The social determinants of health are the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of resources between communities. The social determinants of health are the main cause of health inequality in Australia - the unfair and avoidable differences in health status in rural and remote communities.
The Robert Wood Johnson Foundation estimates that only 20 percent of health outcomes can be attributed to access to health and medical care. Upstream social determinants of health account for the other 80 percent, including socioconomic factors (40 percent), environmental (10 percent), and behaviours (30 percent.
Research, and work overseas and in Australia, has shown that targeted interventions to address social determinants at a local level can significantly improve health outcomes in rural and remote communities, reduce preventable illness and reduce the economic burden of increasing hospital and aged care costs resulting from higher levels of chronic disease.
For example, people with poor health literacy are between 1.5 and 3 times more likely to experience an adverse health outcome; walking 30 minutes a day reduces the burden of disease by 26 percent according to the Australian Instituyte of Health and Welfare; quitting smoking before 40 years of age will reduce the risk of dying of a smoking related illness by 90 percent.
Improving health and well-being requires engagement at a community and individual level. Successful programs engage local communities in planning for their own health futures encouraging improved health literacy, greater community awareness of the causes of poor health and better coordination of existing resources and services. Community Health Partnerships bring together the community with local health and human service providers to jointly improve access to services and provide continuity of care for people in their community.
A key barrier to effective community and individual engagement is the lack access to clear and easy to understand information and data to define local problems and opportunities. Communities also need help to design place-based solutions and grow local health leadership capacity.
In 2019/20 RARMS funded the Cooee Initiative to trial a model to support community-led place-based health planning in three vulnerable rural and remote communities in NSW.
Theories of change describe how interventions can bring about long-term improvements in community and individual health through a logical sequence of intermediate outcomes. They are used to design and measure the impact of public health programs through monitoring and evaluation.
Underpinning RARMS Theory of Change is a number of assumptions:
While rural and remote communities share common health characteristics, each community is unique in terms of its voice, culture, history, experiences and decision making processes
All communities are equal and their unique voices deserve to be heard
Individuals can change with the right information, skills and support
Systems and institutions can become more responsive to communities by developing a common language and shared aims.
The 'Cooee Initiative' aims to map individual and community health through a stepped process:
Adapt patient history taking to develop a better understanding of patient's individual histories and determinants and map these to Individual Care Plans;
Use data to populate a public insight portal that will provide the community with insight into their shared challenges and opportunities.
Engage community, government, NGOs and community organisations to develop a Place-Based Health Plan in response to insights.
Measure the impact of interventions in a way that demonstrate value to all stakeholders.