Social Indicators For Addressing Health Inequalities

Social Indicators
For
Addressing
Health Inequalities
2003
The State of Queensland
© Queensland Health, 2003
Copyright protects this publication. However, Queensland Health has no objection to this
material being reproduced with acknowledgment, except for commercial purposes.
Permission to reproduce for commercial purposes should be sought from the Policy and
Quality Officer, Queensland Health, GPO Box 48, Brisbane Q 4001.
ISBN: 0 7345 2921 X
This document is available on the Queensland Health Internet site at:

http://www.health.qld.gov.au/HealthyLiving/social_determinants_HP.htm.
Social Indicators for Addressing Health Inequalities Version 1, 2003, prepared by the
Southern Public Health Unit Network, West Moreton Public Health Unit for Public Health
Services, Queensland Health.
For further information and copies contact:
Southern Public Health Unit Network

West Moreton Public Health Unit
c/- Ipswich Hospital
Chelmsford Avenue
PO Box 73
IPSWICH 4305
Ph: 07 3810 1500

Fax: 07 3810 1155
email: wmphu@health.qld.gov.au
FOREWORD
This report aims to serve a growing demand for a compilation of a concise but
comprehensive list of social indicators for use by staff of Public Health
Services in assessing the impact of government policies on health and health
inequalities within Queensland. This initial listing contains 60 individual and
clustered social indicators grouped according to their being identified as either
socioeconomic or community capacity factors. It needs to be acknowledged
however, that in some cases the indicator could be relevant to either
dimension. Public Health Services is continuing its efforts with active
collaboration within Queensland Health to extend the set of indicators and
improve their comparability.
The chosen indicators are listed together with their general information on
sources and definitions. Most of the indicators are readily and easily available
and in the majority of cases accessible through the Internet on a regular basis.
John Scott
Manager
Public Health Services
Queensland Health
July 2003
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Contents
Foreword ...................................................................................................................... 1
Overview of the document........................................................................................... 5
PART 1 ............................................................................................................6
AN I NTERPRETATIVE GUIDE................................................................................................... 6
What are social indicators for?.................................................................................... 7
The structure of the indicators .................................................................................... 7
The use of the indicators ............................................................................................. 8
Figure 1: National Health Performance Framework ................................................................... 9
Description of the indicators ..................................................................................... 10
Caution ....................................................................................................................... 10
The future ................................................................................................................... 11
Review process .......................................................................................................... 13
PART 2 ..........................................................................................................14
SOCIAL INDICATORS ........................................................................................................... 14
SOCIOECONOMIC FACTORS ................................................................................................. 15
Benefits....................................................................................................................... 15
1. Dependent children of selected pensioners and beneficiaries as a percentage of
all children aged from 0-15 years by SLA. ................................................................. 15
2 Proportion of people receiving a pension by type of government
pension/allowance (principal and auxillary, full or part) by gender. ............................. 16
3. Proportion of sole parent pensioners as a percentage of all persons aged 15
years and over by gender. ........................................................................................ 16
4. Unemployment benefits by region by sex. ................................................................. 17
Death rates ................................................................................................................. 17
5. Gender differentials in death rates across socioeconomic quintiles for males
and females aged 15 years old and above. ............................................................... 17
Education.................................................................................................................... 18
6. De-enrolment and retention rates in government and non-government schools. ......... 18
7. Proportion of highest level of schooling completed (highest educational
attainment) by age and gender for persons aged 15 years and over. ......................... 18
8. Percentage of year five students achieving the national reading benchmark............... 19
9. Percentage of year five students achieving the national numeracy benchmark. .......... 20
Employment ............................................................................................................... 20
10. Labour force status by gender and age for persons aged 15 years and over. ............. 20
11. Number of unemployed and unemployment rates, States/Territories and
Statistical Local Areas, June Quarter 2001 to June Quarter 2002. ............................. 21
12. Trends in proportion of employed persons by industry by gender and age.................. 22
13. Trends in unemployment rates by gender and age groups......................................... 22
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14. Trends in participation rates by gender and age groups............................................. 23
15. Trends in long-term unemployment as a proportion of total unemployed. ................... 23
16. Trends in proportion of employed persons by gender and age. .................................. 23
17. Underemployment – Populations by State or Territory of usual residence for
September 2000. (Includes underemployed workers by sex). ................................... 24
Health Expenditure..................................................................................................... 25
18. Health expenditure Australia 2000-01. ...................................................................... 25
19. Trends in proportion of adults covered by private health insurance in addition to
Medicare.................................................................................................................. 26
20. Trends in proportion of adults holding a Health Care Card by card type and
gender. .................................................................................................................... 26
Housing Costs............................................................................................................ 26
21. Monthly housing loan repayment: Occupied private dwellings being purchased.......... 27
22. Weekly rent by landlord type: occupied private dwellings being rented. ...................... 27
COMMUNITY CAPACITY ....................................................................................................... 28
Community support services..................................................................................... 28
23. Proportion of children receiving formal and informal care by State. ............................ 28
24. Distribution of health facilities by statistical division.................................................... 29
25. Proportion of surveyed Queensland communities with limited access to healthy
food basket items..................................................................................................... 30
Demography ............................................................................................................... 30
26. Collection of demographic indicators available through Queensland Health................ 30
27. Indigenous population by age, sex and statistical local area (time series)................... 31
28. Indigenous population by age (5yr gaps), sex, statistical local areas and health
service districts ........................................................................................................ 31
29. Age (5 yr gaps) by sex by statistical local area and health service districts, Qld.......... 31
30. Births – selected variables as per Perinatal Annual Report, Qld ................................. 31
31. Proportion of population of postcode in each SLA in Qld (SD, SSD and District
identifiers)................................................................................................................ 31
Ethnicity...................................................................................................................... 32
32. Ancestry by birthplace of parents. ............................................................................. 32
33. Birthplace (countries) by sex..................................................................................... 32
34. Birthplace (regions) by sex. ...................................................................................... 33
35. Distribution of Emerging Communities by Local Government Area............................. 33
36. Humanitarian entrants by birthplace and region of settlement. ................................... 34
37. Language spoken at home by sex. ........................................................................... 34
38. Proficiency in spoken English by year of arrival in Australia. ...................................... 35
Family ......................................................................................................................... 35
39. Family type - families and persons in families in occupied private dwellings
(excluding overseas visitors)..................................................................................... 35
40. Weekly family income by family type: Families in occupied private dwellings.............. 36
Housing needs ........................................................................................................... 36
41. Estimated potential SAAP clients and unmet needs by gender, age and State. .......... 36
42. Dwelling structure - private dwellings and persons in occupied private dwellings. ....... 37
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43. Dwelling structure by tenure type and landlord type: Occupied private dwellings. ....... 37
44. Number of SAAP support periods of accommodation on the 15th of the month,
by month and region, Queensland. ........................................................................... 38
45. Distribution of private dwellings by type of occupancy (rented, being
purchased). ............................................................................................................. 38
46. State government housing assistance by program and type of assistance,
Queensland, 1988-89 to 1997-98. ............................................................................ 39
Income ........................................................................................................................ 39
47. Distribution of weekly individual income by age and gender (persons aged 15
years and over)........................................................................................................ 39
48. Distribution of weekly household income by household type. ..................................... 40
49. Population distribution by index of relative disadvantage Socio Economic
Indexes For Areas (SEIFA)....................................................................................... 40
50. Type of educational institution attending (full-time/part-time). ..................................... 41
Safety .......................................................................................................................... 41
51. Victim of assault in last 12 months. ........................................................................... 42
52. Victim of break-in in last 12 months. ......................................................................... 42
53. Victim of assault or break-in in last 12 months........................................................... 42
54. Victim of domestic violence in the last 12 months (source: Family Services who
funds a domestic violence service for NESB women: the Immigrant Women’s
Emergency Support Service). ................................................................................... 42
55. Feelings of safety at home during day:...................................................................... 42
56. Crime and Safety - Offences reported by police region and type of offence,
Queensland, 1991-92 to 2000-01. ............................................................................ 42
Social supports .......................................................................................................... 43
57. Relationship in household by age by sex – Persons in occupied private
dwellings. ................................................................................................................ 43
58. Religious affiliation by sex. ....................................................................................... 43
59. Social Capital (generalised reciprocity and cohesion; community identity;
generalised trust; tolerance of diversity; civic trust; community involvement;
informal social networks), Queensland...................................................................... 44
Transport .................................................................................................................... 44
60. Method of travel to work by sex: Employed persons (excluding overseas
visitors).................................................................................................................... 45
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OVERVIEW OF THE DOCUMENT
This document has been produced as a tool to aid Public Health Service
(PHS) staff in addressing health inequalities. It comprises two parts: an
Interpretive Guide and a Social Indicators set.
Part 1: An Interpretative Guide.

The guide discusses why social indicators are important in public health
practice whilst acknowledging that many of the indicators chosen are outside
the traditional role of the health system. The indicators have been organised
according to the framework devised by the National Health Performance
Committee.1 Using this framework, ‘upstream’ determinants are divided into
the categories of socioeconomic and community capacity factors.
A number of possible uses for the indicators are provided including those
suitable for adoption and reporting on the social conditions of whole-of-
population and various sub-populations of the Queensland community. Equity
is an important component of these factors. As such the indicators help us to
understand the social environment as a consequence of government policy.
Possible future indicators at the macro level are identified which may be
worthwhile for PHS to explore in terms of their impact on health and health
inequalities including activation policies; ecological footprint; healthy
communities index; income inequality; safe communities; and tax burden.
Part 2: Social Indicators.

This section outlines the actual social indicators that have been identified
under the categories of socioeconomic and community capacity factors. Each
category comprises a number of sub-categories with specific indicators.
The socioeconomic sub-categories include: benefits; death rates; education;

employment; health expenditure; and housing costs. The community capacity
sub-categories include: community support services; demography; ethnicity;
family; housing needs; income; safety; social supports; and transport.
The chosen indicators are by no means exhaustive and have been listed
together with their general information on sources and definitions. Most are
readily available and easily accessible via the Internet. Wherever possible the
actual web address has been provided as the first point of call for the
investigator.
The indicator set selected for inclusion in this document are aligned with, and
complement Queensland Health’s Health Determinants Reports (formerly
known as Zonal Indicator reports). The indicators identified in this report
reflect our best understanding as of June 2003, however, it is anticipated that
this document will be reviewed and updated as the evidence base develops.
1
National Health Performance Committee (2002) National Report on Health Sector
Performance Indicators 2001. A report to the Australian Health Minister’s Conference.
Brisbane: Queensland Heath.
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Part 1
An Interpretative Guide
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Part 1 – An Interpretative Guide
WHAT ARE SOCIAL INDICATORS FOR?
Socioeconomic and community capacity factors are important determinants of

health. Many of the indicators listed within this document are external to the
traditional view of the health system, for example, education, employment,
community infrastructure. In order to evaluate the impact of policy on health,
it is important to identify need and measure the impact of socioeconomic and
community determinants on health outcomes. Reporting of health outcomes
against social determinants will work towards highlighting the need for and
facilitate inter-sectoral approaches where appropriate to improve health
outcomes.
The indicator set contained within this document aligns with and complements
the health indicators reported on within Queensland Health’s zonal indicator
reports2
THE STRUCTURE OF THE INDICATORS
The structure applied in this document falls well short of being a full-scale
framework for the collection of social statistics but nevertheless reflects the
‘upstream’ social dimensions contained within the framework developed by
the National Health Performance Committee (NHPC) (Figure 1)3.
! Socioeconomic factors have been shown to have a clear association

with health status with lower socioeconomic groups having poorer health
than those better off4. Reporting the socioeconomic factors affecting
health will help to inform public policy. Appropriate indicators include
health outcomes or health determinants affected by education,
employment status, or income.
! Community capacity incorporates information on characteristics that can

influence health such as housing, community support services and
transport. It also includes measures of local services. Concepts and
measures of community capacity are currently the focus of much debate,
research and development.
2
Queensland Health (2001) Health Indicators for Queensland: Southern Zone. Brisbane:
Public Health Services, Queensland Health. Note, reports are also available for the Central
and Northern Zones.
3
Performance Indicators 2001. A report to the Australian Health Minister’s Conference.
Brisbane: Queensland Health.
4
Turrell, G.; Oldenburg, B.; McGuffog, I. and Dent, R. (1999) Socioeconomic Determinants of
Health: Towards a National Research Program and a Policy and Intervention Agenda.
Canberra: Queensland University of Technology, School of Public Health; Ausinfo.
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THE USE OF THE INDICATORS
The socioeconomic and community capacity indicators in themselves describe

the social conditions of the population. To measure change in any particular
context we need to track the performance of the system being affected.
Implicit in this process are guiding values that underpin the selected
indicators. As you can see from the NHPC model, the identification of
indicators that incorporate equity are integral to the framework.
There are many dimensions of equity including access, opportunity and
outcome. Within and across societies there are likely to be a multitude of
opinions as to what exactly a fair distribution of resources entails or what
constitutes a just distribution of access opportunities to social services. With
the performance of any system and the corresponding use of selected
indicators the question needs to be asked, “who misses out?” – “is the
situation the same for all people?” Equity is reflected in the indicators
contained within this document. The indicators help us to understand change
(or the social context) in the social determinants impacting on the population
and the effectiveness of initiatives in achieving the outcomes specified.
Possible uses of the indicators include:
• providing baseline information on health determinants from which

progress can be measured
• assistance with future planning of health and community services
• developing policy and informing resource allocation decisions
• monitoring and evaluation of government policies and practices for their
impact on communities.
A number of these indicators will be adopted and reported for whole-of-

population and various sub-populations such as:
• children and young people

• adults
• older people
• indigenous peoples
• rural and remote peoples
• socioeconomically disadvantaged
• ethnicity.
This report will be produced in the Health Determinants Queensland report to

be released in 2004 by Public Health Services, Queensland Health.
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Figure 1: National Health Performance Framework
Health Status and Outcomes (Tier 1)

How healthy are Australians?
Is it the same for everyone?
Where is the most opportunity for improvement?
Health Conditions Human Function Life Expectancy and Deaths
Wellbeing
Prevalence of disease, Alterations to body, Broad measures of Age and/or condition
disorder, injury or trauma structure or function physical, mental, and specific mortality rates.
or other health-related (impairment), activities social wellbeing of
states. (activity limitation) and individuals and other
participation (restrictions in derived indicators such as
participation). Disability Adjusted Life
Expectancy (DALE).
Determinants of Health (Tier 2)
Are the factors determining health changing for the better?
Where and for whom are they changing?
Environmental Socioeconomic Community Health Person-related
Factors Factors Capacity Behaviours Factors
Physical, chemical Socioeconomic Characteristics of Attitudes, beliefs Genetic – related
and biological factors factors such as communities and knowledge and susceptibility to
such as air, water, education, families such as behaviours e.g. disease and other
food and soil quality employment, per population density, patterns of eating, factors such as blood
resulting from capita expenditure age distribution, physical activity, pressure, cholesterol
chemical pollution on health, and health literacy, excess alcohol levels and body
and waste disposal. average weekly housing, community consumption and weight.
earnings. support services and smoking.
transport.
Health System Performance (Tier 3)
How well is the health system performing in delivering quality health actions to improve the health of all
Australians?
Effective Appropriate Efficient
Care, intervention or action achieves Care/intervention/action provided is Achieving desired results with most
desired outcome. relevant to the client’s needs and cost effective use of resources.
based on established standards.
Responsive Accessible Safe
Service provides respect for persons Ability of people to obtain health care The avoidance or reduction to
and is client orientated and includes at the right place and right time acceptable limits of actual or
respect for dignity, confidentiality, irrespective of income, physical potential harm from health care
participation in choices, promptness, location and cultural background. management or the environment in
quality of amenities, access to social which health care is delivered.
support networks, and choice of
provider.
Continuous Capable Sustainable
Ability to provide uninterrupted, An individual’s or service’s capacity System or organisation’s capacity to
coordinated care or service across to provide a health service based on provide infrastructure such as
programs, practitioners, skills and knowledge. workforce, facilities and equipment,
organisations and levels over time. and be innovative and respond to
emerging needs (research,
monitoring).
Source: National Health Performance Committee (2001) National Health Performance

Framework – Report p. 7.
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DESCRIPTION OF THE INDICATORS
The chosen indicators are listed as either socioeconomic or community

capacity factors. The descriptions include:
• a brief rationale to illustrate their relevance to health and health

determinants
• the potential use by Public Health Service staff
• the geographic parameters in which they have been collected
• when last reported
• the source of the data (in most cases Internet web addresses are
given)
• if applicable, how they could be collected by others.
In most cases individual indicators are given and in others a set of indicators
but in all cases they were selected against a range of criteria. It is not
anticipated that each criterion will be met for every indicator, rather the
selection criteria provided guidance only. The criteria included:
• be worth measuring
• be measurable for diverse populations
• be understood by people who need to act
• galvanise action
• be relevant to policy and practice
• measurement over time will reflect results of actions
• be feasible to collect and report
• comply with national processes of data definitions.
It must be acknowledged that the list of indicators is by no means

comprehensive. The number of indicators available is immense and so the
line had to be drawn somewhere, at a somewhat arbitrary point and
consequently, the reader will note omissions. However, this is an ongoing
process with the aim to continually develop and improve the list of indicators
over time. In addition, a collection of indicators at a more Regional, State
National and International levels needs to be collated to enhance the work of
Public Health Services. In the following section possible indicators for use at
a more macro level are given as possibilities for capturing this ‘bigger picture’.
CAUTION
Due to the small population numbers in some geographic reporting areas eg

Australian Bureau of Statistics (ABS) Collection Districts, caution must be
used in the interpretation of individual or small numbers of data points. This
same caution applies to comparisons between areas or between time periods.
More meaningful data can be generated by aggregating small areas or by
extending the reported period beyond a single year.
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Furthermore, ABS randomises demographic cell entries of three persons or

less to either zero or three. This leads to inconsistency when some areas or
data entries are aggregated.
THE FUTURE
There are possibly many alternative social indicators that may better suit the
needs of PHS. In the immediate future perhaps we need to identify what
information is ‘missing’ – for example, on the accessibility of basic social
services, or the quality of housing.
Possible future indicators at the macro level which may be worth exploring for
their impact on health and health inequalities, include
1. Activation policies: Activation policies comprise a range of public

measures intended to improve beneficiaries’ prospects of finding gainful
employment, job-skills of the labour force, and the functioning of the labour
market. Macroeconomic and structural policies are crucial in fostering
efficient labour market outcomes. Public expenditure on the Active Labour
Market Policies (ALMPs) include the value of cash benefits, employment
services and fiscal measures, including reductions of social security
contributions targeted at groups of workers and jobs5..
2. Ecological footprint: The Ecological Footprint6 measures the amount of

nature’s resources an individual, a community, or a country consumes in a
given year. Official statistics are used to track consumption and translate
that into the amount of biologically productive land and water area required
to produce the resources consumed and to assimilate the wastes
generated using prevailing technology. People use resources from all over
the world, and affect faraway places with their pollution, the Footprint is the
sum of these areas wherever they are on the planet. This index gets to
the heart of sustainability – how much of the earth’s resources does a
person consume compared to the amount of resources available. In the
short term, it is a measure of intra-generational equity, while in the long-
term it is an indicator of whether future generations will be able to meet
their needs.
Components of the Ecological Footprint:

• growing crops
• grazing animals
• harvesting timber
• catching fish
• accommodating Infrastructure
• absorbing carbon dioxide emissions
5
Organisation for Economic Cooperation and Development (2001) Society at a Glance –
OECD Social Indicators. OECD, pp. 48.
6
Redefining Progress: Sustainability Program Ecological Footprint Accounts. [online]
http://www.rprogress.org/programs/sustainability/ef/methods/components.html downloaded
rd
23 October 2002.
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3. Healthy communities index: This indicator is based on the Tasmanian

Healthy Communities Survey7, which was designed to measure the health
and wellbeing of the adult Tasmanian population. The survey was also
designed to measure those factors that were identified in the research
literature as being determinants of health and wellbeing. The information
collected enables a better understanding of why some sections of the
community experience better levels of health and wellbeing than others.
Sections covered in the survey include:
• your health
• quality of life
• personal background
• beliefs and behaviours
• health conditions and use of services
• employment and income
• community involvement
• voluntary work.
Possible uses of the survey:
• to provide baseline health and wellbeing information from which

progress can be measured
• to assist with the future planning of health and community services
• to research health and wellbeing profiles to assist with needs-based
planning
• to research the connections between socio-economic status,
employment, family and friendship networks and access to services,
and health and wellbeing outcomes
• to provide strategic information concerning the factors that determine
levels of health and wellbeing
• to develop policy and inform resource allocation decisions.
4. Income inequality: Income distribution statistics inform us about what is

happening in relation to the economy – who are ‘winners’ and who are
‘losers’ from economic changes and government policies. From a more
normative viewpoint, ideas about what constitutes ‘fair’ are closely linked
with the distribution of income8.
7
Dept of Health and Human Services (1999) First Results of the Healthy Communities Survey
1998. Tasmania: Health and Wellbeing Outcomes Unit, Dept of Health and Human Services.
8
OECD (2001) op cit p. 64.
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5. Safe Communities indicators where safe communities have9:
• an infrastructure based on partnership and collaborations, governed by

a cross-sectional group that is responsible for safety promotion in their
community
• long-term, sustainable programs covering both genders and all ages,
environments and situations
• programs that target high-risk groups and environments, and programs
that promote safety for vulnerable groups
• programs that document the frequency and causes of injuries
• evaluation measures to assess their programs, processes and the
effects of change
• ongoing participation in national and international Safe Communities
networks.
6. Tax burden on labour: a measure of the size of the tax burden on labour
involves consideration of the ‘wedge’ between what employers pay for the
labour of an employee, and the consumption a worker can purchase from
this income. Consideration of this ‘wedge’ is important as such taxes
either raise the cost of employing labour, or reduce the financial returns to
working10. It involves calculation of the taxes and contributions paid when
someone is employed at average earnings. A fairer tax burden will help
the less well-off who are in work.
REVIEW PROCESS
It is anticipated that a review process will be adopted to assess the

application, merits and progress of this document. Within such a review
consideration will need to be given to the indicators and their relevance and
applicability to practices such as Health Impact Assessments. Consideration
will also need to be given to its future development including application to an
interactive internet site and alignment with the zonal indicator reports
produced by Public Health Services, Queensland Health.
9
WHO Collaborating Centre on Community Safety Promotion (2002) Safe Community News,
No 2, 2002, p. 1.
10
OECD (2001) op cit p. 60.
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Part 2
Social Indicators
Part 2 – Social Indicators
SOCIOECONOMIC FACTORS
Research has shown a clear link between socioeconomic position and health
outcomes with people who occupy positions at lower levels of the
socioeconomic hierarchy faring significantly worse in terms of their health.
Specifically, experiencing higher mortality rates for most major causes of
death11. People variously classified as ‘low’ socioeconomic status (SES) have
greater ill-health (both physiological and psychological), and their use of
health care services suggest they are less likely to prevent disease or detect it
at an early stage. In addition, socioeconomic differences in health are evident
for both females and males at every stage of the life-course (birth, infancy,
childhood and adolescence, and adulthood) and the relationship exists
irrespective of how SES and health are measured12.
BENEFITS
For the least well-off members of society it is the benefit system which is the
principal determinant of living standards. Studies of the budgeting
arrangements of poor families have shown that frequently living standards
such as nutrition are compromised when there is insufficient money to go
around and so placing health at risk13.
1. Dependent children of selected pensioners and beneficiaries as a

percentage of all children aged from 0-15 years by SLA.
A child, and additional children, presents a much greater impact on the
standard of living of people who are not well off than for better-off
households14. This indicator includes age, disability, newstart
allowance; sickness and special benefits; youth training allowance; sole
parent pensions and family allowance payments.
Potential use by PHS: indicator of magnitude of a community’s social
protection system (and at-risk population)
Geographic reporting unit: SLA
Last reported: Published by Soxail Atlas of Australia 1999
Data source: Department of Families data; ABS Labour Force Survey
data includes ‘children without an employed parent’ and is available on
request although not published
How could it be collected by PHS staff: available on request from
ABS
11
Turrell, G.; Oldenburg, B.; McGuffog, I. and Dent, R. (1999) op cit.
12
National Health Strategy (1992) Enough to Make you Sick: How Income and Environment
Affect Health. Canberra: National Health Strategy.
13
Acheson, D. (1999) Independent Inquiry into Inequalities in Health Report. London: The
Stationary Office, pp. 32-36.
14
Acheson (1999) op cit p. 33.
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2 Proportion of people receiving a pension by type of government

pension/allowance (principal and auxillary, full or part) by gender.
The differences in incomes between those people on means-tested
benefits and those with other sources of income are a major
determinant of income inequality 15.
Geographic reporting unit: Centrelink only sells processed data but
can provide any customised tables (as long as the numbers in each cell
exceed 20)
Last reported: Centrelink data sets and General Social Survey 2002.
ABS 1998 Cat No 4139.3
Data source: Centrelink; General Social Survey (ABS 1998 Cat No
4139.3) GSS processed data available April 2003; Microdata not
available until June 2003
Centrelink
3. Proportion of sole parent pensioners as a percentage of all

persons aged 15 years and over by gender.
Women are more likely than men to take primary responsibility for
caring for children and other family members. Improving the financial,
social and environmental conditions in which women in disadvantaged
circumstances care for their families is likely to be an essential part of
any strategy to reduce socioeconomic inequalities in health16.
Geographic reporting unit: Centrelink only sells processed data but
can provide any customised tables (as long as the numbers in each cell
exceed 20)
Last reported: Centrelink data sets (available on request)
Data source: Centrelink data sets
Centrelink
15
Kawachi, I.; Kennedy, B. and Wilkinson, R. (eds) (1999) The Society and Population Health
Reader: Income Inequality and Health. New York: The New Press.
16
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4. Unemployment benefits by region by sex.

There is good evidence that unemployment is detrimental to both the
physical and mental health of people and their families with long-term
unemployed people being especially at risk17 18. Men who experience
loss of employment are at increased risk of mortality from both cancer
and cardiovascular disease compared to employed men19.
Potential use by PHS: needs assessment (eg community needs);
project/program reach
Geographic reporting unit: Reports can be modified to suit eg sorted
by region types (eg State; LGA; Centrelink Service Centre) by sex by
time period. Data bases to be updated
Last reported: Quarterly 1998.
Data source: QRSIS Regional Statistics (Office of Economic and
Statistical Research) http://www.oesr.qld.gov.au/views/regional/qrsis/qrsis_fs.htm
How could it be collected by PHS staff: not applicable
DEATH RATES
Statistics relating to deaths are easily presented as crude death rates ie the
number of deaths in a year divided by the number of individuals in the
corresponding population.
5. Gender differentials in death rates across socioeconomic quintiles

for males and females aged 15 years old and above.
Men experience higher rates of serious illness, more disability, and die
earlier than women do. Mens mortality rates have consistently proved
to be higher than womens for most of the leading causes of death in
Australia20. Socioeconomic status has been implicated in differentials
in death rates for males and females21
Potential use by PHS: indicator of gender and socioeconomic
differentials in mortality of a community
Geographic reporting unit: Qld
Last reported: 1999 based on 1996 data
Data source: Social Atlas of Australia, Vol 4 Queensland
How could it be collected by PHS staff: via the data source; try
Census data also
17
Marmot, M. (1999) The Solid Facts: The Social Determinants of Health. Health Promotion
Journal of Australia, vol. 9, no. 2, pp. 133-139.
18
National Health Strategy (1992) Enough to Make You Sick: How Income and Environment
Affect Health, Canberra: National Health Strategy.
19
Morris, J., Cook, D, and Shaper, A. (1994) Loss of Employment and Mortality. BMJ, vol.
308, no. 6937, pp. 1135-1139.
20
Australian Institute of Health and Welfare (2000) Australia’s Health 2000. Canberra: AIHW
Cat No 19,
21
Queensland Health (2001) Social Determinants of Health – The Role of Public Health
Services. Brisbane: Public Health Services, Queensland Health, pp. 54-55.
17 of 50
EDUCATION
Generally, people with the worst health status have low education levels.
Education is important as it provides a route out of poverty. A strong
education system offers a significant contribution to society and ensures equal
opportunity for people in disadvantaged groups 22.
6. De-enrolment and retention rates in government and non-

government schools.
Early school leavers are disadvantaged by their high incidence of
unemployment; lower hourly earnings; lower incidence of full-time
employment23. The retention rate relates the number of students in a
year level in a particular year to the cohort's enrolment when it was in
some earlier year level. Year 8 has been used as the base. In effect,
the retention rate is a simplified method of showing the survival of a
particular cohort as it progresses through its schooling. However, it
does not allow directly for the impact of students skipping year levels,
repeats, migration and school leaving.
Potential use by PHS: indicator of impact of programs (eg Health
Promoting Schools programs)
Geographic reporting unit: Queensland
Last reported: 2000
Data source: The Corporate Data Warehouse, Education Queensland.
Will need to register with the ‘data warehouse’ to access smaller area
data. http://www.oesr.qld.gov.au/data/tables/compendium/table0540.htm
7. Proportion of highest level of schooling completed (highest

educational attainment) by age and gender for persons aged 15
years and over.
Education contributes to economic growth, facilitates socioeconomic
mobility, and improves social and individual wellbeing. Average
earnings and educational attainment are linked, such that the higher
the educational attainment, the higher the average earnings24.
Educational qualifications are a determinant of an individual’s labour
market position, which in turn influences income, housing and other
material resources. These are related to health and health inequalities.
Education is seen as a route out of poverty25.
22
Queensland Health (2001) op cit p. 26.
23
Speirings, J. (2000) Youth disadvantage: Some key indicators and future policy directions.
In, Massey, D. (ed) New Horizons in Education – The Journal of World Education Fellowship
Australia pp. 25-46.
24
ABS (2002) Australian Social Trends 2002: Education – Educational attainment: Education
and training: International comparisons. Australian Bureau of Statistics.
25
Acheson (1998) Independent Inquiry into Inequalities in Health. Department of Health pp.
35-44.
18 of 50
Potential use by PHS: can contribute to community profile

Geographic reporting unit: Collected with Census. Available for all
Census geographic areas from Collection District level to total Australia
Last reported: 1996; 2001
Data source: Australian Bureau of Statistics - Census data:
http://www.abs.gov.au/ausstats/abs%40census.nsf/4079a1bbd2a04b80ca256b9d002
08f92/fb0ad60108ae958cca256bc000145411!OpenDocument
How could it be collected by PHS staff: individual survey; Census
Data
8. Percentage of year five students achieving the national reading

benchmark.
Literacy skills are critical for coping effectively in our society. Among
other things, being literate allows people to assimilate information
about health. Adult literacy is also related to infant mortality26. This
indicator is incorporated in a yearly report to the Minister for Education
which covers: statewide and national comparisons regarding
Queensland students years three, five and seven, literacy and
numeracy skills of Indigenous students, students with A Language
Background Other Than English (LBOTE), students with an English
Speaking Background, rural and urban, and male and female cohorts.
Potential use by PHS: can be used for indicating literacy levels for
boys, girls, Indigenous and LBOTE students and impact of programs
(eg health promoting schools programs)
Geographic reporting unit: statewide and national comparisons
Last reported: Statewide Student Performance in Aspects of Literacy
and Numeracy (2000), p55
Data source: Queensland School Curriculum Council. Report to the
Minister for Education - Statewide Student Performance in Aspects of
Literacy and Numeracy (Queensland Years three, five and seven
Testing Program 2001
http://www.qsa.qld.edu.au/yrs1_10/testing_assessment/publications.html
26
National Advisory Committee on Health and Disability (1998) The Social, Cultural and
Economic Determinants of Health in New Zealand: Actin to Improve Health. Wellington, New
Zealand: the National Advisory Committee on Health and Disability pp. 28-30.
19 of 50
9. Percentage of year five students achieving the national numeracy

benchmark.
Both literacy and numeracy skills are related to social functioning and
health assessment 27 28. This indicator is incorporated in a yearly report
to the Minister for Education which covers: statewide and national
comparisons regarding Queensland students years three, five and
seven, literacy and numeracy skills of Indigenous students, students
with a Language Background Other Than English (LBOTE), students
with an English Speaking Background, rural and urban, and male and
female cohorts.
Potential use by PHS: can be used for indicating literacy levels for
boys, girls, Indigenous and LBOTE students and impact of programs
(eg health promoting schools programs)
Geographic reporting unit: statewide and national comparisons
Last reported: Statewide Student Performance in Aspects of Literacy
and Numeracy (2000), p57
Data source: Queensland School Curriculum Council. Report to the
Minister for Education - Statewide Student Performance in Aspects of
Literacy and Numeracy (Queensland Years 3,5 and 7 Testing Program
2001 http://www.qsa.qld.edu.au/yrs1_10/testing_assessment/publications.html
EMPLOYMENT
Employment is central to our role in society. People define themselves and

are defined through what they do for a living. Income is one of the main
determinants of poverty, which is closely linked to poor health. Income is
primarily derived from employment.
10. Labour force status by gender and age for persons aged 15 years
and over.
Employment, is a primary source of status in industrialised countries
while also significant in providing purpose, social support, structure to
life and a means of participating in society. Unemployment is potentially
a major risk to health for the working age population and their families29
Potential use by PHS: an indicator of community need, program
impact (eg employment initiatives) and basic information for community
profile
27
Estrada, C.; Barnes, V; Collins, C. and Byrd, J. (1999) Health literacy and numeracy.
JAMA, Vol 282 No 6 p. 527.
28
Woloshin, S.; Schwartz, L.; Moncur, M.; Gabriel, S. and Tosteson, A. (2001) Assessing
values for health: Numeracy matters. Medical Decision Making, Vol 21, No 5, pp. 382-90.
29
Acheson, D. (1999) op cit p. 44-50.
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How could it be collected by PHS staff: individual surveys; ABS
Census Data; Local Government Associations
11. Number of unemployed and unemployment rates,

States/Territories and Statistical Local Areas, June Quarter 2001
to June Quarter 2002.
Research has shown comprehensively, that a high prevalence of ill
health and excess mortality in men and women who are unemployed30.
The unemployment rate is calculated as a percentage of the labour
force, rather than of the entire population of working age. Health
problems associated with unemployment include depression and other
mental health problems, chronic illnesses such as cardiovascular
disease, and high levels of risk behaviours such as smoking. In
addition, unemployment impacts on health by reducing people’s ability
to purchase goods and services – such as adequate nutrition and
housing – and through its psychosocial effects, including lowered self-
esteem and loss of social networks 31
Potential use by PHS: can be used as community profile information
and needs of communities
Geographic reporting unit: This indicator presents estimates of
unemployment and the unemployment rate for each of the
approximately 1,300 Statistical Local Areas (SLAs), the smallest
available geographical units, on a State/Territory and Metropolitan/Non-
metropolitan basis. For the States, estimates for the Capital City and
the balance of each State are also provided
Last reported: Quarterly, March 2002
Data source: Department of Employment and Workplace Relations -
Publications-employment-labour market analysis-small area labour
markets. Dept Employment and Workplace Relations: Small Area
Labour Markets Australia June Quarter 2002 (p16-23).
http://www.workplace.gov.au/Workplace/WPDisplay/0,1251,a3%253D475%2526a0%
253D0%2526a1%253D517%2526a2%253D533,00.html
30
Bartley, M., Ferrie, J. and Montgomery, S. (1999) “Living in a High-Unemployment
Economy: Understanding the Health Consequences” in, Marmot, M. and Wilkinson, R. (eds.),
Social Determinants of Health, Oxford: Oxford University Press, pp. 81-104.
31
New South Wales Department of Health (2002) The Health of the People of New South
Wales. Report of the Chief Health Officer, 2002. NSW Department of Health, September, pp.
12.
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12. Trends in proportion of employed persons by industry by gender

and age.
The type of industry within a community can indicate potential
occupational hazards (eg mining, manufacturing) or the vulnerability of
a community to fluctuating fortunes (eg tourism). Some industries are
characterised by casualisation of labour (eg manufacturing and
tourism) or shift work with resultant health effects 32 33. The incidence
of low-paid employment (eg young people in the construction industry)
gives an indication of the differences across and within communities in
the distribution of earnings and income 34
Potential use by PHS: can indicate fluctuating employment (eg
communities with high tourism and incidence of high casual labour) and
hence socioeconomic status
13. Trends in unemployment rates by gender and age groups.

Unemployment and its accompanying health effects are not distributed
evenly throughout the population with unemployment rates being
highest among people aged less than 25 years, and higher in rural than
urban areas. Also, variation over time is a multifactorial phenomenon.
Potential use by PHS: can indicate fluctuations in socioeconomic
disadvantage
Geographic reporting unit: State
Last reported: ABS Labour Force Survey October 2002 (p30). ABS
Cat No 6203.0
Data source: Australian Bureau of Statistics – Census data
32
Theorell, T. (2000) ‘Working conditions and health’. In, Berkman, L. and Kawachi, I. (eds)
Social Epidemiology. Oxford: Oxford University Press, pp. 95-117.
33
Kasl, S. and Jones, B. (2000) ‘The impact of job loss and retirement on health’. In, In,
Berkman, L. and Kawachi, I. (eds) Social Epidemiology. Oxford: Oxford University Press, pp.
118-136.
34
Marmot, M., Siegrist, J., Theorell, T. and Feeney, A. (1999) “Health and the Psychosocial
Environment at Work”, in Marmot, M. and Wilkinson, R. (eds.) Social Determinants of Health.
New York: Oxford University Press.
22 of 50
14. Trends in participation rates by gender and age groups.

Participation rate refers to the labour force expressed as a percentage
of the civilian population aged 15 years and over35.
disadvantage for different age groups, by gender and by birthplace
Geographic reporting unit: Australia
Last reported: ABS Labour Force Survey October 2002. ABS Cat No
6203.0 (pp26-27)
15. Trends in long-term unemployment as a proportion of total

unemployed.
The impact of unemployment on health is thought to increase with the
length of unemployment, with many chronic physical and mental health
problems acting as barriers to re-employment 36
disadvantage associated with length of unemployment and by gender
Last reported: ABS Labour Force Survey October 2002. ABS Cat No
6203.0 (p32)
16. Trends in proportion of employed persons by gender and age.

Amount of esteem and social approval in interpersonal life largely
depends on the type of job, professional training, and level of
occupational achievement. Furthermore, type and quality of
occupation and especially the degree of self-direction at work, strongly
influence personal attitudes and behavioural patterns in areas that are
not directly related to work, such as leisure, family life, education, and
political activity 37.
Potential use by PHS: best practice assessments eg work
environments regarding effort and reward; control and demand issues
35
New South Wales Department of Health (2002) op cit p. 341.
36
37
Marmot, M.; Siegrist, J.; Theorell T. and Feeney, A. (1999) op cit pp. 105-131.
23 of 50

How could it be collected by PHS staff: ABS Census Data
17. Underemployment – Populations by State or Territory of usual

residence for September 2000. (Includes underemployed workers
by sex).
Underemployment may be time related (ie not working as many hours
as people would prefer) or through inadequate employment situations
(ie a persons skills/training may not be fully or appropriately utilised)38.
This indicator can reflect people who are socioeconomically
marginalised and who can exhibit characteristics of people who are
unemployed (see above).
Potential use by PHS: indicate fluctuations in socioeconomic
disadvantage associated with underemployment and by gender
Last reported: 1999
Data source: ABS Cat No 6265.0. The report includes Australian
labour force status for current and previous years including
underemployment status; employed persons; part-time workers who
want more work
http://datahub.govnet.qld.gov.au/ausstats/subscriber.nsf/Lookup/D5470CE2AA98FEC
BCA256A7700053010/$File/62650_sep+2000.pdf :
38
ABS (2001) Measuring Wellbeing: Frameworks for Australian Social Statistics. Chapter 6:
Work, p. 6. Canberra: Australian Bureau of Statistics.
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HEALTH EXPENDITURE
Total expenditure on health is the amount spent on health care goods and
services plus capital investment in health care infrastructure. Changes in
health expenditure over time can indicate changes in the level of goods and
services used, either from a population growth perspective or from more
intensive per person use of goods and services 39 and the sources of funding
for health care.
18. Health expenditure Australia 2000-01.

This is a collection of indicators on health expenditure and includes:
• health expenditure and the general level of economic activity
• health expenditure per person
• total health expenditure, by State and Territory
• sources of health expenditure
• broad trends in funding
• government sources of funds
• non-government sources of funds
• recurrent expenditure on health goods and services
• capital formation
• capital consumption by governments
• international comparison.
Potential use by PHS: assessment of health service usage; policy

implications; systems advocacy concerning health expenditure
Geographic reporting unit: the latest in an existing series of annual
reports on health expenditures for Australia plus time series data
covering the period from 1990-91 to 1999-00. Estimates of health
expenditure split by State and Territory are provided for each year from
1996-97
Last reported: AIHW 2001
Data source: Australian Institute of Health and Welfare (AIHW) 2002.
Health Expenditure Australia 2000-01. Health and Welfare Expenditure
Series No 14, Cat no HWE 20. Canberra: AIHW.
http://www.aihw.gov.au/publications/hwe/hea00-01/hea00-01.pdf
39
AIHW (2002) Health Expenditure Australia 2000-01. Health and Welfare Expenditure
Series no. 14. Cat. no. HWE 20. Canberra: AIHW. p. 58.
25 of 50
19. Trends in proportion of adults covered by private health insurance

in addition to Medicare.
The existence of a universal health insurance scheme in Australia
(Medicare) is important to ensuring equity. Since its introduction the
level of private health insurance has declined. It is based on a levy on
income, and so is progressive in that those who earn more pay more,
and everyone receives the same services40.
Last reported: Health Information Centre Omnibus Surveys 2001,
2002
Data source: HIC
How could it be collected by PHS staff: contact HIC direct or via your
public health unit research officer
20. Trends in proportion of adults holding a Health Care Card by card

type and gender.
Health Care Cards are provided for people receiving government
income support benefits (eg unemployment, sickness benefits) and
pensions (eg age pension) but is only available for over 18 year olds.
Last reported: Health Information Centre Omnibus Surveys 2001,
2002
Data source: HIC
How could it be collected by PHS staff: contact HIC direct or via your
Public Health Unit Research Officer
HOUSING COSTS
Shelter is a pre-requisite for health. However, people who are disadvantaged

suffer both from a lack of housing and from poor quality housing. In addition,
the fear of crime compounds the social exclusion of people living in
disadvantaged areas 41.
40
Baum, F. (2001) The New Public Health: An Australian Perspective. New York: Oxford
University Press, pp. 429-430.
41
Acheson (1999) op cit pp. 50-55.
26 of 50
21. Monthly housing loan repayment: Occupied private dwellings

being purchased.
As housing costs are generally a fixed expense of families, relatively
high housing costs leave less money for other budget items essential
for health such as a nutritious diet, education, transport, leisure
activities and health services 42.
Potential use by PHS: can indicate socioeconomic disadvantage and
as such is a component of community profiles
Last reported: ABS 2001
22. Weekly rent by landlord type: occupied private dwellings being

rented.
The need for affordable housing to address the health and wellbeing of
people less well off is essential 43. Cost and source of rental
properties can indicate areas of disadvantage.
Potential use by PHS: can indicate socioeconomic disadvantage and
as such is a component of community profiles
Last reported: ABS 1996; 2001
42
Queensland Health (2001) op cit. p32.
43
27 of 50
COMMUNITY CAPACITY
Community capacity incorporates information on characteristics of

communities that can influence health as it is recognised that individuals are
embedded in ‘societies’ and populations and consequently, ill health needs to
be considered in the social context. The greatest improvements in population
health are likely to be derived from addressing why some populations have a
particular distribution of risk. A social patterning can be seen. For example,
people who are poor, have low levels of education, and are socially isolated
are more likely to engage in a wide range of risk-related behaviours and are
less likely to engage in heath-promoting ones 44.
COMMUNITY SUPPORT SERVICES
Within a social determinants framework access to community support services

such as childcare, education, and health services is important for both short
and long term benefits. The notion of access to services is steeped in social
justice principles and is embedded within the National Health Performance
Framework45. Access is the capacity or potential to obtain a service and
incorporates concepts of geographical access, physical/architectural access,
cultural/linguistic access, service acceptability and affordability46.
23. Proportion of children receiving formal and informal care by State.

Child care refers to arrangements (other than parental care) made for
the care of children under 12 years of age. Formal child care is
regulated care which takes place away from the child’s home and
includes attendance at preschool, a child care centre, family day care
and occasional care. Informal care is care, which is non-regulated and
can take place in the child’s home or elsewhere. It includes care by
family members, friends, neighbours and paid babysitters. Parents
often use a combination of formal and informal arrangements to
provide for children’s care needs 47. Provision of high quality out-of-
home day care, especially if integrated with pre-school education, is
associated with improvement in a range of educational and social
measures. Since it is easier to combine paid work and family
responsibilities when parents have access to high quality day care, it is
a potential mechanism to alleviate family poverty for parents who wish
to combine work with parenting 48.
44
Queensland Health (2001) Social Determinants of Health: The Role of Public Health
Services – Summary Document. Brisbane: Public Health Services, Queensland Health.
45
Performance Indicators 2001. A report to the Australian Health Ministers’ Conference, p. 7.
46
Eagar, K.; Garrett, P. and Lin, V. (2001) Health Planning: Australian Perspectives. Crows
Nest: Allen & Unwin, pp. 17-18.
47
ABS (1999) Child Care. Cat No 4402.0, p. 3.
48
28 of 50
Potential use by PHS: This indicator is relevant for helping to

determine need for child care services in Queensland
Geographic reporting unit: States, Territories, Australia
Last reported: ABS 1999 Cat No 4402.0 p13
Data source: ABS Child Care Survey conducted throughout Australia
in June 1999. This survey is a continuation of a series of surveys on
this topic conducted since 1969. The previous survey was conducted
in March 1996
How could it be collected by PHS staff: Not applicable. Need to
access results of ABS Child Care Survey for data on both formal and
informal child care. See:
http://datahub.govnet.qld.gov.au/Ausstats/subscriber.nsf/Lookup/C827365E22F0613
CCA2568F50081F5B5/$File/44020_jun+1999.pdf
and Queensland Department of Families for data on Licensed Child
Care Services 49. See web site:
http://www.families.qld.gov.au/childcare/census2000.html
24. Distribution of health facilities by statistical division.

Access to effective primary care is influenced by several ‘supply’
factors:
• the geographical distribution and availability of primary care staff
• the range and quality of primary care facilities
• levels of training, education and recruitment of primary care staff
• cultural sensitivity, timing and organisation of services to the
communities served
• distance and the availability of affordable and safe means of
transport.
Communities most at risk of ill health tend to experience the least

satisfactory access to the full range of preventive services 50. Adults of
low socioeconomic status receive more health care than adults of
higher socioeconomic status 51.
Potential use by PHS: needs assessment concerning service
provision for communities
Geographic reporting unit: Reports generated through Queensland
Regional Statistical Information System (QRSIS) are flexible with this
particular indicator listing total health facilities (eg all, private hospitals,
public hospital beds, nursing homes, and community health facilities)
for Queensland statistical divisions
Last reported: 1999/00 (via QRSIS/Office of Economic and Statistical
Research (OESR)
49
Department of Families (2000) Child Care Census 2000: Licensed Child Care Services in
Queensland.
50
29 of 50
Data source: original data source is Queensland Health. QRSIS is

available through data hub at:
http://qhin.health.qld.gov.au/hic/csu/products/infobank/ib3.htm#subtopic6
25. Proportion of surveyed Queensland communities with limited

access to healthy food basket items.
A healthy diet is fundamental to the maintenance of good health and
well being. A range of factors can influence access including the cost
of food, family income, education, food preferences, quality and variety
of the food available 52.
Potential use by PHS: identification of vulnerable communities and
populations regarding access to healthy food choices, and evaluation
of statewide policies and programs to address food security issues
Last reported: 1998 HFAB Survey, Queensland Health
Data source: 2000 HFAB Survey, Queensland Health at:
http://qheps.health.qld.gov.au/PHS/Documents/shpu/9137a.pdf
How could it be collected by PHS staff: not applicable. The Healthy
Food Access Basket (HFAB) survey is a cross-sectional survey of the
costs and availability of basic food items, healthy food choices and
tobacco and take-away food items. The survey was carried out in 92
selected stores in locations with varying degrees of
accessibility/remoteness across Queensland
DEMOGRAPHY
Demography employs the concept of residency, which links people and

households to a place of usual residence. Age and sex are important
determinants of the health of individuals. The age and sex structure of
different populations and communities is reflected in their patterns of illness
and use of health services 53.
26. Collection of demographic indicators available through

Queensland Health.
This basket of indicators is available on Queensland Health’s Info Bank
for a number of categories including:
• Aboriginality eg Census Counts, Time Series: Indigenous
Population by Age, Sex and Statistical Local Area, Queensland
(based on 1996 SLAs), 1996
• Births - Selected Variables as per Perinatal Annual Report,
Queensland, 1987 to 1999
51
National Health Strategy (1992) op cit. pp. 12-13.
52
Queensland Health (2000) The 2000 Healthy Food Access Basket (HFAB) Survey.
Queensland Health, pp. 18-19.
53
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• Deaths eg Number and Age-specific Rate/100,000 by Chapters 54,

Age and Sex, Central Zone, 1997-2000
• Ethnicity eg Language Spoken at Home by Sex, SLA, District, and
CSR, Queensland, 1996
• Geography eg Census Postcodes & SLAs: Proportion of
Population by Postcode in each SLA in Qld (SD, SSD & District
identifiers), 2001; Description of the new District Service
Boundaries (& lists assoc. facilities), 1996
• Population-Census Counts eg Age (5yr gps) by Sex by
Postcodes, Qld 2001; Indigenous Population: Indigenous/Non-
Indigenous by Statistical Local Areas, Zone and Health Service
Districts, 2001
• Population-Estimated Resident eg ERPs 55: Age (5 yr gps) by
Sex, Health District and Zone, Qld., 2001
• Population Projections eg Projections based on ASGC 56 1996
from ABS by States and Qld., 1999 to 2019.
Specific demographic indicators available through InfoBank include
27. Indigenous population by age, sex and statistical local area (time
series)
28. Indigenous population by age (5yr gaps), sex, statistical local

areas and health service districts
29. Age (5 yr gaps) by sex by statistical local area and health service
districts, Qld
30. Births – selected variables as per Perinatal Annual Report, Qld
31. Proportion of population of postcode in each SLA in Qld (SD, SSD

and District identifiers)
Potential use by PHS: demographic information provides basic
community profile information in that they give a picture of a
community’s population distribution (including ethnicity, age, gender)
Geographic reporting unit: various, depending on indicator
Last reported: various – depending on specific indicator
Data source: Health Information Centre available through Info Bank at:
http://qhin.health.qld.gov.au/hic/csu/products/infobank/ib3.htm#subtopic6
How could it be collected by PHS staff: not applicable (collected by
HIC)
54
Chapters’ relates to ICD10 Chapters eg Class 1 – Infectious and Parasitic Diseases.
55
Estimated Resident Populations
56
Australian Standard Geographical Classification
31 of 50
ETHNICITY
A high foreign or foreign-born population creates both challenges and

opportunities to societies. Those who freely choose to live in a different
country and even culture from that of their birth tend to be better educated and
more dynamic, even entrepreneurial, than those who choose to remain at
home. On the other hand, new migrants may face problems in their daily lives
in their new country, from having to learn a new language, adjusting to a new
culture, to dealing with any racist attitudes from the resident population.
Some of these problems are also acute for second-generation migrants 57.
Survivors of torture and trauma come into Australia from a wide number of
countries and experience a diversity of physical and mental health problems
as a consequence of their experiences 58.
(nb also see indicators listed under ‘Population distribution – Demography’).
32. Ancestry by birthplace of parents.

This is an indicator of cultural origins and diversity within communities.
Groupings are by main geographic areas (eg Oceania) and sub-
groupings of origins (eg New Zealander).
Potential use by PHS: constitutes ethnicity component of community
profiles indicating cultural origins
33. Birthplace (countries) by sex.

This also is an indicator of cultural diversity of communities. For many
groups, particularly ethnic groups, culture is central to their health and
well being, quite apart from socioeconomic factors 59.
57
OECD (2001) op cit, pp. 28.
58
Queensland Health (2001) op cit pp. 43-44
59
Queensland Health (2001) ibid.
32 of 50
How could it be collected by PHS staff: ABS Census Data; individual

survey
34. Birthplace (regions) by sex.

This is a broad indicator of cultural origins based on broad geographic
regions (eg NW Europe) and sub-regions (eg UK, Ireland) of origin.
35. Distribution of Emerging Communities by Local Government Area.

Queensland is a culturally and linguistically diverse society comprising
over 120 ethnic communities. Some communities are large and well
established, due to a long history of migration to Queensland. Other
communities are relatively small and newly arrived and may lack the
“critical mass” to develop ethno-specific organisations, information
networks, services and advocacy strategies. Such emerging groups
may not be included in funding, planning and program development
avenues, and may lack advocacy and assistance adequate to the
communities’ needs60.
Potential use by PHS: this is an indicator reflecting emerging culturally
and linguistically diverse communities and hence changing needs
Geographic reporting unit: Queensland Local Government Area
Last reported: 2002 (based on 1996 Census data)
Data source: Multicultural Affairs Queensland (2002) New and
Emerging Communities in Queensland. MAQ, pp 45, Appendix 1.
http://www.premiers.qld.gov.au/about/maq/pdfs/nec.pdf
60
Multicultural Affairs Queensland (2002) New and Emerging Communities in Queensland.
MAQ.
33 of 50
36. Humanitarian entrants by birthplace and region of settlement.

Turbulence in the social and political situation within countries leads to
individuals and families being displaced from their homes. Refuge may
be sought in other countries. Refugees are defined as those who fall
under the various United Nations conventions, protocols or statutes on
this topic. Asylum-seekers are usually people whose applications for
refugee status are pending in the asylum procedure or who are
otherwise registered as asylum-seekers61. Humanitarian entrants are
frequently at risk of mental and physical health problems as a
consequence of their being displaced.
Potential use by PHS: this is an indicator reflecting emerging culturally
and linguistically diverse communities and hence changing needs
Geographic reporting unit: Brisbane, Moreton, Darling Downs,
Fitzroy, Mackay, Northern Queensland, Far North Queensland
Last reported: 2002 (based on 1996 Census data)
Data source: Multicultural Affairs Queensland (2002) New and
Emerging Communities in Queensland. MAQ, pp 16
http://www.premiers.qld.gov.au/about/maq/pdfs/nec.pdf
37. Language spoken at home by sex.

Migrants from other countries, ethnic minority groups, refugees and
people seeking asylum are particularly vulnerable to social exclusion,
and their children are likely to be at special risk 62. Language
difficulties may present a barrier to access to health care, social
services, affordable housing and employment.
61
OECD (2001) op cit pp. 30.
62
Wilkinson, R. and Marmot, M. (1998) The Social Determinants of Health: The Solid Facts.
WHO: p. 14.
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38. Proficiency in spoken English by year of arrival in Australia.

Changes in the leading languages spoken at home can reflect shifting
migration patterns within and between communities63. Also, see
‘Language spoken at home’ above.
profiles indicating cultural origins and changing migration patterns
between and within communities
FAMILY
The immediate family and the wider community are the context for individual
achievement in other areas of social concern. They are the arenas in which
children become socially responsible adults, and individuals gain a sense of
belonging 64.
39. Family type - families and persons in families in occupied private

dwellings (excluding overseas visitors).
An individual’s family is often their most fundamental source of
emotional, physical and financial care and support. Individuals and
families also receive support and care from the wider community.
Potential use by PHS: indicates family structures within communities
and is an important component of community profiles
63
64
ABS (2001) Measuring Wellbeing: Frameworks for Australian Social Statistics. Chapter 3:
Family and Community.
35 of 50
40. Weekly family income by family type: Families in occupied private

dwellings.
Families with relatively low living standards are of concern to
organisations that aim to minimise the effects of relative poverty on the
wellbeing of families 65. This indicator can indicate disadvantaged
communities.
Potential use by PHS: can indicate family and community
socioeconomic status and is an important component of community
profiles
HOUSING NEEDS
In some areas, the health impact of poor quality housing is combined with
neighbourhood problems such as substandard community services, high
levels of unemployment, inadequate public transport and recreational
facilities, environmental hazards and violence66. Homelessness is caused by
structural factors such as poverty, an inadequate supply of affordable housing
and unemployment. People may experience family, community or social
isolation as a consequence of, or a precursor to, homelessness67. In addition,
health problems faced by homeless people are often exacerbated by the
likelihood that health services may not be available to them because they
have no fixed address.
41. Estimated potential SAAP clients and unmet needs by gender, age
and State.
This publication is one of the Series 5 reports on the Supported
Accommodation Assistance Program (SAAP) National Data Collection
1999-2000. The series provides information on people who are
homeless and people who were at risk of being homeless who
accessed the SAAP in 1999-2000. Indicators include:
• support provided in 1999-2000 (provision of services; referral of
services)
• demand for accommodation (demand by clients; demand by
potential clients; meeting the daily demand)
• total assistance provided (daily assistance; one-off assistance)
65
ABS (1999) Australian Social Trends 1999. Income & Expenditure – Income Distribution:
Lower Income Working Families. Australian Bureau of Statistics.
66
Queensland Health (2001) op cit pp.32-33.
67
Commonwealth Advisory Committee on Homelessness (2001) Working Towards a National
Homelessness Strategy. Consultation Paper. CACH, p. 8.
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Potential use by PHS: important needs indicator for homelessness

Geographic reporting unit: in some cases State and Territory tables
are provided
Last reported: 1999-2000
Data source: Australian Institute of Health and Welfare (2001)
Demand for SAAP Assistance 1999-2000. A report from the SAAP
National Data Collection. Canberra: AIHW Cat No HOU 60. Online at
http://www.aihw.gov.au/publications/hou/saapndcar00-01qld/index.html
42. Dwelling structure - private dwellings and persons in occupied

private dwellings.
People without jobs and with family responsibilities and those with
special needs and outside the labour market graduate towards the
rented sector. Those with least choice gravitate towards the least
desirable dwellings and areas. Households living in these areas are
dependent on local facilities and low demand housing areas tend to be
poorly served by other services.
Potential use by PHS: An indicator of areas of deprivation
43. Dwelling structure by tenure type and landlord type: Occupied

private dwellings.
An indicator of home ownership, rental accommodation and public
housing in a community. Compared to owner-occupiers, people who
rent their home from a public or private landlord have increasingly
higher death rates68.
68
Shaw, M.; Dorling, D. and Davey-Smith, G. (1999) ‘Poverty, social exclusion, and
minorities’. In, Marmot, R. and Wilkinson, R. (eds) Social Determinants of Health. Oxford:
Oxford University Press, pp. 211-239.
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44. Number of SAAP support periods of accommodation on the 15th

of the month, by month and region, Queensland.
This indicator can indicate people in need of accommodation support in
a range of Queensland regions. The Supported Accommodation
Assistance Program (SAAP) was established in 1985 to consolidate a
number of Commonwealth, State and Territory government programs
designed to assist people who are homeless or at risk of being
homeless, including women and children escaping domestic violence69.
Potential use by PHS: important needs indicator for homelessness
Geographic reporting unit: Available on request from AIHW. Regions:
Remote and North-West; Cairns and Tablelands; Townsville and
surrounds; Mackay/Whitsundays; Central; Wide Bay Burnett;
Toowoomba and South-West; Caboolture and Redcliffe Peninsula;
Sunshine Coast; Brisbane; Ipswich/Logan; Gold Coast/Redlands
Last reported: AIHW 2001 (NB not a regular component of SAAP
report)
Data source: AIHW (2001) Demand for SAAP Assistance 1999-2000.
A report from the SAAP National Data Collection
AIHW
45. Distribution of private dwellings by type of occupancy (rented,

being purchased).
An indicator of community households including people who are
socially isolated. Can also be used to indicate homelessness in a
community as it picks up people living in improvised dwellings.
69
AIHW (2001) Demand for SAAP Assistance 1999-2000. A report from the SAAP National
Data Collection. Canberra: AIHW Cat No HOU 60, p. 1.
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46. State government housing assistance by program and type of

assistance, Queensland, 1988-89 to 1997-98.
A basket of indicators of people assisted with housing needs including
community housing. Parameters include:
• public rental housing
• Aboriginal and Torres Strait Islander Rental Housing
• community housing
• Private Housing Assistance
• Home Purchase Assistance
Last reported: 1997-98 Queensland Department of Housing
Data source: OESR:
http://www.oesr.qld.gov.au/views/statistics/products/surveys/qhs/qhs_fs.htm
How could it be collected by PHS staff: access through Queensland
Health - data hub
INCOME
Poverty, the extent of relative deprivation, and the processes of social

exclusion in a society have a major impact on the health of its population.
People who are worse off in socioeconomic terms have worse health
outcomes and higher death rates than people who are better off. It is not only
the case that the poorest in society have poor health, but a gradient of ill
health and mortality spans all socioeconomic levels. In addition, relative
deprivation, a concept that refers to the disadvantaged position of an
individual, family or group relative to the society in which they belong can
result in poor health70.
47. Distribution of weekly individual income by age and gender

(persons aged 15 years and over).
People on low income are more likely to be unemployed, lone parents
and their children, people with disabilities or pensioners and to live in
social housing. People on low income suffer disproportionately ill
health and higher rates of morbidity and mortality. They are also more
likely to have unhealthy behaviours such as inactivity, substance abuse
and be obese71 72.
70
Wilkinson, R. (1999) ‘Putting the picture together: prosperity, redistribution, health, and
welfare’. In, Marmot, M. and Wilkinson, R. (eds) Social Determinants of Health. Oxford:
71
National Health Strategy (1992) op cit.
72
Marmot, M. (1999) op cit.
39 of 50

48. Distribution of weekly household income by household type.

As per individual income but can also indicate individuals and families
in need.
Potential use by PHS: An indicator of areas of deprivation (eg
socioeconomic disadvantage; social isolation)
49. Population distribution by index of relative disadvantage Socio

Economic Indexes For Areas (SEIFA).
SEIFA were constructed by the Australian Bureau of Statistics, using
data from the 1996 Census of Population and Housing, to summarise
the social and economic conditions of Australia. SEIFA scores are
age-biased eg the Gold Coast is low because many variables are age
dependent eg educational attainment is lower in the elderly and income
does not take into account assets. Lower scores indicate lower
socioeconomic status73. The five indexes comprising SEIFA are:
1. Urban Index of Relative Socio-Economic Advantage
2. Rural Index of Relative Socio-Economic Advantage
3. Index of Relative Socio-Economic Disadvantage
4. Index of Economic Resources
5. Index of Education and Occupation.
Potential use by PHS: An indicator of areas of socioeconomic

disadvantage
Geographic reporting unit: The five index scores are available for a
number of different geographic areas, namely:
• Collection District (CD)
• Statistical Local Area (SLA)
• Legal Local Government Area (LGA)
73
Australian Bureau of Statistics (1998) 1996 Census of Population and Housing.
Socioeconomic Indexes for Areas. ABS Cat No 2039.0. Canberra: ABS.
40 of 50
• Statistical Sub-division (SSD)

• Statistical Division (SD)
• Postal Area (POA)
Last reported: 1996 [Australian Bureau of Statistics (1998) 1996
Census of Population and Housing. Socioeconomic indexes for areas.
ABS Cat. No. 2039.0. Canberra: ABS]
Data source: access through local Public Health Unit data managers,
research officer, epidemiologist, or the Health Information Centre. Also
through Info bank: http://165.86.8.41/hic/infobank/seifa/sla96.xls
50. Type of educational institution attending (full-time/part-time).

Education is an important strategy for reducing inequities. Those
groups in society with the worst health status, in general, have the least
education. People may face many barriers in gaining access to the
education system: insufficient resources to participate fully in the
school community, cultural alienation from the school system (likely to
be particularly acute for Indigenous and Non-English Speaking
Background (NESB) people), and pressures to leave formal education
in order to earn money74.
Potential use by PHS: can indicate educational resources and hence
contribute to community profile
Geographic reporting unit: Available for all Census geographic areas
from Collection District level to total Australia
Last reported: ABS 1996 Census
Data source: ABS Census data.
How could it be collected by PHS staff: Not applicable
SAFETY
Crime influences health. Areas with high crime rates tend to have higher
death rates, indicating that the social origins of crime - including social
disorganisation, income inequality, and low social capital – are causes of ill
health75. Personal violence and assault has direct effects on the physical and
mental health of victims and witnesses. Victims of property crime may suffer
psychological harm. Fear of crime may be a factor that limits enjoyment of
life. Crime and ill-health also share common causes. Indicators available
through the ABS General Social Survey are given below (see Indicators #51-
55).
74
Baum, F. (2001) The New Public Health: An Australian Perspective. South Melbourne:
75
Kawachi, I.; Kennedy, B. and Wilkinson, R. (1999) Crime, social disorganization and
relative deprivation. Social Science and Medicine, Vol 48, pp. 719-731.
41 of 50
51. Victim of assault in last 12 months.
52. Victim of break-in in last 12 months.
53. Victim of assault or break-in in last 12 months.
54. Victim of domestic violence in the last 12 months (source: Family

Services who funds a domestic violence service for NESB women:
the Immigrant Women’s Emergency Support Service).
55. Feelings of safety at home during day:
Potential use by PHS: identification of vulnerable communities

including possible social isolation as a consequence of fear of crime.
Also can indicate safe communities.
Geographic reporting unit: variable
Last reported: ABS 2003 General Social Survey (GSS). Results from
the GSS will be made available from April 2003 in the form of a national
level publication. Access to microdata is expected by June 2003
Data source: ABS GSS:
http://datahub.govnet.qld.gov.au/ausstats/abs%40.nsf/5e3ac7411e37881aca2568b00
07afd16/a45a323a76b94324ca256bd000286790?OpenDocument
56. Crime and Safety - Offences reported by police region and type of
offence, Queensland, 1991-92 to 2000-01.
Areas with high crime rates tend to have higher death rates, indicating
that the social origins of crime including social disorganisation, income
inequality, and low social capital are causes of ill health76.
Potential use by PHS: identification of vulnerable communities
including possible social isolation as a consequence of fear of crime.
Also can indicate safe communities
Geographic reporting unit: Queensland Police regions: Metropolitan
North (Brisbane Central, Brisbane West, North Brisbane and Pine
Rivers districts); Metropolitan South (Oxley, South Brisbane and
Wynnum districts); South Eastern (Gold Coast and Logan districts);
North Coast (Bundaberg, Maryborough, Gympie, Sunshine Coast and
Redcliffe districts); Southern (Charleville, Dalby, Ipswich, Roma,
Toowoomba and Warwick districts); Central (Gladstone, Longreach,
Mackay and Rockhampton districts); Northern (Mt Isa and Townsville
districts); Far Northern (Cairns, Innisfail and Mareeba districts)
Last reported: 1991-92 to 2000-01
Data source: Office of Economic and Statistical Research
http://www.oesr.qld.gov.au/data/tables/compendium/table0290.htm
42 of 50
SOCIAL SUPPORTS
A strong correlation exists between social supports and health status such
that people with diverse networks of quality, supportive relationships manifest
more robust health than people who are socially isolated77. Unequal societies
tend to be those with the lowest levels of community cohesiveness and loss of
the ‘social glue’ that holds groups together may have adverse consequences
such as violence, sexual exploitation and drug taking78.
57. Relationship in household by age by sex – Persons in occupied

private dwellings.
Social support networks improve health at home, work and in the
community. Social support and good social relations make an
important contribution to health. Social support helps give people the
emotional and practical resources they need and operates on the levels
of both the individual and society79. Social isolation and exclusion are
associated with increased rates of premature death and poorer
chances of survival after heart attack80.
Potential use by PHS: can indicate social networks including social
isolation
Last reported: ABS 1996, 2001 Census
Data source: ABS Census Data:
58. Religious affiliation by sex.

Religious membership can promote social cohesiveness and provide
social support with major health inequalities associated with religious
affiliation. Whether measured by group membership or by the degree,
to which a person participates in religious activities, the evidence
indicates that the more religious have a substantial health advantage81.
76
Kawachi, I.; Kennedy, B. and Wilkinson, R. (1999) op cit
77
Shumaker, S. and Czajkowski, S. (eds) (1993) Social Support and Cardiovascular Disease.
New York: Plenum Press.
78
Wilkinson, R. (1999) Health, hierarchy and social anxiety, Annals of the New York Academy
of Science, No 896, pp. 48-63.
79
Shumaker, S. and Czajkowski, S. (eds) (1994) Social Support and Cardiovascular Disease.
New York: Plenum Press.
80
Wilkinson, R. and Marmot, M. (1998) op cit pp. 20-21.
81
Najman, J. (2001) ‘A General Model of the Social Origins of Health and Well-being’. In,
Eckersley, R.; Dixon, J. and Douglas, B. (eds) The Social Origins of Health and Well-being.
Melbourne: Cambridge University Press, pp. 73-82.
43 of 50
Potential use by PHS: indicator of social support hence can help

identify support needs
Data source: ABS Census Data:
59. Social Capital (generalised reciprocity and cohesion; community

identity; generalised trust; tolerance of diversity; civic trust;
community involvement; informal social networks), Queensland.
Social capital has been described as "features of social organisation,
such as networks, norms and social trust that facilitate coordination and
cooperation for mutual benefit” 82. Social capital binds people together
and acts as the primary means of exchanging information, skills and
the help that we need in our daily lives. Social capital, in its many
forms, has both individual and collective aspects. It has been shown to
be strongly associated with health and wellbeing, as well as
educational performance, lower crime rates and economic prosperity.
Potential use by PHS: baseline data on community involvement, trust
and reciprocity in the Queensland population
Last reported: 2002 Public Health Services (Statewide Social Capital
and Omnibus Survey)
Data source: Public Health Services, Queensland Health; Health
Information Centre
TRANSPORT
People’s health is directly related to the conditions in which they live. One
factor shaping these conditions is transport, and the way in which it is
organised for people to gain access to goods and services.
82
Queensland Health (2002) Social capital: Interpersonal trust, reciprocity and community
involvement in Queensland (Draft Information Paper). Public Health Services, Queensland
Health, p1.
44 of 50
60. Method of travel to work by sex: Employed persons (excluding

overseas visitors).
Transport constitutes one of the major service requirements in cities
and suburbs and in rural and remote regions. It conveys many benefits
to society in terms of personal mobility for work and leisure; it increases
the number of choices for residential space and it serves as an
important ’lubricant’ to commerce and trade83.
Potential use by PHS: can indicate communities disadvantaged by
transport infrastructure and impacts on socioeconomic status and
social networks through limiting access to employment options and
networking
Data source: Australian Bureau of Statistics Census Data:
83
Queensland Health (2001) op cit pp. 34-35.
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Social Indicators For Addressing Health Inequalities

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Social Indicators

© Queensland Health, 2003

ISBN: 0 7345 2921 X

This document is available on the Queensland Health Internet site at:

For further information and copies contact:

Southern Public Health Unit Network

Ph: 07 3810 1500

Part 1: An Interpretative Guide.

Part 2: Social Indicators.

The socioeconomic sub-categories include: benefits; death rates; education;

WHAT ARE SOCIAL INDICATORS FOR?

Socioeconomic and community capacity factors are important determinants of

THE STRUCTURE OF THE INDICATORS

! Socioeconomic factors have been shown to have a clear association

! Community capacity incorporates information on characteristics that can

THE USE OF THE INDICATORS

The socioeconomic and community capacity indicators in themselves describe

Possible uses of the indicators include:

• providing baseline information on health determinants from which

A number of these indicators will be adopted and reported for whole-of-

• children and young people

This report will be produced in the Health Determinants Queensland report to

Figure 1: National Health Performance Framework

Health Status and Outcomes (Tier 1)

Source: National Health Performance Committee (2001) National Health Performance

DESCRIPTION OF THE INDICATORS

The chosen indicators are listed as either socioeconomic or community

• a brief rationale to illustrate their relevance to health and health

It must be acknowledged that the list of indicators is by no means

Due to the small population numbers in some geographic reporting areas eg

Furthermore, ABS randomises demographic cell entries of three persons or

1. Activation policies: Activation policies comprise a range of public

2. Ecological footprint: The Ecological Footprint6 measures the amount of

Components of the Ecological Footprint:

3. Healthy communities index: This indicator is based on the Tasmanian

Possible uses of the survey:

• to provide baseline health and wellbeing information from which

4. Income inequality: Income distribution statistics inform us about what is

5. Safe Communities indicators where safe communities have9:

• an infrastructure based on partnership and collaborations, governed by

It is anticipated that a review process will be adopted to assess the

1. Dependent children of selected pensioners and beneficiaries as a

2 Proportion of people receiving a pension by type of government

3. Proportion of sole parent pensioners as a percentage of all

4. Unemployment benefits by region by sex.

5. Gender differentials in death rates across socioeconomic quintiles

6. De-enrolment and retention rates in government and non-

7. Proportion of highest level of schooling completed (highest

Potential use by PHS: can contribute to community profile

8. Percentage of year five students achieving the national reading

9. Percentage of year five students achieving the national numeracy

Employment is central to our role in society. People define themselves and

Data source: Australian Bureau of Statistics - Census data:

11. Number of unemployed and unemployment rates,

12. Trends in proportion of employed persons by industry by gender

13. Trends in unemployment rates by gender and age groups.

14. Trends in participation rates by gender and age groups.

15. Trends in long-term unemployment as a proportion of total

16. Trends in proportion of employed persons by gender and age.

Data source: Australian Bureau of Statistics - Census data:

17. Underemployment – Populations by State or Territory of usual

18. Health expenditure Australia 2000-01.