Perils of Place: Identifying Hotspots of Health Inequalities

When people end up in hospital for diabetes, tooth decay, or other conditions that should be treatable or manageable out of hospital, it’s a warning sign of system failure. Australia’s health system is consistently failing some communities. Places such as Mount Isa and Palm Island in Queensland, and Broadmeadows and Frankston in Victoria, have had appalling rates of potentially preventable hospital admissions for at least a decade. Using data that were available for two states, this report identifies 38 places in Queensland and 25 in Victoria that have had potentially preventable hospitalisation rates at least 50 per cent higher than the state average in every year for a decade. This is unacceptable place-based inequality. Australia is not a uniform country and a one-size-fits-all response will not work. Disadvantaged areas are more likely to experience health inequalities, but just because an area is disadvantaged does not make it likely that it will have persistently high rates of potentially preventable hospitalisations. No uniform pattern in any area exists. Local, tailored policy responses are required. Primary Health Networks have a responsibility to identify and address health needs in their regions. This report introduces a useful tool for this purpose: a methodology for identifying small areas with a persistent but reducible problem. These are the places where health inequalities are already entrenched and, without intervention, are most likely to endure. The role of place in shaping people’s health and opportunity is well-established. Yet there is only limited evidence of what works in reducing health inequalities. Government should therefore invest in trials to reduce health inequalities in priority places. We recommend a three- to five-year intervention trial in a small number of areas. Place-based interventions should be developed locally, with the support of Primary Health Networks and the relevant communities, and must be rigorously evaluated. If potentially preventable hospitalisations in priority places were reduced to average levels in the two states we studied, we estimate direct savings to be at least $10 to $15 million a year. Indirect savings should be significantly larger. The cost-effectiveness of interventions must be established on a small scale before they are rolled out to further areas. Government and Primary Health Networks must ensure that all communities get a fair go. Improving the health of people in these priority places will, in the long-run, improve well-being and opportunity, social cohesion and inclusion, workforce participation and productivity, and reduce health system costs. We propose options for specific responses in priority places. Persistent hotspots are rare, so targeting hotspots alone will not substantially reduce the overall burden of potentially preventable hospitalisations in Australia. But it’s an important first step. As Primary Health Networks get more sophisticated in identifying the people most in need, and as the evidence from trials builds, efforts to reduce health inequalities should be strengthened and expanded beyond the priority places identified here.