This was the third session at the Advocacy Sector Conversations forum held at St Michael’s Hall on 9 July 2019.
The VicHealth Indicators survey is conducted every 4 years. It’s a population-level survey focused on behaviours and attitudes associated with chronic disease risk. The findings show inequities in health and wellbeing exist between Victorians with a disability and those without. VicHealth consulted with organizations working to improve outcomes for people with disability in Victoria around what could be done to address these inequities. Maya Rivis, Manager Health Promotion Operations at VicHealth, shares key insights from this consultation along with an overview of the survey’s findings.
Scroll down to the bottom of this post to find links to resources mentioned in this presentation.
Transcript & Audio
MELISSA HALE, DARU COORDINATOR:
Thank you everybody. Our next session is from Maya Rivis, the Manager of Health Promotions Operations at Vic Health who will be talking about the Vic Health Indicators Survey on Disability. Welcome Maya.
MAYA RIVIS, VICHEALTH:
Thank you Melissa. Thank you for the opportunity to come and present today. My name is Maya Rivis as Melissa said, I’m the Manager of Health Promotion Operations at Vic Health. The reason I’m here to talk with you is that health equity comes under my remit as does the Vic Health Indicators Survey which this is part of.
I will start by saying I’m relatively new to my role so even though these come under my remit I might sound a bit scratchy as I get my head around what they exactly are. I’m just going to walk to and from to change the slides as we go.
Just to start off a little bit about Vic Health. We’re a health promotion agency, we’ve been around since 1987 so just over 30 years. We originally and still are actually, our mandate for being is in the Tobacco Act. We originally started out 30 something years ago buying out tobacco sponsorship.
We’ve come a long way from then even though smoking rates have declined a long way there is still a long way to go. We work across a whole lot of different areas. We work across we call them five imperial areas, they’re essentially five focus areas. We look at physical activity, mental well-being, alcohol, tobacco and mental well-being.
We also have what we call cross imperative strategy so they’re the things that work across all of those and health equity is one of those. We do a lot of research and we do work in the arts. We’ve been doing work in the arts since we were established as an organisation. In fact we bought out tobacco sponsorship in arts which seems amazing that that was the case, smoke could be part of the arts.
Health equity is a big part of what we do. We say it’s at the heart of what we do. We know that the biggest factor that influences somebody’s health is actually the social determinants of health. So someone’s individual choice as to what they do plays very little in terms of the impact on their health. Our health equity strategy and our fair foundations framework is what we work by has a huge focus on the social determinants on health.
We say as an organisation and it’s up there in the second dot point, we want good health and well-being for everyone regardless of cultural background, gender, sexual orientation, disability or ability, income and location of where they live. We know this isn’t the case. Our vision ideally is what we’re aiming for is that everybody is equal in terms of their health outcomes.
The reason I’m here to talk to you today is about some of the results we got from our last Vic Health Indicator Survey in 2016. This survey is a population health survey. We interviewed via telephone about 20,000 Victorians. The main reason was to get a sense of what they were doing in terms of their health, their attitudes around health and behaviours around health.
Specifically why I’m here today is because we asked one question around disability and it was hard to decide what question we were going to ask. We asked whether the respondents had a disability health condition or injury that has lasted or is likely to last six months or more which restricts their everyday activities.
When we were working through what questions we would ask we did look at what other questions were asked across other population health surveys. The ABS, Australian Bureau of Statistics has a scale. When you do these population, caddy surveys, the telephone surveys you can only ask so many questions because if you ask too many people hang up in the end.
The number of questions we ask is really restrictive. In a lot of our work whether it be mental well-being, physical activity we try and condense down and ask single item questions. There are limitations to that and I will talk about that soon.
In terms of the overall result, just really high level, one in three people that we surveyed responded yes to that question. They viewed themselves as having a disability or injury that actually impacted their life in the last six months. That is different to what the national survey showed and that showed one in five had a disability. The difference there is we’re just using different questions.
Those with a disability were more likely to be older, born in Australia, declared they were Aboriginal or Torres Strait Islander, report less income, lower education and more unemployment and more likely to live in rural Victoria. It just means more likely it doesn’t mean everybody that fits those categories has a disability.
What I’ve done in the next few slides is just broken into the imperative areas we work across. I’ve just broken it down into our imperative areas. Just looking at mental well-being, physical activity, healthy eating and alcohol. For those people that reported having a disability, only half were as likely to feel safe when they were walking at night, 25% less likely to feel positive about their local neighbourhood.
The reason we ask these questions it’s actually really important for peoples mental well-being to feel connected to their neighbourhood and to feel safe walking at night. Scored lower in satisfaction of life as a whole and that’s a series of questions we ask and we come up with a score to see how satisfied people are with life. Scored lower for subjective well-being and had lower levels of resilience.
Just keep in mind I’m going to talk a little bit later about what we did in response to these findings. But mental well-being was a huge – there was a massive difference between those Victorians who have a disability and those that don’t.
In terms of physical activity, when compared to people without a disability with a disability were 40% less likely to be physically active and the gap widens with age, and gender. And are less likely to participate in both organised and non-organised physical activity. Again, of our imperative areas we focus on at Vic Health again there is a significant gap between those with a disability and those without a disability.
In terms of healthy eating, men with a disability were 1/3rd more likely to eat take away food more regularly than men without. People with a disability consumed slightly less fruit and vegetables than those without a disability. In terms of alcohol those who reported having a disability actually drank less at risky levels, they were 25% less likely to be drinking at risky levels.
In terms of high risk levels, in alcohol we talk about short term harms and long term harms. The short term harms are things like you get drunk and fall over and hurt yourself. If you have five or more drinks you put yourself at greater risk of hurting yourself because you’ve had too much to drink in that single session.
We say when people drink eleven or more drinks they are at really high risk. In the survey we asked people about five drinks and then eleven drinks because we know eleven is really risky. It was interesting those that reported having a disability there was no difference between those with or without in terms of drinking at really high risk levels. I don’t know what that means, it’s just that’s what it shows.
Essentially it just shows, the report shows that there are inequities between those people who have a disability and those that don’t in terms of health. What next, is the question. In my work because we do a lot of research and we do a lot of surveys I feel that we’re really good at describing issues but when it comes to actually addressing them we can probably do a little bit better.
At the end of this, once we did the extra analysis for the disability supplement it was okay we know this what do we do with it now. One thing I did fail to say at the start is that at Vic Health we’re not experts in disability. Health equity is our remit and we know people with disabilities experience poorer health outcomes and that’s why we’re interested in this space. But in terms of working directly with people with disability that’s not our area of expertise.
What we did, is we went out and spoke to those organisations that actually have more expertise than us. Those organisations that actually have the health and well-being of people with a disability at the core of their work. This is just a list here of the people we went out and consulted with because we wanted to have a response to what the data was showing.
When we went to consult with these organisations we really focused mainly on mental well-being and physical activity because that’s what the data showed us being where there were the biggest gaps. We went to these organisations and said if we’re going to improve the health outcomes of people with a disability in relation to mental well-being and physical activity what should we do.
With all the consultation that we did, and we met individually and in groups, we synthesised the information we were getting and we could break it into these four but I actually think there is five dot points here. The very first one that’s not listed is we need to get better at collecting data that can be interrogated more so we can understand the different types of disabilities and how that’s playing out in terms of health outcomes.
Then the activities or the risk behaviours, the things that are impacting on people’s health. At the moment the one item question that we used in Vic Health indicators is quite crude because we can’t differentiate between disability type and we can’t really differentiate between the lifestyle factors that are potentially impacting their health.
Even though it’s good to include the question but we’ve actually got to do better next time. One of the recommendations after talking to all the organisations we talked to was we need to get better whether it be Governments collecting data or researchers doing research in having better questions to ask so we can have clearer more nuance data.
Another one was off course changing attitudes, community attitudes around disability. To do that it was suggested we need to change the way disability is represented in the media. I’ve just come from a NAIDOC week launch. We have an Aboriginal Torres Strait Islander person on our board and she was just saying there is a need to always represent Aboriginal people in all our publications. I feel it’s the same for people with a disability. We’re going to be changing attitudes and social norms around the way people see disability, we’ve got to be representing that well in all our publications.
We’ve also got to create more opportunities to participate in community, sporting and recreation activities by ensuring that the environments are welcoming. We are doing a little bit of work in this space and I’ll talk about that soon. We also need to ensure there is ways to participate in decision making, advisory and planning bodies. We also need to make sure there are peer support networks and self-advocacy groups for people with a disability to improve their health outcomes.
What is Vic Health doing; we had the survey, we spoke to organisations with expertise that was better than our own. Now we’ve got to go and make some actions. I’m just going to talk very briefly about our Fair Foundations Framework.
It’s set up like a tree. It has the root system at the very bottom so what are those things that affect our health the most. They are our social and economic policies, those cultural drivers that influence what we do. If we can get those big macro things right then our health or our trees are more likely to flourish.
Half way up the trunk we have daily living conditions. This is like what happens to us every day our work environment, our education environment, even the design of the streets that we’re in that will impact out health. That’s about half way, of the trunk because that’s going to have impact on our health.
The very top where the leaves are where we flourish is our individual attitudes, behaviours. What it’s trying to show is you have to work on these foundational things to be able to flourish at the top of the tree.
At Vic Health our health equity approach includes those bottom, the root causes, the social determinants of health and that’s actually really hard to do. I’m sure I’m not telling you anything new but we all think we need to provide targeted programs. We need to provide opportunities for people to participate which is more at the top of the tree.
In terms of what we’ve done for that more targeted approach sponsorship in 2011 and 2015 we provided some money to sporting organisations to improve opportunities for people with disability to participate in sport. Since then we’ve supported several community and sporting clubs to actually increase opportunities as well.
We’ve done a little bit beyond sport so in our recent Bright Futures Challenge which is a mental well-being program, we’ve provided funding for a program called Band Mates. That’s where people with a disability can go out and actually enjoy live music and live music venues.
Pleasingly but I can’t announce today because it’s going to be announced mid-July we’re funding three more programs out of our innovation challenge recently that are specifically focused to people with a disability.
I feel we’re doing okay. Everyone can always do better. We’re doing okay in providing some opportunities for people with disability to participate whether it be through arts, or through sport. But what we need to get better at which I will show on the next slide is that social determinants of health.
So where we want to do more work is in the middle layer and the bottom layer of the Fair Foundations Framework. We know we’ve got to provide better daily living conditions for people with a disability and we’ve also got to change the social and cultural and economic policies that influence our daily lives, every day to make a difference.
We know we can’t do those things on our own. What we can do is probably what I showed in the last slide, we can fund some programs to increase opportunities for people with a disability to participate in sport nights but where it gets a little bit harder is us influencing the daily living conditions and social determinants of health.
Over the course of the next four years we’re really trying to get interested. We want to partner with more people. We’re going to start with our immediate partners, our partners we work with all the time in health promotion and public health and we want to expand that to address those social determinants of health more broadly.
That’s it in terms of the presentation, just providing the overview of what the data is showing, some of the programs that we’re funding and some of the things we would like to do. I’m happy to take questions now.
Me again, I was one of the people that did the survey, had a rather bored person on the other end of the phone. One of the things that I found particularly frustrating as an LGBTIQ person is that you had to answer whether you identified as male or female to continue with the survey.
It was only half way through that you could actually explore what your identity meant for you and answer in a non-binary sense in relation to gender and actually explore LGBTIQ health outcomes and identities.
I’m just wondering about how some of these programs are addressing the fact that a lot of us have intersectional identities and aren’t just a person with a disability or aren’t just LGBTIQ and how we’re looking at additional levels of disadvantage or minority stress and how that might be impacting on health and what we’re doing at the intersections of those spaces?
Thank you for those questions. To be one of those 20,000 people interviewed it’s nice to hear someone was interviewed but at the same time I’m concerned there was that issue at the start you had to identify as one or the other.
I am told that’s been rectified and we did a lot of work to make the options not just be binary and going forward they would no longer be. It meant that trans and gender diverse Victorians there was very low levels of responding to the survey because people just dropped out.
So there is a mistake and we will fix that next time. In terms of your other questions, again really good question. Probably the best way for me to respond to that is just to acknowledge we are really good at siloing or single issuing those things where people are complex.
I don’t mean complex in a bad way but there’s a lot that makes up a human and we’re not just low SES, we’re not just someone with a disability, we’re not just an age. I think historically the way we analyse our surveys is by demographics. Then we expand them a little bit more and we know that that’s actually a flaw but I don’t know if it’s got a response to that. Anything there is a journey.
We are here and we need to get to here. I think the fact that we’re aware that we need to be more sophisticated in our understanding of human behaviour and actually asking people the things that are influencing their lives, their health and their well-being is a good start. But I have to admit it’s a complex road to get from here to here. I don’t think it will be a short journey.
Probably even the way we are structured as public health clinicians or health promotion practitioners is we generally focus on one area, so we have an area of expertise. We need to be more generalist to understand the complexities of life. I can say we are slowly moving in that direction and I hope we move there quicker is my response.
I will say one final thing and I will definitely hand the microphone over to other people. From a disability rights perspective, I think understanding the social determinants of disability is a really important step. That question for me being the only question that encompasses my experience as a person with a disability comes from a very medical model understanding of impairment. Understanding impairment as a deficit based thing that is impacting my life where we need to understand it as a social issue of rights and discrimination. I’d love to see a question that moved towards that because I would give a very different answer.
Okay that’s really interesting and I know in our supplements, so I’ve only just presented the high level findings from the Vic Health Indicator Survey but we have published the supplement. It talks about the difference between the physical model and the social model. I don’t know if it says to move from one to the other but acknowledges there are social influences that we need to acknowledge.
There is another question just down here.
Just with regard to the determinants I remember working in public health maybe 20 years ago, we also had a focus on environmental determinants or ecological determinants. In terms of intersections, one of the great intersections is place, is landscape, is climate and how eco systems are performing has a huge impact on the health of human beings. First of all is there a reason why that’s not in your foundations?
Look I’d say it is it’s just not called out as much as it needs to be. I’d say it’s in the smaller font, the smaller text as opposed to the larger text. It’s certainly acknowledged that – and probably where it does come out and I hope I’m interpreting your question properly because I think you’re talking about the built environment, where we live – no.
It’s multifaceted but it’s also climate as well so that’s part of it. How is Vic Health preparing some of the most vulnerable people for climate as well as the social issues? The social issues have been around for a long time we know what they are but we’re living in the 21st Century. We need to engage these things that we began talking about in the 70s, we need to be really engaging them now.
It needs to be lifted I think outside the small font into the large.
I agree. I think the daily living conditions, our built environment in which we live is that middle layer the daily living conditions. Absolutely environment matters and we’re again early in our journey to incorporating it in here, but we acknowledge that environmental change so climate change is going to have the greatest impact on the most vulnerable population. We say that without any hesitation and that concerns us a lot. It definitely need to be in there.
There are some groups, Sustainability Victoria and VCOSS are doing some fantastic work in terms of trying to advocate on climate change purely because of the impacts on vulnerable populations and we need to get there too.
Recently there was a big health promotion, Public Health World Conference in New Zealand and one of the communicates out of that was we need to start thinking about what we’re doing about climate change. Absolutely, it’s just not there yet and it needs to be.
My second question is a conceptualisation question. It’s similar to what was the previous speaker. In a sense people with a lived experience of mental illness always had kind of a discussion at least if not a debate about whether it’s an illness or not. The first question is does Vic Health define, you talk about mental well-being but do you also use a medical model when you’re defining mental illness?
Yes, we don’t talk about mental illness, we talk about mental well-being. We don’t use a medical model at all. We say that we are in a space of talking about well-being not illness.
Then the second thing that’s come into vogue with the NDIS is if you call something mental illness for example as a social construct then do you call it a disability or not. Is that a disability, and I just noticed on your disability list of organisations there were none associated with mental health or mental illness?
Yes, good question and I’m not sure how to respond to that either. I can make a comment though. I was at the consultation for the next Victorian Public Health and Well-being Plan. They had listed on their risk factors as mental illness. Someone says mental illness is not a risk factor, it’s not someone ‘s choice. Everything else up there was something that someone would choose to do.
I think we’ve got to get our terminology right and I don’t think I can respond properly yet to that. I think I need to give that more thought.
Just relating to what Darryl was saying I think coming from a mental health organisation perspective, from VMIAC you would’ve actually captured a lot of people with mental illness in that broad question about disability. Has your intervention like you said, looking at mental well-being has it addressed taking people with mental illness to concerts, or getting them involved with exercise and sports? That’s a huge area where people with psychosocial disability are missing out and need support to do those things. Is that something that’s on your radar?
We would certainly say people with a psychosocial disability are someone we would like to support. Band Mates I’m not sure, I don’t know who is actually participating in that so I couldn’t answer. I don’t know if I’ve answered your question properly.
Just adding to that, the life expectancy of people with mental illness is very much shorter than the broader population. I definitely think that it should be a part of the disability sphere.
Yep. I wish I could provide better responses it’s just not my area of expertise. It’s a difficult space. We would include anyone disability or not really. We would hope that we’re reaching everyone. We just do targeted programs to hopefully reach those that don’t necessarily get reached by our broader pieces of work that have more of a general population focus.
The beauty of coming to events like today and getting questions is it makes us think. Now, absolutely psychosocial disability and I don’t want to call it a disability, it’s something we need to be thinking about and making sure we’re filling that space.
We’re absolutely aware and I’ve worked for a long time in tobacco control many years ago about the impact of smoking on the life expectancy of people with a mental illness and how we needed to do more. In fact for a long time we just said it was good for people which is absolutely horrendous. At least we’re changing from there. I don’t think I’m giving great questions, but what I want to say is I’m hearing you and it will inform what we do in the future.
Thank you very much Maya. A fun fact, you were talking about sporting grant and support you give, one of the support Vic Health gives us is for my deaf womens cricket team. One of the fun facts about that is its enabled us to capture young deaf girls and it’s been absolutely life changing for them to have access to older deaf women, mentors. It’s brought them their lives. Vic Health is really doing some really great stuff in the sporting space.
Thank you for that. Like you said it’s just the beginning and hopefully we can all go along on this journey with you and get some really good data out of it. Thank you very much.
VicHealth Supplementary Report Disability (off-site)Download presentation slideshow
- Date published:
- Tue 9th Jul, 2019