Outreach MIDWEST – POPULATION AND HEALTH SNAPSHOT The Midwest is located in the middle-Western section of Western Australia. The Midwest incorporates four health districts – Gascoyne, Geraldton, Midwest and Murchison. The Midwest encompasses 600,000 square kilometres, making up nearly a quarter of the land mass of the State of Western Australia. The major population centre of the Midwest is the coastal town of Geraldton. The bulk of the population of the Midwest reside on or near the coast. The other main centres are Carnarvon, Dongara, Exmouth, Kalbarri, Meekatharra, Morawa and Mullewa. According to the Accessibility/Remoteness Index of Australia (ARIA), 91% of the Midwest is classified as Very Remote. The Geraldton and Greenough areas are classified as Inner Regional, with the coastal portion classified as Remote. Midwest health services Population The Midwest region incorporates a network of public The estimated regional population of the Midwest in 2016 hospital facilities supported by a range of community- was 64,884, representing 12% of the population of country based services including public health, aged care and Western Australia and 2.5% of the State’s population. mental health services as well as a number of public and There are approximately 0.14 people per square kilometre private health partners and providers. which is lower than the State and rural average (1.0 and 0.24 people per square kilometre respectively). The Geraldton Health Campus is the primary public hospital facility in the Midwest region, supported by the There is a slightly greater proportion of males to females smaller Carnarvon Health Campus. Both hospitals support in the Midwest (51% vs 49%). The Midwest also has a smaller regional hospitals including Dongara, Exmouth, different age structure to the rest of the State, with a Kalbarri, Meekatharra, Morawa, Mullewa, Northampton greater proportion of residents in the 0-14 year age and Three Springs, as well as the region’s remote clinics. bracket and people aged over 40. Figure 1 illustrates the There is one private hospital in the Midwest region which age structure of the Midwest against the rest of Western is located in Geraldton. Australia (see Figure 1 – page 2). There are two Aboriginal Community Controlled Based on the 2015 estimated regional population, Health Services (ACCHSs) in the Midwest region based Aboriginal people account for 13% of the population of in Geraldton and Carnarvon. These services provide the Midwest. This is greater than the State proportion of culturally appropriate services and outreach to the 3.6% and the Western Australian average of 10.4%. The smaller communities in the Midwest. Aboriginal population has a younger age structure than the non-Aboriginal population in the Midwest. 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 listed under Regional Health Profiles PAGE 1 Figure 1 Age structure of the Midwest region OUTREACH SERVICE CONSIDERATIONS • The large proportion of Aboriginal people in the Midwest highlights the need for culturally safe health service provision. • Consider undertaking or updating your cultural awareness and safety training as part of your preparations. • Consider connecting with the Yamatji Aboriginal Health Planning Forum prior to commencing your outreach service. Source: DOH, Health Tracks Measure of disadvantage Table 1 – 2011-2015 top five leading causes of PPH in ages 15-64 years Socio-Economic Indexes for Areas (SEIFA) measures a broad range of determinants of disadvantage. A score of Condition Number % of Rate 1,000 is considered a baseline and scores over or below total vs are considered to represent advantage or disadvantage PPH State respectively. Research has shown that a lower SEIFA score Cellulitis 909 16 2.4 is correlated with increased factors contributing to poor health. Dental conditions 745 13 1.2 Diabetes complications 581 10 1.8 The Midwest Local Government Area (LGA) with the lowest UTIs incl. pyelonephritis 515 9 1.3 SEIFA score was Upper Gascoyne (737) and the greatest was Chapman Valley (1,028). Around 2,500 Midwest Convulsions and epilepsy 428 8 1.7 residents live in an LGA with scores in the lowest 10% of Source: DOH, Health Tracks the State. These LGAs are Meekatharra, Mount Magnet, Murchison, Upper Gascoyne and Wiluna. Mortality Hospitalisations Mortality is an important population health indicator. Knowing the reasons for and causes of death can assist The overall hospitalisation rate in the Midwest was in the planning of health services to prevent and avoid greater (1.2 times) than the State. The main causes of mortality where possible. hospitalisation for Midwest residents was digestive diseases (11%) followed by pregnancy and childbirth (8%), There is a demonstrable gap in life expectancy between and injury and poisoning (8%). rural Western Australia and metropolitan Perth. This gap increases the more remotely a person lives. Potentially preventable hospitalisations In the Midwest, rates of potentially preventable There is also a discrepancy between the life expectancy hospitalisations (PPH) were 40% greater than the rest of Aboriginal and non-Aboriginal people in Australia. This of Western Australia across all categories (vaccine gap is estimated by the Australian Bureau of Statistics to preventable, acute and chronic conditions). Table 1 be 8.6 years for males (71.6 years life expectancy) and 7.8 represents the leading causes of PPH during the period years for females (75.6 years life expectancy)1. 2011-2015. Rates of PPH in Aboriginal people were similar to the State rate for Aboriginal people. However, these rates were much greater when compared to PPH in non-Aboriginal residents of the Midwest. PAGE 2 1 ABS, Life Tales for Aboriginal and Torres Strait Islander Australians, 2015-2017 In the Midwest during the period 2011-2015, the mortality Child and adolescent health rate was greater than the rest of the State (rate ratio of 1.1). The top five leading causes of death are described in Low birth weight Table 2. Low birth weight is defined by the World Health Organisation as less than 2,500 grams. From the period Table 2 – 2011-2015 Midwest leading causes of 2007-2008 to 2015-2016, the proportion of low birth mortality weight full-term babies born to mothers in the Midwest was similar to the rest of the State (2.7% and 2.0% Condition % of all Rate respectively). The proportion was greater amongst deaths ratio Aboriginal babies (5.2%) which was similar to the State Ischaemic heart disease 13 1.2 rate (5.1%). Lung cancer 7 1.4 Australian Early Development Census COPD 5 1.4 The Australian Early Development Census (AEDC) is a measure of how children are developing across five Cerebrovascular diseases 4 0.7 domains upon commencing full-time school. These Diabetes and impaired glucose 4 1.5 domains are physical health and wellbeing, social regulation competence, emotional maturity, language and cognitive skills, communication skills and general knowledge. For Source: DOH, Health Tracks more information on the AEDC, visit https://www.aedc. More than half of all deaths in the Midwest during the gov.au/about-the-aedc. period 2011-2015 were considered to be avoidable (54%). Within the Midwest, proportions of developmentally Avoidable mortality occurred at a rate 1.4 times greater in vulnerable children in one or more domains ranged the Midwest than the rest of the State. Table 3 shows the from 12% in Irwin to 30% in Carnarvon. The proportion causes and rate ratios of the top five causes of avoidable of developmentally vulnerable children in two or mortality in the Midwest. more domains ranged from 0% in Morawa to 17.5% in Table 3 – 2011-2015 Midwest leading causes of Carnarvon. Table 4 shows the AEDC scores of LGAs in the avoidable mortality Midwest. Condition % of all Rate Table 4 – 2015 Midwest AEDC scores deaths ratio Community Vulnerable children Total surveyed Ischaemic heart disease 20 1.5 One or Two or Suicide and self-inflicted injuries 11 1.4 more more domains domains Transport accidents 10 2.6 # % # % Colorectal cancer 6 1.4 Carnarvon 24 30 14 17.5 80 Cerebrovascular diseases 6 1.5 Chapman Valley 2 12.5 1 6.25 16 Source: DOH, Health Tracks Exmouth 9 22 5 12.2 41 Geraldton- 145 27 76 14.1 538 Greenough OUTREACH SERVICE CONSIDERATIONS Irwin 4 12.1 1 3.33 33 • Screening and prevention activities can help to Morawa 2 12.5 0 0 16 reduce the rate of avoidable mortality. Northampton 10 27 5 13.5 37 • Interventions should target modifiable risk factors for leading causes of avoidable mortality. Australia 22.0 11.1 • Drive safely, ensuring you take regular breaks when Source: DOH, Health Tracks travelling on Midwest roads. PAGE 3 Immunisation Chronic diseases in Aboriginal people The Australian target for immunisation is a rate of greater In 2018-2019, 46% of Aboriginal people reported having at than 90% of children with a complete vaccination least one chronic disease that posed a significant health schedule at two years of age, with the recommendation problem. This represents an increase of 6% since 2012- that 100% of children are vaccinated at the age of school 20133. entry. National evidence reports a greater burden and In the Midwest in 2017, the proportion of all children prevalence of chronic disease among Aboriginal vaccinated exceeded the target of 90% with the exception people when compared to non-Aboriginal people. The of Aboriginal children in the 12 to 27-month age group. demographic factors of remoteness (isolation) and socio- Table 5 describes the immunisation status of children in economic disadvantage of the Aboriginal population the Midwest.