Patient populations and social determinants of health

Understanding your patient population, inequities and the challenges these can cause is an important step in providing safe, high-quality health care that is appropriate for your local community. 

Health inequities are systematic differences in the health status or in the distribution of health resources between different population groups. This arises from social conditions in which people are born, grow, live, work and age and can lead to further differences in health outcomes.[i],[ii] Examples of population groups that experience inequities include:

• People of Aboriginal and Torres Strait Islander origin
• People with disability – noting that intersectional needs and experiences may be due to a variety of factors
• People with diverse backgrounds – that is social, economic and geographic circumstances as well as their cultural backgrounds, religions, beliefs and practices, languages spoken, sexual orientation, gender identity and gender expression, and sex characteristics. 

People can belong to multiple population groups, and there are intersections and tensions that must be considered.

Considering the trends of population groups accessing the service can inform the planning and delivery of health care for patients in a way that maximises access and seeks to overcome these challenges. In turn, this reduces the risk of avoidable differences in health outcomes. 

Links to Actions 1.10 Patient populations and social determinants of health; and 1.24 and 1.25 Safe environment

• What are the local patient populations that access your healthcare service?
• What potential challenges do these population groups face that could have an impact on their health outcomes?

• Identify patients in your healthcare service that are at risk of avoidable differences in health outcomes. This can be done via review of healthcare records and observation within the healthcare service, or by supporting patients to self-identify.

The type and comprehensiveness of evidence used is dependent on each healthcare service context, but could include: 

• A list of patient populations where health inequities exist and the potential challenges these population groups face that could have an impact on their health outcomes.

Resources

• Australian Bureau of Statistics Census data: QuickStats and Community Profiles – search Census data – useful resources including an interactive map to assist with search options.
• Australian Government Department of Health and Aged Care: Your local Primary Health Network – information about the population profile and location of your local Primary Health Network (PHN), plus links to tools. 
• Pride in Health + Wellbeing: Statistics – provides the latest LGBTQI+ health statistics from research in the previous 12 months.

Health inequities are systematic differences in the health status or in the distribution of health resources between different population groups, arising from social conditions in which people are born, grow, live, work and age. This can lead to further differences in health outcomes.^5,6 

Healthcare services have an important role to play in ensuring that healthcare providers consider information on population groups, and tailor care to achieve better health outcomes. Figure 1 describes the impact of equality, equity and justice. In a healthcare setting, information on your patient populations and the inequities that exist can inform planning and delivery of health care to achieve better outcomes.

Figure 1: Demonstration of the differences between equality, equity and justice

• Source: Assessing the Aboriginal and Torres Strait Islander actions in national safety and quality standards: Learner’s Guide (ACSQHC, 2022, unpublished)

Care should be planned and delivered that is tailored to meet patients’ needs and preferences and ensure the principles of the Australian Charter of Healthcare Rights (second edition)^[i] are applied.

• How does your healthcare service tailor its care to meet the different needs of its patient population groups? 

• Use information on patient groups to identify challenges and barriers to health care and inform the planning and delivery of health.
• Provide access to training and or support for the workforce to improve awareness and understanding of patient population groups using your healthcare service.

Links to Actions 1.09 Patient populations and social determinants of health; 1.24 Safe environment; 2.02 Healthcare rights and informed consent; and 2.06 Communication that supports effective partnerships

Examples of evidence will be dependent on patient populations identified in your healthcare service’s locality, but could include: 

• Amended processes or protocols 
• Accessing resources or information packs in different languages 
• Using an appropriately trained and credentialed interpreter. Interpreters may be required in Auslan, First Nations sign languages or spoken languages other than English
• Examples of referring a patient on to other service providers if health issues are identified that impact on the care your healthcare service is providing
• Hiring a workforce that speaks languages other than English to support communication with local community members 
• Participation in programs to support services improve their inclusive care 
• Adjustments to premises to support disability access including appropriate adaptations and remedial action to existing infrastructure.

Commission resources

The principles and strategies outlined in these resources are broadly applicable:   

• NSQHS Standards User Guide for Health Service Organisations Providing Care for Patients from Migrant and Refugee Backgrounds – provides practical support for healthcare services where specific efforts or additional attention is required to meet the health needs of this patient population, based on the NSQHS Standards. 
• NSQHS Standards User guide for Aboriginal and Torres Strait Islander health – provides practical support for the implementation of the Aboriginal and Torres Strait Islander-specific actions in the NSQHS Standards. 
• NSQHS Standards User Guide for health service organisations providing care for patients with cognitive impairment or at risk of delirium – provides practical support for healthcare services where specific efforts or additional attention is required to meet the health needs of this patient population, based on the NSQHS Standards. 
• NSQHS Standards User Guide for health services providing care for people with mental health issues – provides practical support for healthcare services where specific efforts or additional attention is required to meet the health needs of this patient population, based on the NSQHS Standards. 
• NSQHS Standards User Guide for acute and community health service organisations that provide care for children – provides practical support for healthcare services where specific efforts or additional attention is required to meet the health needs of this patient population, based on the NSQHS Standards. 

Other resources

• Australian Federation of Disability Organisations: How to be Disability Inclusive – provides tips and examples for disability inclusion.
• Australian Government Department of Health: National Roadmap for Improving the Health of People with Intellectual Disability – aims to address serious health inequities faced by people with intellectual disability. It outlines how we can create a health system where people with intellectual disability are valued, respected and have access to high-quality, timely and comprehensive health care.
• Council for Intellectual Disability: Resources for health practitioners – resources for healthcare providers to support better appointments when working with people with intellectual disability. 
• Dementia Australia: Dementia-Friendly Communities – ensures that people living with dementia are welcome, included and valued.
• Developmental Disability WA: Resources – provides current resources for people with disability, including online courses.
• NSW Government Agency for Clinical Innovation: Intellectual Disability Network Resources – relates to the care and health of people with intellectual disability across all ages, including acquired brain injuries by enhancing the capacity of primary and secondary health services.
• NSW Government Agency for Clinical Innovation: Brain Injury Rehabilitation Network Resources – relates to rehabilitation outcomes for adults, young people and children following traumatic brain injury.
• Pride in Health + Wellbeing – a national membership program that supports organisations within the Health, Wellbeing and Humans services sector to improve their LGBTQI+ inclusive care, remove systematic barriers to accessing care and thereby reduce health disparities faced by LGBTQI+ communities.
• CheckUP Australia: Access for All – a free online course funded by the National Disability Insurance Agency that aims to improve disability awareness among healthcare providers, and increase understanding about the barriers people with disability experience when accessing health care. 
• Queensland Centre for Intellectual and Developmental Disability (QCIDD): Resources – provides current resources for people with intellectual disabilities and their support people.