What really matters for our health? Hospital waiting lists, or access to the internet, green space and community connections?
A new survey gives some handy signposts as to how our discussions about health and wellbeing might be usefully broadened.
The VicHealth Indicators Survey, a triennial survey of about 25,000 adult Victorians, was first conducted in 2007 and collects a wide range of information about the social determinants of health.
It is designed to “support the development and use of local community wellbeing indicators as a tool for informed, engaged and integrated community planning and policy making, to improve health outcomes and reduce health inequalities”.
While the report is aimed at local governments developing Municipal Public Health and Wellbeing Plans as required by Victorian legislation, it will no doubt be of interest to Medicare Locals.
In the article below, Dr Mark Ragg profiles the findings from the 2011 survey, and concludes that it is “heartening to see the social determinants of health so well used in a significant piece of research”.
Measures of health
Mark Ragg writes:
Sick of seeing hospital waiting lists used as a proxy measure for health and health system performance? A new report – the VicHealth Indicators Survey 2011 – goes well beyond this.
Declaration of interest up front – we were commissioned by VicHealth to work with them on preparing this report. That over, it throws up some interesting findings.
For example, most retirees have internet access at home. Not as many as those youngsters, of course, but sometimes it’s easy for us to concentrate too much on differences.
The majority of retirees (62 per cent) had access at home, as did the majority of people with disability (72 per cent), the majority of people with low income (70 per cent of those earning less than $20,000 a year) and the majority of people who are unemployed (89 per cent). While there is still a social gradient, online now reaches the great majority of people in our society.
An interesting social gradient exists with alcohol. The indicators looked not at consumption but at purchasing – questions related to ‘did you buy alcohol in the past week?’ and ‘how much did you spend?’.
Alcohol presents here as more of a problem for people with higher levels of income and education, who are employed, and who are not from culturally and linguistically diverse backgrounds. So any campaign to target those at risk from alcohol should be aimed at … well … those most likely to design such a campaign. That would make a change.
But the really interesting part of this report is the breadth of the range of indicators chosen. Obviously, hospital service measures don’t come into it. The usual risk factors – smoking, alcohol and obesity – are there, but dressed differently.
But many of the questions relate to issues beyond what the average person – and keep in mind that our elected representatives are meant to represent the average person – would consider would relate to health.
What proportion of people visit green space regularly? What proportion of people feel safe walking alone in their area during the day, or at night? What proportion of people volunteer regularly? Or have some other form of citizen engagement, be that going to church, attending local council meetings or signing a petition? And what proportion of people attend arts events, or spend time on making arts and crafts?
Others are doing similar work, of course. But it is heartening to see the social determinants of health so well used in a significant piece of research, and to see those social determinants defined so broadly.
• Dr Mark Ragg is director of RaggAhmed (www.raggahmed.com) and Adjunct Senior Lecturer in the School of Public Health at the University of Sydney.