Social Determinants of Health

The social determinants of health are strongly influenced and shaped by the access to income, education and resources that women have access to. They drive the health and wellbeing of women and we need to understand these to undertake health promotion and primary prevention in the Southern Metropolitan Region (SMR).

Population

Analysis of population data from the region tells us that the SMR is highly dynamic and diverse. As can be seen in the chart below, growth and economic projections from local Councils further indicate that this change will not decline but rather, increase from approximately 1.573M residents in 2018 across all 10 LGAs to 2.103M in 2036 (State of Victoria, 2019).

Economy

Australian Bureau of Statistics data (2019) data shows that as of June 30, 2018, there were 157,918 businesses across all sectors in the 10 LGAs making up WHISE’s region. As can be seen in the chart below, Casey had 14% (n = 22,310) and Port Phillip had 13% (n = 21,216) of those businesses with the other LGAs having a reasonably consistent distribution.

As can be seen in the chart below, ABS (2019) data shows that in 2018, the region’s biggest industries were:

1. Construction
2. Professional, scientific and technical services
3. Rental, hiring and real estate
4. Financial and insurance
5. Transport, postal and warehousing

These industries employed approximately 391,559 people (ABS, 2021). As can be seen in the chart below, ABS (2021) data shows that the industries with the greatest employment in the SMR are:

1. Health care and social assistance
2. Manufacturing
3. Retail industry
4. Education and training
5. Construction

What is most important to note, however, is the variability in employment across the region.

Given that primary prevention activity occurs across a range of settings and is long-term behavioural and cultural work responding to the social determinants of health, it is useful to consider the forecasts for employment (and workplaces) in the next 5 to 10 years.

Every year, the Federal Government’s Department of Jobs and Small Business produces a set of employment projections for Australia’s regions (Statistical Area level 4) based on ANZIC industry classifications. These projections provide a guide to the future direction of the labour market (Department of Jobs and Small Business, 2021).

According to the employment growth projections to May 2024 for the SMR, education and training (35.2%) and professional, scientific and technical services (33.2%) will grow while mining (-12.1%) and information media and telecommunications (-4.1%) will decline (Department of Jobs and Small Business, 2021).

Socio-economic advantage/disadvantage

The SMR consists of contrasting socio-economic statuses. At one end of the spectrum, for example, Greater Dandenong is one of the most disadvantaged areas in Victoria with a median income of $799 per week for persons over the age of 15 at (see the chart below; ABS, 2018). In contrast, Bayside’s median income for the same grouping is $1,119 and is one of the least disadvantaged areas in the country.

According to the Socio Economic Index for Areas (SEIFA), Greater Dandenong is ranked as the second most disadvantaged municipality within Victoria (see chart below; ABS, 2018). Within Australia, Greater Dandenong is ranked in the lowest 10% of municipalities in terms of disadvantage. On the other end of the socio-economic spectrum, four of the 10 municipalities within the SMR are ranked in the top 10% of least disadvantage within Victoria and Australia (ABS, 2018).

Poverty is defined as “not having enough available income to afford life’s necessities” (Women’s Health Victoria, 2021).

The chart below displays the proportion of females and males aged 15 years and over who live in households with a disposable income of less than $353.45 per week (Women’s Health Victoria, 2021). As can be seen, Greater Dandenong have the greatest percentage of both males and females who live in poverty. In each LGA (and indeed, Victoria-wide), more females than males live in poverty. Bayside has the lowest proportion of people living in poverty.

In the Victorian Population Health Survey, 2020 (State of Victoria, 2021), poverty was measured by asking whether respondents had run out of money to buy food in the last 12 months. The responses are displayed in the chart below. In Bayside, 2.4% of respondents reported running out of money to buy food in the last 12 months which is statistically significantly lower than the Victorian estimate of 5.9%. The estimated 12.9% in Greater Dandenong is statistically significantly higher than the Victorian estimate. These trends are consistent with the income reports in the chart above. Note that estimates were not provided for Glen Eira or Stonnington.

As can be seen in the chart below, homelessness is a significant issue within the SMR. The LGAs of Greater Dandenong, Port Phillip and Casey are shown to have the highest rates of homeless persons enumerated as part of the 2016 Census (ABS, 2018).

Data from the 2016 Census also revealed that between 2011 and 2016, an increase in the number of homeless persons within the SMR was seen with the exception of Stonnington, Port Phillip and Bayside which saw a decrease of approximately 20%. Cardinia saw the biggest increase in the number of homeless persons, with a 52% increase, followed by Casey (37%), Glen Eira (30%) and Greater Dandenong (28%; ABS, 2018).

A disproportionately higher number of women experience housing instability and homelessness than men, but they are less visible as they are less likely to sleep on the streets. For example, in 2019-2020, the Australian Institute of Health and Welfare (2020) reported that 60% of clients who accessed specialised homelessness services were female. Moreover, the two leading contributing factors to homelessness affect women significantly more than men:

1. Domestic and family violence is predominantly experienced by women and children (Ponic, et al., 2011) and leads to difficulties with maintaining housing, paying mortgages, bills or rent, or having to live in temporary accommodations with family and/or friends (Kushel, et al., 2006).
2. Older women (meaning, women aged 55 and over) in Australia have a greater risk of housing insecurity and homelessness than their male counterparts and this is tightly bound to their experiences of financial insecurity (The National Older Women’s Housing and Homelessness Working Group, 2018).

Recent data shows that homelessness among older Australian women increased by 31% between 2011 and 2016 (Women’s Agenda, 2019). Meanwhile, in Victoria, the same time period saw a staggering increase of 40% (ABS, 2018).

The chart below shows the rates of homelessness in the SMR among females in 2019. As can be seen, Frankston, Port Phillip and Greater Dandenong have the largest rates of homelessness per 10,000 population for females.

Women who leave their homes due to domestic and family violence often find it difficult to secure suitable accommodation (ANROWS, 2019). For example, research has found that more than 90% of first requests by victim survivors to Specialist Homelessness Services for long-term accommodation are unable to be met and nearly 60% of women report experiencing housing stress (ANROWS, 2019).

According to the Australian Institute of Health and Welfare (2019), between 2016-17 and 2017-18, an increase of 10.7% was seen in Victoria in the rate of people seeking support for insecure housing or homelessness because of domestic and family violence (see the chart below).  This is a significantly higher increase than that observed across Australia (3.8%).

Family

There are a significant number of single-parent households in the SMR. Frankston (12.8%) and Greater Dandenong (11.2%) have the highest proportions of single-parent households with dependent children in the SMR (ABS, 2018). As can be seen in the chart below, they are predominantly female headed with most LGAs having around 82% as female headed households which is in comparison to around 17.6% being male headed (Women’s Health Victoria, 2021).

Diversity

In 2016, the total Indigenous population was approximately 7,200 within the SMR (Greater Dandenong, 2018). While this number is not as substantial as found in other parts of Victoria, this still represents a large proportion of those living in the SMR. As can be seen in the chart below, the LGAs of Frankston, Mornington Peninsula, Cardinia and Casey had the highest numbers of Indigenous Australians. Casey had 1,616, Frankston had 1,338 and Mornington Peninsula had 1,304 Indigenous Australians (Greater Dandenong, 2018).

The SMR is an ethnically diverse region. The chart below shows that Greater Dandenong (64.2%), Casey (43.9%) and Port Phillip (42.1%) have the greatest proportions of overseas born communities (Greater Dandenong, 2018).

Within Greater Dandenong, the top countries of birth include Vietnam (8.7%), India (8.2%), Cambodia (4.5%) and Sri Lanka (4.2%). The top countries of birth in Casey are varied and include India (6.0%), Sri Lanka (3.8%), the UK (3.8%) and Afghanistan (2.8%). Within Port Phillip, the top countries of birth are the UK (7.1%), New Zealand (3.0%), India (2.0%) and China (1.8%; Greater Dandenong, 2018).

The different ethnic communities living in Greater Dandenong and Port Phillip reflects the relative affluence (or lack of) of particular overseas born communities. It also prompts consideration of the different reasons for migrating to Australia. Greater Dandenong, for example, has 1,056 (21.2%) asylum seekers (people fleeing war and persecution) which is the largest population in Victoria; while migrants in Port Phillip are more likely to have relocated to Australia for lifestyle choices and to access higher education.

According to the ABS (2018), in 2015, almost one in five people (18.3%) had a disability in Australia. Within the SMR, the percentage of people living with a severe or profound disability varies across its municipalities.

Research into the causal factors and experiences of violence against people with a disability is lacking. Women with Disabilities Victoria (2017) have stated that violence against women with a disability, in particular, is not well understood and often ignored or under-reported. A review of the literature on violence against women with disabilities revealed that there is a need for “more robust data collection and consideration of risks for women with disabilities and different sectors of service provision. In Australia and Victoria there are limited sources of correlated data that provide accurate information about the prevalence of violence against girls and women with disability” (Women with Disabilities Victoria, 2017, p. 12).

Carers are defined as “persons who provide unpaid care for someone with a disability” (ABS, 2018). Across the SMR, significant numbers of individuals are carers (Greater Dandenong, 2018). For example, in Port Phillip, 9.8% of the population are defined as carers. In Frankston, the percentage is 12.5% and in Greater Dandenong, the rate is 11.5%. In actual numbers, the SMR has a total population of 129,243 carers.

Interestingly, and perhaps not surprisingly, carers are predominantly female across all LGAs. As can be seen in the chart below, data from the Census (ABS, 2020) shows that of the total number of carers in each LGA, a greater proportion of women than men undertake this work. Cardinia and Mornington Peninsula have the highest proportions of female carers (both 62.4%) and Greater Dandenong has the most male carers (42.9%).

Young people within the SMR represent a large proportion of the population. As can be seen in the chart below, both Cardinia and Casey, in particular, have substantial populations in the 0-14 year bracket (Greater Dandenong, 2018). These two LGAs also encompass large numbers within the 15-24 year bracket. Although not as substantial as that of the 0-14 year bracket, these statistics highlight the significant presence of young people. As two of the fastest growing regions in Victoria, the growth corridors of Cardinia and Casey have attracted large numbers of young families as evidenced in the data.

Accurately measuring the number of people who are LGBTIQA+ in Australia is a significant gap in research (Carman, et al., 2020). Population-level data is important because it informs our “understanding of health and wellbeing needs of LGBTIQ people, and the development of policy and programs for LGBTIQ communities” (Carman, et al., 2020, p. 2). The Australian Human Rights Commission (2014) have therefore estimated that “up to 11 in 100 Australians may have a diverse sexual orientation, sex or gender identity.”

Defining sexual and gender identity is complex and the use of correct and respectful terminology is important. The ABS attempted to acknowledge the diversity of the Australian population by including a third option to the question about being male or female in the 2016 Census. However, the addition of ‘other’ as a response option highlighted that collection of this data is far more complex and requires a more nuanced and considered approach for collecting data on gender identity. In fairness, the ABS acknowledged that there were limitations in their approach to collecting data about sex and gender (ABS, 2018). Furthermore, there inherent difficulties to collecting data on gender and sexuality in the Census which go beyond question phrasing. That is, only one person in the household completes the Census and they may not correctly report each household member’s gender and sexual identity. Encouragingly, the ABS have reported that they are “committed to implementing the Australian Government Guidelines on the Recognition of Sex and Gender and will continue to work with the community on approaches for future collections including the 2021 Census” (ABS, 2018).

While imperfect, the 2016 Census did provide some population-level data. Across Australia, 46,800 same-sex couples were living together (49% of which were female) which was a 39% increase since the 2011 Census (ABS, 2018). According to the ABS, the increase “in the reported number of same-sex couples may in part reflect greater willingness by people to identify themselves as being in a same-sex relationship and an improvement over the last 20 years in the rights of same-sex couples. Younger people accounted for almost all of the increase in the number of same-sex couples between the 2011 and 2016 Censuses. Half (51%) of the increase was for the cohort aged 20-29 years in 2016, with an additional 35% of the increase in the cohort aged 30-39 years in 2016” (ABS, 2018).

In terms of same-sex couple families, according to the 2016 Census, there were 8,418 same-sex couples with children under 15 across Australia (ABS, 2018). Out of these 7,291 were female same-sex couples. The number of same-sex couples in Victoria was 12,658 with 6,589 male same-sex couples and 6,066 female same-sex couples (ABS, 2018).

WHISE believes that the SMR has a large proportion of LGBTIQA+ people. This may be especially true of areas such as Port Phillip and Stonnington as these have been areas where those identifying as LGBTIQA+ have historically settled in. While no actual numbers or data can be found, the presence of the LGBTIQA+ community is clear.