What makes a community healthy? March 26, 2006
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A healthy community is one that embraces the belief that health is more than merely an absence of disease; a healthy community includes those elements that enable people to maintain a high quality of life and productivity. The aim of a Healthway’s healthy community initiative is to develop projects that use the healthy community principles and criteria as guides (see below*), to strengthen the ability of individuals, families and communities to increase quality of life, and to create healthy communities.
The Denmark Healthy Community Project aims to help build community cohesion by strengthening community capacity to promote health and to identify and address issues that might negatively affect health and wellbeing.
Healthway identified fourteen broad criteria that characterise a healthy community in WA. These include:
Basic needs met in terms of food, water, housing/shelter, work
A safe community (eg crime prevention and deterrence)
Recreational, cultural and leisure opportunities
Participation in community decision making
Promotion of health and adequacy of health services
Foundations of trust
Economic vitality (including employment and local industry)
Protection and care of the natural environment
Educational and learning opportunities
Clean, pleasant and healthy physical environments
Equity and tolerance of diversity
Quality of work-life
Community/social involvement
Family functioning (including child care provisions).
As part of the first phase of this project the community will be engaged and consulted to identify specific priorities within the above broad criteria. The project will then focus on addressing the identified priorities through community mobilisation and capacity building.
Some of the priority issues faced by the community which could be addressed by the project are highlighted below under the following key headings:
1. Equity and tolerance of diversity and coordination of activities
2. Promotion of health and adequacy of health services
3. Economic vitality (including employment and local industry)
4. Youth Issues
5. Family functioning, social isolation and domestic violence
This list is in no way exhaustive. It is expected that through community consultation and working through the various phases of the project that these key areas could be expanded and refined.
1). Equity and tolerance of diversity and coordination of activities
The lack of tolerance for differences between groups in Denmark was identified as a key issue in two public forums held in Denmark earlier this year. (24th February and 9th March 2005). The forums identified that there are a number of divisions within the community which are related to the concept of social capital. These include a lack of respect; reduced degree of collaboration and cooperation to achieve mutual benefits for the community and lack of collective social cohesion, when addressing community issues and coordinating activities. The latter conflict, which has evolved from the lack of social cohesiveness, was identified as immobilising community action.
The Denmark Report was undertaken between 2002-2003, and released at the end of 2004. This report provides further evidence of social isolation, lack of interconnectedness, identifies issues surrounding respect and trust in decision-making and resultant disharmony and misinterpretations within the Denmark community. The report highlights the difficulties faced by the community in accepting change despite the inevitability of change based on the impact of globalisation. It is felt that a catalyst to embracing change may rest on addressing social capital and cohesiveness issues which are felt to be imperative in establishing a healthy community
2) Promotion of health and adequacy of health services
The lack of adequate health services in the region is an on-going issue in Denmark and identified in “The Denmark Report”. particularly in terms of gaining basic access to health social services. This is an issue strongly identified by the community, based on anecdotal evidence. Other specific areas of need identified by the community include; difficulty accessing services for dental and aged care needs and the lack of inter and intra community public transport to attend services. In (December 2004, the issue was further highlighted with a spate of motor vehicle accidents amongst youth, the lack of adequate health services was also highlighted as a key issue of concern[1]).
Currently, Denmark residents have to source a number of health services from larger regional centres or the Perth metropolitan area (2003/2004)[2]. When considering disease status in Denmark it can be identified that local services are not available to treat certain conditions, for example mental health services for acute conditions are only available from neighbouring towns. Despite the lack of local services, it is identified that Denmark residents continue to have a higher number of hospital separations than the State and National rates, for conditions such as cardiovascular diseases, cancers and injuries.
Based on available information, Denmark is in particular need of health promotion and access to health services related to mental health issues. Local data collected in 2004, indicates that hospitalisations for mental health disorders in the regional area are 7% above the State average and overall, Community Mental Health clients are 54% above the State average (Gill, 2004). The mental health issues in this region are increasing at a rate far higher than the rest of the State. A statistic which is alarming given the added rising suicide rate and the equally indefinable number of causality factors in our many fatal road accidents (both rank number 1 in this region as the most common cause of deaths through injury)[3]. To compound this issue is the worrying current and projected trends indicating increases in serious psychiatric disorders, anxiety disorders, personality and other developmental disorders acquired and congenital brain disorders and alcohol and drug disorders[4].
“The Denmark Report” (2004), highlights the need to create networks of social support, particularly for the young and elderly in the community, both of whom have demonstrated high rates of depression.
Issues surrounding ailing health and financial struggles are suggested to also attribute to the problem. Further independent studies by Kinway, identified depression as a major problem for the Denmark community, with a statistically significant higher proportion of high school males at risk (39%) compared to females (17%)[5]. The results from this study were particularly disturbing in relation to Denmark’s youth, suggesting various precursors to probable mental health issues in adult life.
The community has been trying to address the mental health issue (for example, volunteers have created a soup kitchen and individuals have drawn on their personal resources to fund counselling and the personal needs of vulnerable individuals and families) but require greater support.
“The Denmark Report” has also recognised that access to services, hazards and safety issues are of concern for seniors and those with disabilities. There are almost 800 people with disabilities in Denmark, of which 200 have severe disabilities. Access to services is becoming an increasing problem as the aged population increases. An added issue is the usage of the town centre as the only route for heavy timber carrying trucks and vehicles which can impact on pedestrian safety.
3) Economic viability
The population in the Denmark region is growing at 18% which is far greater than all other towns in the Great Southern Region. This rapid growth impacts on the availability of resources and infrastructure to support community needs such as employment, housing availability, health and social services and educational facilities. The outcome of the growth is expected to create a greater strain on current resources and result in increased social, health and welfare issues.
In conjunction with this population forecast, Denmark is particularly disadvantaged when considering household income and employment. The median weekly household income for Denmark is $500-$599. This is considerably lower than the State median of $800-$999. The unemployment rate in Denmark is 10.1 compared to the WA rate of 7.5 and the opportunities for employment and access to further education are considered to be very limited.
The Denmark region is still reliant on agriculture, with beef cattle (the most valuable commodity), followed by nurseries and milk. Despite the advent of increased tourism in the area since the “Tree-Top” walk was developed in the Shire, Denmark does not benefit greatly from the increased visitations by tourists. The tourist dollar and employment opportunities have done more to assist neighbouring Walpole, rather than Denmark, despite the local council and its residents paying for the upkeep of the facilities.
Compared to other neighbouring townships, Denmark is lagging behind in economic growth and subsequent employment opportunities, which is adversely affecting the health of the community, placing a particular strain on the youth seeking employment.
4) Youth Issues
Youth are identified to be a particular priority target group for Denmark. The large unemployment rate, lack of recreational facilities and activities for youth, in addition to drug and alcohol related issues have been highlighted recently by the community[6] as areas of concern and the “The Denmark Report?[7], highlights the severity of youth issues. Some of the key issues identified include lack of employment, drugs and alcohol misuse, gay and lesbian issues, family dysfunction and/or mental health problems, poverty, lack of housing (the cost of available housing in the region has also risen dramatically recently, promoting further economic and social divisions) and limited social and recreational pursuits. It was also noted in the report that the youth did not have a feeling of belonging in the community and required a greater sense of self-empowerment, greater avenues for social support and wanted further involvement in planning.
The Injury Prevention Committee and “Tha House” Youth Centre would like to address youth related issues by adopting a focus on the determinants of good health in this age group. Some of the issues, which may need to be addressed, include: family functioning; more social or mental health support for youth; mentoring programs in collaboration with the local high school for at-risk students and a greater positive acknowledgment of the contribution youth make to the Denmark community.
5) Family functioning, social isolation and domestic violence
A range of other issues surrounding family dysfunction have also been identified including domestic violence, coupled with mental health problems. There are no pro-active groups in the community to deal with underlying problems associated with domestic violence and there is a shortage of mental health resources to address related mental health and family issues (The Denmark Report, 2004).
Many people in Denmark have no family and consequently lack social support networks (The Denmark Report, 2004). “The Denmark Report” highlights the lack of avenues for social interaction for single parents due to the lack of formal and informal entertainment activities that encourage community-wide interaction and support. Greater diversity in opportunities for social interaction is needed, such as facilities where individuals can meet for regular interaction and greater access for mothers (The Denmark Report, 2004).
Social health and inter connectiveness in conjunction with youth and mental health issues could be addressed as a whole of community approach by the creation of a proposed holistic “healthy community” philosophy.
[1] Interagency meetings minutes December 2004 and February 2005.
[2] Information provided by the Department of Health via direct request, based on hospital separations.
[3] Legg, M., Gillam. C & Gavin, A. 2004. Injury in Western Australia: An epidemiology of injury, 1990-2001. Southern and Central regions’ Companion. Injury Research Centre: Perth WA.
[4] Gill, L. 2004. Population Health Profile: Great Southern Health Region. Great Southern Public Health Services: Western Australian Country Health Services.
[5] Gill, L. 1999. Depression in the Denmark and Walpole Areas; Lifestyle survey data analysis. Lower Great Southern Primary Health Service.
[6] The Denmark Police report that there are increasing numbers of people in the community involved with heavier types of drug usage, such as Amphetamines - a decade ago Denmark was considered the dope capital of Australia. (The Denmark Report, 2004, p. 21).
[7] The Denmark Report . 2004. Great Southern Development Commission & Denmark Shire Council.
Aged Care and Carers Information Session March 6, 2006
Posted by gill in : Uncategorized , 1 comment so farThe Healthy Community Project Officer has been approached by a number of seniors concerned about the lack of information they have in making decisions about aged care options. They seem concerned about the various terminology e.g. ILUs (Independent Living Units), accessibility and potential costs, so we’re organising an information session to address these concerns.
Anyone interested in aged care or independent living is invited to attend a Carers and Aged Care information meeting on Monday, 20 March at 10 am in the Garden room at the hospital and information about the Commonwealth Carelink program and the Commonwealth Carer Respite program will also be presented by Irene Smith the regional Carelink Coordinator.
Morning tea will be provided so mke sure you RSVP to either Katie Baxter on 98480612 or Gill Sellar on 98483514 or email us at gillian.sellar {at} health.wa.gov(.)au by March 17 2006