Midwest – population and health snapshot
The Midwest region comprises about 25% of Western Australia’s total land area, with its population concentrated along the coast. Geraldton is the main regional centre with other population hubs centred around Dongara, Kalbarri, Morawa, Meekatharra, Mullewa, Carnarvon and Exmouth. The region incorporates four health districts – Gascoyne, Geraldton, Midwest and Murchison. Based on the Accessibility/Remoteness Index of Australia (ARIA), the Midwest region is classified as:
l Outer regional for the Geraldton and Greenough areas. l Remote for the coastal portion of the Midwest health district. l Very remote for the remaining 91% of the Midwest region.
Population Measure of disadvantage
The estimated resident population in 2013 was 67,800, Socio-Economic Indexes for Areas (SEIFA) measures a a 1.4% increase since 2006. The age-structure of the broad range of socio-economic indices from a baseline Midwest differs from the State with a: of 1,000. Research shows that a lower SEIFA (<1000) l significantly larger proportion of children 0-14 years; correlates with a lower health status with increased risk factors to ill health. l lower proportion of adults 15-39 years and 85+ years; and The Midwest region has areas with differing levels of l higher proportion of adults 40-79 years. disadvantage especially in the eastern areas. Higher proportions of Aboriginal people live in areas with lower The proportion of adults over 65 years is projected to SEIFA scores. A significant number of Midwest residents increase by 43% between 2014 and 2026. Aboriginal live in local government areas with SEIFA scores in the people represented 12% of the region’s population in bottom 10% of the state. These are1: 2011. The Aboriginal population has a younger age structure than the non-Aboriginal population and Upper Gascoyne 760 population numbers vary between health districts. Wiluna 814 Meekatharra 857 Mount Magnet 862 Planning outreach teams Cue 864 [ Consider differing age structure when planning Murchison 910 Aboriginal programs and services. [ Target low Socio-Economic Indexes for Areas (SEIFA) 1 ABS, 2033.0.55.001 – Socio-economic Indexes for Areas (SEIFA), score areas, in particular very remote Midwest Data Cube only, 2011. communities.
With thanks to WA Country Health Service for permission to use data from various sources including the Midwest Regional Health Profile 2015 which can be accessed at www.wacountry.health.wa.gov.au/index.php?id=445.
PAGE 1 Maternal health
Overview of rural maternity Smoking during pregnancy to Midwest women who reported services Risks associated with smoking smoking during pregnancy. In 2013, Community based pregnancy and during pregnancy include low birth 45% of Aboriginal mothers and 14% maternity care services are provided weight, premature birth, placental of non-Aboriginal mothers smoked by WA Country Health Service, private complications and stillbirths. Figure 1 during pregnancy. general practitioners, Aboriginal shows the proportion of births Community Controlled Health Services and a range of community Figure 1: 2011-2013 proportion of women smoking during pregnancy, Midwest residents. based and non-government organisations. Specialist obstetric services are mainly provided at the regional hospitals. In the Midwest, planned birthing services are available at Geraldton Hospital, Carnarvon Health Campus and the St John of God Geraldton Hospital2. Aboriginal maternity issues There is a large body of evidence to demonstrate that Aboriginal women experience poorer maternal health outcomes, higher rates of perinatal and infant mortality, and deliver babies with lower average birth weights when compared to non- Notes: The error bars represent the 95% confidence interval of the proportion: 2013 is preliminary data. Aboriginal women. Source: Midwives Notification System. Birth rates The following trends were seen within Alcohol during pregnancy The FASD birth prevalence has been the Midwest region between 2009- reported to be 0.26 per 1,000 births 2013: Fetal Alcohol Spectrum Disorder (FASD), miscarriage and stillbirth are within all of the WA population. Of l There was a 7% decrease in among the consequences of drinking these, 89% were Aboriginal. The FASD total number of births within during pregnancy. FASD is a common birth prevalence was 4.08 per 1,000 the region. On average, births in cause of medical, cognitive and within the WA Aboriginal population, Aboriginal women decreased by behavioural problems for children significantly higher than non- 6% per year and by 0.3% per year including prematurity, brain damage, Aboriginal children (0.03 per 1,000). in non-Aboriginal women. birth defects, growth restriction and Table 1 below shows the proportion l The age-specific birth rate for developmental delay. of Australian women drinking during Aboriginal women was 111 per pregnancy. 1,000 women which was 1.6 times higher than the non-Aboriginal rate (69 per 1,000 women). Table 1: 2012-2013 levels of drinking during pregnancy, Australian women aged 18-44 years. Teenage pregnancy Low risk levels of drinking High risk levels of drinking In 2012, 7.1% of Midwest women who Aboriginal 28.4% 11.6% gave birth were aged less than 20 Non-Aboriginal 42% 9.5% years, a proportion that is 1.8 times Sources: WA Register for Developmental Anomalies and the Midwives Notification System greater than the State. In 2012, the percentage of Aboriginal teenage women giving birth was 19% and 4% in non-Aboriginal teenage women.
2 www.healthywa.wa.gov.au/Articles/F_I/Having-a-baby-in-a-public-country-hospital-in-WA
PAGE 2 Maternal health
Gestational diabetes mellitus Table 2: 2005-2007 women who gave birth in Australia and gestational diabetes mellitus status. Diabetes in pregnancy increases the Gestational diabetes mellitus Births risk of complications of pregnancy, Percent Number Total labour and delivery for mothers and Aboriginal 5.1% 1,562 30,518 their babies. It is also an indicator of increased risk of developing Non-Aboriginal 4.7% 37,539 802,175 type 2 diabetes later in life. The risk Source: Australian Institute of Health and Welfare, 2010 is increased for those with pre- existing diabetes prior to pregnancy. Aboriginal mothers and their babies Planning outreach teams generally experience the adverse [ effects of gestational diabetes Health promotion interventions on drinking during pregnancy targeting Aboriginal women of child bearing age. mellitus (GDM) at higher rates. [ Access to dietitians and nutritional professionals for expectant 7% of Western Australian women who Aboriginal mothers. gave birth in 2012 were diagnosed [ Strengthen partnerships with primary care providers such as local general practices and Aboriginal Medical Services. with GDM. Table 2 provides an overview of gestational diabetes mellitus status in Australia during 2005-2007.
Child and adolescent health
Low birth weight From 2008-2012 in the Midwest In 2012, Australian Bureau Statistics A baby’s birth weight is a key region, 15% of Aboriginal babies data classed 22% of Australian indicator of health status. The World were born with a low birth weight, children as developmentally Health Organisation defines low birth compared to the overall Midwest low vulnerable on one or more domains weight as less than 2,500 grams. birth weight rate of 8%. of the AEDC. In addition, 11% were developmentally vulnerable on two Australian Early Development Babies born with a low birth weight or more domains. have a greater risk of poor health Census and dying, and are more likely to The Australian Early Development Within Midwest communities the develop significant disabilities and Census (AEDC) is a measure of proportion of children rated as have a greater risk of poor health and how children are developing upon developmentally vulnerable on one mortality outcomes. commencing full-time school for the or more domains ranged from first time. 10% to 65%. The five towns in the Midwest with Planning outreach teams the highest percentages of children [ Increase allied health professionals to assist early childhood developmentally vulnerable are development. Teams could include speech pathologists, shown in Table 3. occupational therapists, physiotherapists and child health nurses. To learn more about the AEDC, visit www.aedc.gov.au/about-the-aedc.
Table 3: 2012 AEDC, Midwest children vulnerable on at least one domain. Children vulnerable: 1+ domains Children vulnerable: 2+ domains Community Number % of total surveyed Number % of total surveyed East Carnarvon/Kingsford 8 42 4 21 Karloo 9 47 4 21 Meekatharra and surrounds 15 65 11 41 Spalding 19 42 12 27 Utakarra 11 65 8 47
PAGE 3 Ear health
Ear diseases, in particular otitis media, household conditions, passive l Rate of PPH due to ENT infections and associated hearing loss are highly smoking, premature birth and was significantly higher for prevalent among Aboriginal children. malnutrition4. Aboriginal children than the non- In 2012-2013, national prevalence of Aboriginal rate (1,851 versus 602 In the Midwest, the following ear chronic otitis media causing hearing per 100,000). health trends were observed during problems in Aboriginal children aged 2008-2012 for children aged 0-14 0-14 years was double that of non- years: Planning outreach Aboriginal children (7% as compared teams to 3.6%)3. l Ear, nose and throat (ENT) infections were the second leading [ Focus on ENT infections and Otitis media begins within weeks of respiratory disease in children cause of potentially preventable birth and can persist into adolescence especially Aboriginal children. hospitalisations (PPH) and was with reoccuring episodes. Preventing [ Increase programs aimed at slightly higher than the State rate. ear disease is a high priority as it can prevention and management of risk factors. significantly reduce delays in child l The majority (70%) of these [ Identify links with other primary learning and development. Risk hospitalisations were for very health care services. factors include poor environmental- young children aged 0-4 years.
Adult health
Chronic disease prevalence Cancer of the lung, bronchus and l 1.2 times more likely to report Chronic disease refers to long-term trachea was significantly higher (1.4 having cardiovascular diseases. conditions that last for six months times) than the State rate. l 2 times more likely to report having asthma. or more. Prevalence data within the Chronic disease amongst l 2 times more likely to report Midwest population collected during Aboriginal people 2009-2012 by WA population based kidney disease. Available national evidence reports surveys found that: a greater burden and prevalence of Diabetes: Majority have type 2 l One in five adults (21%) reported chronic disease among Aboriginal diabetes. Risk factors include arthritis. people. The demographic factors of being overweight/obese, leading l One in five adults (21%) reported remoteness (isolation) and socio- a sedentary lifestyle and poor an injury requiring medical economic disadvantage of the nutritional intake. treatment. Aboriginal population contribute to Cardiovascular disease: The leading l One in eight adults (12%) reported the significantly greater burden of types are ischaemic heart disease and a currently diagnosed mental disease compared to non-Aboriginal stroke. health problem. people. Research collected from Respiratory disease: The two major l One in eleven (8%) adults had 2011-2013 indicates that compared types being asthma and chronic asthma. to non-Aboriginal people, Aboriginal obstructive pulmonary disease. The top five cancer incidence people were found to be5,6: Kidney disease: Often develops as rates in Midwest from 2008-2012 a complication of other medical l Half as likely to report excellent or were for cancers of the breast, conditions including diabetes, very good health. skin (melanoma), prostate gland, high blood pressure, urinary tract l 3.5 times more likely to report colorectal and lung, bronchus and infections and drug use. trachea. having diabetes. Strategic focus areas that have been Planning outreach teams identified for Aboriginal health planning in the Midwest region are [ Health promotion interventions targeting the prevention and chronic disease particularly diabetes, management of modifiable risk factors for chronic disease. sexual health, child development and [ Consider how services can align with the strategic focus areas of the region. tobacco cessation7. [ Contact major health care providers and discuss how your team could collaboratively work together in service delivery and coordination.
3 ABS 2013. Australian Aboriginal and Torres Strait Islander Health Survey: First Results, Australia, 2012-2013. 4 Closing the Gap Clearinghouse (AIHW and AIFS) 2014. Ear disease in Aboriginal and Torres Strait Islander children. Resource sheet number 35. 5 AIHW 2015. Cardiovascular disease, diabetes and chronic kidney disease – Australian facts: Aboriginal and Torres Strait Islander people. 6 ABS 2013. Australian Aboriginal and Torres Strait Islander Health Survey: First Results, Australia, 2012-2013. 7 Midwest Regional Aboriginal Health Planning Forum data. PAGE 4 Mental health
Health trends Table 4: 2002-2011 youth suicide rates, Midwest residents, 15-24 years. Youth suicides (per 100,000 For 2009-2012, one in eight (12%) Midwest Metro State Midwest adults 16 years and over person)* suffered from a diagnosed mental Males (15-24 years) 20.2 15.6 19.9 health problem, yet only 5% accessed a mental health care service in the last Females (15-24 years) 8.3 5.4 6.0 year. These rates have been age-standardised to the Australian 2001 population. Source: DoH, Health Tracks Prevalence was higher among females than males (15% and 10% congenital brain disorders in males Midwest is markedly higher than the respectively). Aboriginal residents have and alcohol and drug disorders in State youth suicide rate. Table 4 shows reported levels of psychological stress females were both significantly higher the Midwest youth suicide rates by 2.7 times higher than non-Aboriginals in the Midwest than the State. gender during 2002-2011 to preserve on a national level. confidentiality. Youth Suicide: From 2007-2011, Access: Community mental health the female youth suicide rate in the services accessed in the Midwest between 2006 and 2010 were at Planning outreach teams a significantly lower rate than the [ Increase access to mental health services targeting the Midwest female State, primarily for serious psychiatric and Aboriginal population. disorders. Rates for acquired and [ Health promotion interventions for Aboriginal people need to be targeted and culturally appropriate.
Eye health
Eye health conditions are very In 2011-2012, over half (53.7%) Diseases of the eye were the second common in Australia and can of Australians reported having a leading cause of hospitalisations for contribute to disadvantage due to chronic eye condition. In 2013- Midwest residents 65 years and over, childhood learning delays, lower 2014, Aboriginal people had a lower from 2008-2012. participation in education and rate of hospitalisations for cataract employment, and social isolation. extraction as compared to non- Aboriginals (7.3 compared with 8.9 per 1,000 population)8.
Hospitalisations
Regional hospitalisations Table 5: 2008-2012 leading causes of hospitalisation by major category, Midwest residents. Overall, the hospitalisation rate for % of total State Rank Cause of hospitalisation Number Midwest residents was 1.1 times (15-64 yrs) rank higher than the State in 2008-2012, 1 Digestive diseases 114,343 11 1 meaning Midwest residents are hospitalised 10% more often. 2 Injury and poisoning 109,677 7 4 The hospitalisation rate for Aboriginal 3 Neoplasms 109,632 7 2 residents in the Midwest was 2.3 4 Musculo-skeletal diseases 108,562 6 5 times higher than the rate for non- Aboriginals. Renal dialysis accounted 5 Pregnancy and childbirth 107,856 6 6 for 14% of total hospitalisations of All hospitalisations 134,546 100 Midwest residents. Note: leading causes exclude ‘factors influencing health status and contact with health services’ and Table 5 shows the leading causes ‘attending health services for examination and investigation’, reproduction, specific procedures, and of hospitalisation other than renal other circumstances, and potential health hazards related to communicable diseases, socioeconomic and psychosocial circumstances, family and personal history. This also includes renal dialysis. dialysis, by major category. Source: DoH, Health Tracks
8 www.aihw.gov.au/eye-health-cataract-surgery PAGE 5 Hospitalisations
Potentially preventable l Diabetes with its complications l Aboriginal residents had an overall hospitalisations was the leading cause of PPH rate three times greater than Potential preventable hospitalisations PPH for both Aboriginal and non-Aboriginal residents. (PPH) are hospitalisations which non-Aboriginal residents in could have been avoided with disease the Midwest (25% and 18% intervention plans and various respectively). Other conditions are methods of preventative care. Three shown in Figure 2. categories are identified: acute, chronic and vaccine preventable. Figure 2: 2008-2012 leading conditions for potentially preventable hospitalisations, Midwest residents . During 2008-2012, the following trends were observed for PPH in Midwest residents: l PPH accounted for 10,334 (8%) of hospitalisations. This figure was significantly higher when compared to the rest of the State.
Source: DoH, Health Tracks
Major health service providers Major health services
Community and public Mental health and aged Aboriginal Medical Hospital services health services care services Services
l Health Services: Dongara- l Community Health Service l Central West Mental Health l Geraldton Regional Eneabba-Mingenew, Morawa- - Carnarvon, Exmouth, Service – Geraldton Aboriginal Medical Perenjori, North Midlands Geraldton, Meekatharra, l Midwest Community Drug Service (Three Springs), Northampton Morawa-Perenjori, Mount Service Team l Carnarvon Medical Hospital, Mullewa Hospital Magnet, Mullewa, North l Meekatharra Mental Services Aboriginal Midlands l Geraldton Hospital Health Service Corporation l Population Health Unit – l Exmouth Multipurpose l Midwest Aged Care l Ngangganawilli Gascoyne, Geraldton Service Assessment Team Aboriginal Health Service l Carnarvon Multipurpose l Carnarvon Mental Health Service Service l Meekatharra Hospital l Murchison Hostel l St John of God Geraldton l Nazareth Care Hospital l Juniper Hillcrest
Further health service information can be found at www.myhospitals.gov.au and www.ruralhealthaustralia.gov.au.
PAGE 6 Mortality
Mortality is an important population During this period, the leading causes Avoidable mortality health indicator. Knowing the of death in the Midwest region were During 2007-2011, 58% of Midwest reasons for and causes of death can found to be9: resident deaths under the age of 75 assist in the planning of primary l ischaemic heart diseases, lung could have been avoided through the and community care services to cancer, chronic obstructive better use of primary prevention and prevent avoidable mortality. There pulmonary disease, treatment interventions. is still a discrepancy between the cerebrovascular diseases and The avoidable mortality rate for life expectancy of Aboriginal people diabetes including impaired Aboriginal people was 5 times higher when compared to non-Aboriginal glucose regulation. people. Current estimations suggest than for non-Aboriginal people in the that non-Aboriginal people live For Aboriginal residents, the leading Midwest. In 2002-2011, the leading 9 around ten years longer than causes of death were : causes of Aboriginal avoidable deaths Aboriginal people. l ischaemic heart diseases, diabetes were ischaemic heart disease (18%) including impaired glucose and lung cancer (6%). These were Leading causes of death regulation, lung cancer, transport also the leading causes of avoidable The Midwest mortality rate was accidents and cerebrovascular deaths in non-Aboriginal people in significantly higher than the State diseases. 2007-2011, accounting for 12% and rate in 2007-2011. 11% of deaths, respectively.
Planning outreach teams [ Interventions should consider modifiable risk factors for leading causes of avoidable mortality. [ Explore partnerships with existing primary and therapeutic services.
9,10 All mortality and avoidable mortality statistics were sourced from the Department of Health, Health Tracks – Epidemiology Branch (PHI) in collaboration with the Cooperative Research Centre for Spatial Information (CRC-SI). 04.16
PAGE 7