ACKNOWLEDGEMENTS Goulburn Valley Medicare Local gratefully acknowledges the contribution of the following: Strategic Leadership Group Members GVML Board Members Focus Group Participants Ms Georgia Von Guttner (Chair) Mr Phillip Bain Mr Soenke Tremper Ms Leigh Rhode Ms Faye Hosie Ms Kim Fitzgerald Ms Janet Chapman Ms Suzanne Miller Mr David Jobling Dr Susan Furphy Mr Michael Hall Dr Satpal Singh Mr Kevin Boote Mr Charles Furphy Ms Felicia Dean Ms Suzanne Miller Ms Georgia Von Guttner Rumbalara Playgroup UnitingCare Cutting Edge Multicultural Playgroup Australian Breast Feeding Association Diversity and PFLAG RIAC Youth Advocacy Group Yarrawonga Friends of the Library Nathalia Women s Health Support Group Cobram Iraqi Women and Girls Swimming Group Mitchell Shire Youth Council Kilmore Men s Shed Violet Town Community Garden Working Bee Nagambie Senior Citizens Survey Respondents All 230 plus respondents Medicare Locals also gratefully acknowledge the financial and other support from the Australian Government Department of Health. 2
INDEX ACKNOWLEDGEMENTS... 2 THE PRIORITIES... 3 EXECUTIVE SUMMARY... 3 GOVERNANCE... 5 BACKGROUND RESOURCES... 5 THE PROCESS... 6 Population health profile... 8 Policy priorities... 10 Community and service provider consultation... 12 Triangulate results... 14 Ranking priorities... 16 ASSESSMENT PROCESS... 16 THE PRIORITIES... 17 THE PRIORITIES Obesity Diabetes Healthy Ageing Mental Health Smoking, Alcohol and Drugs 3
EXECUTIVE SUMMARY Goulburn Valley Medicare Local (GVML) completed a comprehensive assessment of the health needs of our communities to inform GVML of the priorities to direct programs planning, delivery and investment towards for the next one to three years. This was a requirement of the Commonwealth Department of Health. The Comprehensive Needs Assessment 2014 report was submitted to the Department and approved in June 2014. The GVML Interim Needs Assessment 2012-2013 provided an important baseline to commence the comprehensive needs assessment process as it had established a very real picture of our population and its health challenges. Elaborating on this, background documents were prepared including an in-depth Population Health Profile Report, drawing together quantitative evidence of our communities demographic trends, health status and health outcomes and resulting in 24 potential priorities being identified as meaningful in the context of local health needs, thus providing a platform for community consultation and stakeholder engagement. The categories for consideration were diverse, some being conditions/illnesses/states (e.g. heart disease, kidney disease, suicide), some risk factors (e.g. alcohol and other drugs) and others selective groups within the population (e.g. Women s Health and Men s Health). Consultation, through surveys and focus groups provided valuable additional quantitative and qualitative data on how community members and service providers prioritised these within their communities. The quantitative and qualitative data and National, State, Regional and Local policy priorities were triangulated resulting in the 24 categories being shortlisted to nine potential priorities. These were: mental health; diabetes; healthy ageing; children and young people s health; access to services; obesity; Aboriginal and Torres Strait Islander People s health; smoking, drugs and alcohol; and suicide. The Strategic Leadership Group, formed to govern the assessment process, agreed that the nine shortlisted issues/needs were all worthy of consideration. During the final priority setting meeting, the group assessed, scored and ranked the nine issues against criteria such as severity, consistency with health policy, available resources and amenability to change, resulting in a ranking in the following order, from highest to lowest Obesity; Diabetes; Healthy Ageing; Mental Health; Smoking, Drugs and Alcohol; Aboriginal and Torres Strait Islander People; Access to Services; Children and Young People s Health; Suicide. It was recognised that the four shortlisted priorities which were later eliminated aligned with several of the final priorities. The Strategic Leadership Group considered that while there was evidence identifying an issue or need for Children and Young People s Health, Aboriginal and Torres Strait Islander People, Access to Services and Suicide; they could also be addressed as sub-groups within the key priorities. With approval from the Board of Goulburn Valley Medicare Local, Obesity; Diabetes; Healthy Ageing; Mental Health; Smoking, Alcohol and Other Drugs were confirmed as the immediate priorities to inform our annual plan and focus our program planning, delivery and funding investment for the next twelve months. 4
GOVERNANCE A Strategic Leadership Group was formed early in the assessment process to provide oversight and direction to the activities undertaken. Eight Strategic Leadership Group members were chosen for their expertise in and knowledge of: health service planning and research the differing levels and approaches within the health and community service sectors, i.e. prevention, early intervention, postvention/health and/or promotion/primary care/tertiary care geographic representation from across the GVML catchment connection and/or access to networks and expertise BACKGROUND RESOURCES A range of background resources were prepared to inform and complete the Comprehensive Needs Assessment 2014-17. These can be found on our website www.gvml.com.au and include the following CNA Report as submitted to the Department of Health Interim Needs Assessment 2012-13 Goulburn Valley Population Health Profile summary table Goulburn Valley Population Health Profile Survey Summary Report Community Survey Summary Report Service Providers Focus Group Summary Report Assessment resources for nine short listed priorities 5
THE PROCESS The Commonwealth Department of Health provided Medicare Locals with a framework and detailed guidelines to assist them in completing the Comprehensive Needs Assessment. While the process completed was intensive, the key points are summarised in this document, providing a snapshot. Following completion of the Comprehensive Needs Assessment 2014, GVML developed its Annual Plan determining the activities it would direct resourcing and funding towards to address the health priorities and service gaps identified as a result of this assessment. Develop a population health profile Consider identified policy priorities Community and service provider consultation Triangulate results to shortlist priorities Establish priorities 6
KEY ASSESSMENT ASPECTS Population health profile Developed a local population health profile and collated other background reports Identified health inequalities and demographic trends Comparisons to Victorian average to assess health status Policy priorities National, State and Local Government policy Regional health plans Local agency and community health plans Community and service provider consultation Survey community members Survey service providers Focus groups with special interest groups Triangulate results Qualitative data Quantitative data Health policy Shortlisted from 24 categories to nine priorities Ranking priorities Assessment and ranking of nine priorities Agreement on top five priorities 7 Goulburn Valley Population Distribution at 2011
% PROJECTED CHANGE Population health profile Goulburn Valley Population Distribution at 2011 Greater Shepparton 61,737 Mitchell 35,092 Moira 28,435 AGE DISTRIBUTION COMPARISONS as at 2011 100% age 85+ 90% age 70-84 80% Murrindindi 13,174 Strathbogie 9,622 TOTAL 148,060 70% 60% age 60-69 age 50-59 PROJECTED POPULATION GROWTH 50% age 35-49 25 20 15 10 Annual % change 2026-2031 Annual % change 2021-2026 Annual % change 2016-2021 Annual % change 2011-2016 40% 30% 20% 10% age 25-34 age 15-24 age 5-14 age 0-4 0% 5 0 8
Moira Male life expectancy - ranks 3 rd lowest in Victoria Persons at risk of short-term harm from alcohol consumption - ranks 3rd highest in Vic. Male Smokers ranks highest in Vic. Overweight or Obese persons 59.2% -ranks 3rd highest in Vic Higher than average percentage with high level of psychological stress Greater Shepparton Diversity population- 15.7% of residents born overseas Aboriginal and Torres Strait Islander population - 3 rd highest % in Vic Overweight or Obese persons 53.3% Significantly high proportion of drug use/possession offences Crystal Methamphetamine (Ice) associated ambulance attendances rose from 8.1 per 100,000 population in 2011/12 to 21.6 per 100,000 population in 2012/13 Rank highest regional Vic LGA for ambulance attendances for other amphetamines. 26.9% smoked during pregnancy Higher than average percentage with high level of psychological stress and registered mental health clients Ranked 3rd lowest for % people reporting feeling safe going out at night Strathbogie A quarter of Strathbogie s population is 65 or older Its population has not grown in the last decade Ranks 2 nd in Vic for persons at risk of short-term harm from alcohol consumption Babies born with low birth weight, 2nd highest in State Diabetes (all types) 6.9% of population Overweight or Obese persons 57.5% Ranked highest in Vic for % of persons reporting symptoms of asthma Significantly high number diagnosed with malignant cancers Mitchell Fastest growing LGA in Victoria Significantly young population Ranks highest in Vic - % persons who do not meet physical activity guidelines Overweight or Obese persons - 56.3% Higher than average family violence incidents Higher than average percentage with high level of psychological stress Murrindindi Growth in diabetes (all types) 2001 to 2011 246.9% Overweight or Obese persons 56.9% Ranked 2nd in Vic for % of persons reporting symptoms of asthma A person diagnosed with malignant cancers is almost. 50% higher than Vic average Ranked 3 rd highest in Vic for avoidable deaths (per 1,000) due to cancer See GVML s Population Health Profile for sources and further details 9
Policy priorities The funding and delivery of health care in Australia is a shared responsibility amongst many players. The GVML needs to make sure its proposed priorities are as far as possible, compatible with current policies and strategies at each level of government and those of other key players in the Australian health system. In addition to National, State and Local Government policies, legislation and plans, sectoral and regional initiatives and programs may all be relevant. This understanding is an essential basis for the GVML s activities in support of its goal of helping achieve better coordination and integration of all health services It should be noted that the priorities and plans developed at each layer of policy responsibility do not necessarily neatly overlap. However the National and State Government reform agenda and priorities strongly influence the planning and priorities adopted at other levels. National Policy State Policy Rural Health and Program Policy Hume Region Health Plans Regional Plans Municipal Health Plans PCP Priorites Agency Plans 10
Australian National Health Priorities Arthritis and musculoskeletal conditions Asthma Cancer control Cardiovascular health Diabetes mellitus Injury prevention and control Mental health Obesity Dementia Victorian Public Health and Wellbeing Plan 2011-15 Priorities Increasing healthy eating Increasing physical activity Controlling tobacco use Improving oral health Reducing misuse of alcohol and drugs Promoting sexual and reproductive health Promoting mental health Preventing injury Preventing skin cancer Hume Region Health Plans Health and Aged Care Plan 2013-2018 Closing the Health Gap Implementation Plan 2009-13 Hume Region Chronic Care Strategy 2012-22 Health Promotion Strategy 2012-15 Hume Region Integrated Aged Care Plan 2010-2015 Integrated Oral Health Plan 2010-13 Sub-Acute Service Development & Implementation Plan 2010 11
Community and service provider consultation Consultation was undertaken with community members and service providers across the catchment, with more than 400 individuals engaged through surveys and focus groups. Feedback sought was centred on the priorities identified in the Interim Needs Assessment 2012-13, being mental health; diabetes; ageing; children and young people s health; access to services; however an additional 19 other key areas of need were identified and included in the consultation. Two surveys were circulated, one targeting community members and one seeking feedback from service providers. To enable more in depth consultation, twelve focus groups were conducted across the catchment, engaging a cross section of ages and included males and females. The surveys and focus groups enabled GVML to collect viewpoints from a cross section of our diverse communities, which informed our assessment of health priorities and service needs and gaps. Community Survey - Geographic Coverage Local Government Area % of Respondents No of Respondents Greater Shepparton 43.04% 99 Moira 9.13% 21 Strathbogie 26.52% 61 Murrindindi 10.87% 25 Mitchell 10.43% 24 Total 230 Service Type Service Provider Survey Service Coverage % of Respondents No of Respondents Public Health Provider 25.84% 23 Private Health Service Provider 13.48% 12 Community Based Service Provider 31.46% 28 Local Government 13.48% 12 State Government 6.74% 6 Australian Government 2.25% 2 Other Service Provider 6.74% 6 Total 89 12
FOCUS GROUPS ENGAGED The key population needs and issues included Mental Health Diabetes Ageing Children and Young People s Health Access to Services Chronic Obstructive Pulmonary Disease Asthma Smoking, Alcohol and Other Drugs Dental Health Ischaemic Health Disease Lung Cancer Colorectal Cancer Skin Cancer Other Cancers Suicide Kidney Disease Arthritis Men s Health Women s Health Aboriginal And Torres Strait Islander People s Health Refugee s Health Obesity Dementia Injury Prevention and Control Rumbalara Playgroup UnitingCare Cutting Edge Multicultural Playgroup Australian Breast Feeding Association Diversity and PFLAG Moira Youth Council Kilmore Men's Shed Violet Town Community Garden Working Bee Nagambie Senior Citizens RIAC Youth Advocacy Group Yarrawonga Friends of the Library Nathalia Women's Health Support Group Women with children 18-40 years 8 Females Women with children 18-40 years and grandmother 9 Females Women with children 18-45 4 Females 18 60 years 5 Females, 4 Males 16-18 years 3 Females, 3 Males 45-75 years 23 Males 12-90 years 11 Females, 4 Males 55-90 years 8 Females, 12 Males 18-40 years 5 Females, 2 Males 45-70 years 5 Females, 1 Male 50-70 years 9 Females Cobram Iraqi Women and Girl's Swimming Group 12-55 years 18 Females 13
Triangulate results The principle underlying triangulation is a simple one: adopting a multi-pronged approach is more likely to enable a true picture of the real health needs of the region to emerge. Initially 24 potential priority areas were selected based on a review of quantitative data of our local health status and reflecting Federal, State, Regional and Local policy priorities. The 24 potential priorities were the basis for consultation with service providers and community members enabling the collection of feedback. Each category was applied to a matrix, identifying its representation in policy, qualitative and quantitative data to illustrate the more prevalent areas enabled the shortlisting of nine possible priorities. Qualitative Data Stakeholder feedback Quantitative Data Population data, service and program profiles PRIORITY AREAS Policy Direction Government and other key strategic framework 14
Mental Health Psychological distress: Greater Shepparton is highest (14.8%) in GVML and rated 10 th of LGA s. Other LGA s rated lower than Rural Vic (11.5%) and Victoria (11.4%) with Strathbogie lowest (8.1%) Registered mental health clients per 1,000 populations: All LGA s in GVML have a higher rate than Vic (10.3%) and 3x LGA s higher than Rural Vic (14.4%) Greater Shepparton highest (17.7%) followed by Strathbogie (16.4%) and Moira (14.8%). Other LGA s (14%) Diabetes Type 2 (2008) lower than Vic & Rural Vic 4.8% with exception Mitchell 5%. Lowest Murrindindi 3.3% All Types (2011) All LGA s higher than Vic (4.5%) with exception of Mitchell slightly lower (4.4%). Highest Strathbogie (6.9%) followed by Moira (6.3%). Highest growth for 2001-11 was Murrindindi (246.9%). Lowest growth is Strathbogie (160.3%). In 2011 Greater Shepparton has 3.9 cases diagnosed per week, followed by Moira 2.3 cases. Lowest Strathbogie, 0.8 cases per week. PIP services increased by 589 from 2009-10 to 1,979 in 2011-12. Diabetes Education and Dietetics Services increased by 677 from 2009-10 to 1,932 in 2011-12. Also refer to ATSI section Healthy Ageing The GVML catchment has a much higher proportion of older people (65+) than Hume (2011:16.5% - 2021:20.3%) or Victoria (14% - 16.7) and this proportion will be significantly higher by 2021 Strathbogie (25% - 31.2%), Moira (21.2% - 25.4%), Murrindindi (18.5% - 23.6%). Greater Shepparton (14.6% - 18.7%) will remain below the Hume rate Mitchell will remain constant at 12.9%, Children s and Young People s Health Mitchell (21.7%) and Greater Shepparton (21.1%) have a higher proportion of 0-14 year olds than other GVML LGA s and Hume (19.7%) and Vic (18.2%) Moira and Murrindindi are slightly lower. Strathbogie (15.7%) There is a similar pattern for 15-24 year olds, however proportion of the population is smaller (9.4% - 14.2%) Hume (12.5%) and Vic (13.9%) Population projection 2021: Mitchell increase to 22.9%. In all other LGA s proportion of 0-14 years will decrease. Mitchell and GS higher than Hume (18.7%) and Vic (18.0%) Proportion of 15-24 year olds will decrease in all LGA s with Mitchell and Hume slightly higher than Hume (11.5%) and Vic (12.4%) Suicide In the period 2006-2010 (NB: most recent data) Shepparton (8) had highest rate of intentional injuries treated in hospital per 1,000 populations which is significantly higher than Rural Vic (4.8) and Vic (3.8). There is a significantly higher proportion of suicides per 100,000 in the GVML (17.9) compared with Rural Vic (14.3) and Vic (12.0). Murrindindi East has highest rate (24.2) followed by Strathbogie (18.0) with the exception of Murrindindi West (6.0) all other areas within the catchment are higher than Rural Vic. Suicide is the 14th leading cause of all deaths in Australia at a rate of 11.0 per 100,000 populations in 2012 Obesity All GVML LGA s higher than Rural Vic (54.2%) and Vic (48.6%) Highest is Moira (59.2%), Strathbogie (57.5%), Murrindindi (56.9%), Mitchell (56.3%) & GS (53.3%). Moira ranked 3 rd most obese LGA in Vic. Males in GVML LGA s higher than females and Rural Vic (61.7%) and Vic (57.2%). 70.3% males in Moira obese. Other LGA s between 64.9% and 61.6% Females in GVML LGA s, with exception of GS (42.4%) which is higher than Rural Vic (47.0%) and Vic (40.3%). Mitchell and Murrindindi between Strathbogie (51.5%) and Moira (48.7%), It is anticipated that increases in the prevalence of overweight and/or obesity of between 0.4% and 0.8% per year, such that by 2025. 83% of males and 75% of females aged 20 years and older will be overweight and/or obese Smoking, Alcohol and other Drugs GS (8.7) has a higher proportion of D&A clients per 1,000 pop than other GVML LGA s and rural Vic (6.8). Mitchell is consistent with rural. Moira (5.5), Strathbogie (4.4), Murrindindi (3.3) GS (5.8) has a significantly higher rate of drug use/possession than rural Vic (2.9). Mitchell & Moira consistent with Rural Vic and Strathbogie and Murrindindi lower (2.4). Offences per 1000 population were consistent with this pattern. Murrindindi (19.6%) only LGA with male smoking rate lower than rural Vic (22%). Moira (33%.8%) and GS (28.8%) are significantly higher. In all LGA s, with exception of Murrindindi (18%) the smoking rate of women was higher than rural Vic (19.1%) with highest being Strathbogie (22.5%). Aboriginal and Torres Strait Islander People 3,291 ATSI in catchment, largest proportion in GS where reported 3.63% of the population, this is 3 rd highest LGA in state, followed by Moira (1.48%) and Mitchell (1.23%). The age profile is significantly different from the population as a whole. In all GVML LGA s with the exception of Murrindindi (18.63%) on or about one third of the ATSI population is 0-14 years of age. People 15-24 years represent between 14% (Murrindindi) and 24% (Strathbogie) of the population, more than double the population as a whole. Between 19% (Strathbogie) and 25% (Murrindindi) of the population are 25-44 years which is similar to the population as a whole. Those over 50 years are considered in the term older Australians. GS (14.64%) has the lowest proportion and Murrindindi (34.31%) has the highest proportion of their ATSI population in this cohort Access to Services GVML rural populations generally have poorer health than their metropolitan counterparts. Mitchell (0.14 per 1,000 pop), Moira (0.11) and Strathbogie (0.10) have limited access to dentists compared with rural Victorian (0.16) and Victoria (0.21). Additionally, Greater Shepparton (0.45) and Mitchell (0.57) have significantly fewer allied health professionals than Rural Victoria (0.67), with Moira (0.67) consistent with Rural Victoria and Murrindindi (0.76) and Strathbogie (0.73) significantly higher. However, these rates are significantly lower than in capital cities where there are 3.54 per 100,000. 15
Ranking priorities The shortlisted nine potential priorities were considered by the Strategic Leadership Group and assessed using a modification of the Department of Health Hume Region Regional Health Promotion Strategy: Health Promotion Decision Making Tool. This enabled ranking of the priorities in the following order, with the top five recommended for adoption as the final priorities of the Comprehensive Needs Assessment. 1. Obesity 2. Diabetes 3. Mental Health 4. Healthy Ageing 5. Smoking Alcohol and other Drugs 6. Access to Services 7. Aboriginal and Torres Strait Islander People 8. Children and Young People s Health 9. Suicide Prevalence Consistent with health policy Severity Selectivity Amenability to change Partnerships and Opportunities Resources ASSESSMENT PROCESS Is the problem widely experienced? (Taking into account National, State and Local levels) Does the priority correlate with National and State priorities What are the costs in terms of life expectancy or quality of life? Does the issue affect one group in particular, and does that group suffer other disadvantages? Is it known that interventions have succeeded with this problem? (Evidence to support action? /There is a cost benefit rationale to act?) - Financial cost of not addressing the problem Will the strategy be accepted by the target population? Is there community capacity to identify issues, to have access to the system and to mount/respond to potential interventions? Is there community resilience or ability to accommodate and respond to changes in the environment? Are other agencies already working on this? If so, why would we also want to set it as a priority? Does the priority provide an opportunity to build on and sustain existing partnerships? Does the priority provide an opportunity to create new partnerships? Does the priority provide opportunities to attract additional resources? Do GVML and the sector have the capacity to act on this priority? Is it achievable and realistic within the resources that we have i.e. financial, workforce, and infrastructure? 16
The Strategic Leadership Group considered that while there was evidence identifying an issue or need for Children and Young People s Health, Aboriginal and Torres Strait Islander People, Access to Services and Suicide; they could also be addressed as sub-groups within the key priorities. This would occur for example by targeting diabetes preventative programs at Aboriginal and Torres Strait Islander People and families of children and young people. Closing the Gap and Care Coordination and Supplementary Services programs also ensure GVML is proactive in improving outcomes for Aboriginal and Torres Strait Islander People. GVML provides mental health services through its Navigating Life services, which enables initiatives which also focus on these sub-groups and suicide prevention. Access to services realistically is an element attached to all program planning and delivery. So while they may not have ranked in the top five adopted priorities, Goulburn Valley Medicare Local is still able to give valid attention to these omitted priority areas as an aspect of program planning and delivery. THE PRIORITIES Obesity Diabetes Healthy Ageing Mental Health Smoking, Alcohol and Drugs Consequently, the Strategic Leadership Group were confident when endorsing the five selected priorities and making recommendation to GVML s Board to adopt these priorities and allocate resources accordingly within the GVML Annual Plan 2014-15. 17