, also one of the five most disadvantaged areas, is in south-western Sydney. The five least disadvantaged local government areas were all in metropolitan Sydney: Ku-ring-ai, Mosman, Lane Cove, Woollahra and North Sydney.
• The unemployment rate has remained relatively steady since 2000, and stood at 4.6% for males and 4.7% for females in September 2018. While female participation in the labour force is still lower than that of males, it has been steadily increasing over time while male participation rates have been relatively stable. In September 2018, the rate of female participation in the labour force was 59.9% while that of males was 70.1%.
• In NSW in 2016, 13.8% of the NSW population aged 15 years and over had gross weekly income of less than $150, while 8.8% had income of more than $2000. Males tended to have greater individual weekly income than females in NSW. Majority of persons aged 65 years and over (57.2%) reported earning between $150 and $649 per week.
• The Northern Sydney Local Health District had the smallest proportion of persons with weekly income of less than $600 (37.6%) and the Far West had the greatest proportion (54.8%) in 2016. In the same year, the Northern Sydney Local Health District also had the greatest proportion of persons with gross weekly income of $2,000 and more (6.0%) while the Mid North Coast Local Health Districts had the lowest (3.0%).
Social determinants of health are the economic and social conditions under which people live, which determine their health. The conditions most frequently regarded as social determinants of health are: individual and household income and income distribution in the society; employment and working conditions; education and literacy, including health literacy; housing; health and social services, including early childhood development support; and social cohesion. These factors are resources that a society makes available to its members to enable them to stay healthy, and, in broader terms, to equip them with the physical, social, and personal resources to identify and achieve personal aspirations, satisfy needs, and cope with the environment.
The World Health Organisation defines the social determnants of health in the following way:The social determinants of health are the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. The social determinants of health are mostly responsible for health inequities - the unfair and avoidable differences in health status seen within and between countries.
While Australia ranks among the most advanced nations in the world, the health burden in the Australian population attributable to relative socioeconomic disadvantage is large and much of this burden is potentially avoidable. Many indicators in HealthStats NSW show that socioeconomically disadvantaged groups experience more ill health, and are more likely to engage in behaviours or have a risk factor profile consistent with their poorer health status. These inequalities are important from both social justice and economic perspectives – they are ‘unfair’, preventable and have high direct and indirect impact on the health system.
The World Health Organisation has devleoped areas for action to reduce health inequities – in collaboration with civil society, United Nations and development organizations, academia, donors and the private sector – in five priority areas (as specified by the Rio Political Declaration on Social Determinants of Health): enhancing health policies and decision-making, widening participation in policy-making and implementation, improving health care and services, strengthening international cooperation, and monitoring impact and progress.
World Health Organisation. Taking action to improve health equity. https://www.who.int/social_determinants/action_sdh/en/
Australian Bureau of Statistics at http://www.abs.gov.au
Australian Institute of Health and Welfare at http://www.aihw.gov.au
Healthdirect at http://www.healthdirect.gov.au
World Health Organization. Social determinants of health. Available at: http://www.who.int/social_determinants/en/
• Human health is inextricably linked to the environment.
• The main contributors to air pollution in cities are industry, motor vehicles and wood-burning heaters.
• A range of indicators of the quality of drinking water, and water for recreational use, are monitored continuously. The majority of households in NSW use public water supplies.
• Recent testing of drinking water indicates that drinking water supplied by the Sydney and Hunter Water Corporations meets Drinking Water Guidelines and is of good quality.
• Overall compliance rate for rural water supplies is high, but results from individual supplies vary substantially:
• Leaded petrol has been the main source of lead exposure for most NSW children, except those living near major sites for lead mining. In recent years blood lead levels among preschool children living in Broken Hill, an area with lead mining, have declined steadily.
• The Housing for Health program aims to assess, repair, and replace health hardware in Aboriginal residences. Surveys conducted on houses 6-12 months apart identified major improvements in key areas of safety, and facilities such as working showers and laundries, as a result of the program which has been running in NSW since 1997.
• In 2010, NSW Health published an evaluation of the program that assessed health outcomes from 1998 to 2008. This evaluation, Closing the Gap: 10 Years of Housing for Health in NSW, provides evidence of a 40% reduction in hospitalisation with infectious diseases among residents of houses that received Housing for Health, compared to the rest of the rural NSW Aboriginal population.
Factors in the natural and built environment have direct and indirect effects on human health which can be immediate or long-term. In rural areas issues as diverse as land use, agricultural practice, water quality and biodiversity all affect human health. People in urban and built environments are affected by air and water quality, transport choice, urban form and environmental health infrastructure.
The effects on human health of global phenomena such as population growth and climate change are also recognised at a local level. Potential health impacts include direct (e.g. increasing number of heatwaves and air pollution from bushfires) and indirect (increases in food- and water-borne diseases, increasing prevalence of mosquito-borne diseases from changes to natural ecological systems).
Responding to the large-scale environmental change, the 2008 Public Health Congress called on “all key stakeholders to invest in sustainable policies, actions and infrastructure to address the determinants of health”, including the environmental factors leading to climate change.
Responsibility for the management of environmental health hazards is deployed across three tiers of government. The Commonwealth and States work cooperatively to set environmental standards for drinking water and air quality. In NSW, the NSW Enviromental Protection Authority has carriage of legislation governing controls on air and water quality, chemical hazards, and contaminated land. The NSW Ministry of Health has responsibilities in relation to drinking water, and a variety of infectious hazards linked to premises including Legionella in public air conditioning systems, tattooing and the funeral industry.
The NSW Ministry of Health, Public Health Units in Local Health Districts, and local government manage these hazards in partnership. The NSW Ministry of Health also manages statewide programs such as the Aboriginal Environmental Health Program, the NSW Drinking Water Monitoring Program and the Arboviral Disease Program.
Australian Government Department of the Environment at http://www.environment.gov.au
NSW Office of Environment and Heritage at http://www.environment.nsw.gov.au
Department of Primary Industries Water at http://www.water.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
healthdirect at http://www.healthdirect.gov.au