The shifting sands of community needs: Re-thinking place based interventions

It is timely to think about the implications of the release of the 2016 census data, which is highly anticipated by Governments, researchers, commissioners, service providers, and all those with a specialist interest.

The census provides policy makers with highly detailed intelligence about the communities that they serve.  In particular, it provides information on the demographic composition and the social and economic features of communities – enabling services to be targeted to specific needs of local areas.

The current economic and demographic shifts across metropolitan Australia are providing interesting challenges for Australian, State and Territory Governments. 

Australia’s community is dynamic with significant changes underway across the country:

• Continued strong population growth in Melbourne – with five of the top 10 growing municipalities nationally located in metropolitan Melbourne. This is driven by strong interstate and overseas migration, however many parts of regional Victoria continue a slow population decline.
• Tasmanian interstate migration has turned around.  After five years of outflows to other States, Tasmania is now a net importer of people from across Australia.
• The decline of the residential property market in greater Perth and Darwin with a seven per cent and 10 per cent decline in the residential property value respectively since 2015.
• A rapid increase in net interstate migration from Western Australia and South Australia.  In the case of Western Australia, 7,700 more people departed Western Australia than arrived in 2015/16, an increase from 1,962 in 2014/15.  The softening of the mining boom of the early 2010’s is likely to be a key contributor.

The identification of communities of high need for government services is facilitated through interrogation of a range of information: hard data from bodies such as the ABS and the Australian Institute of Health and Welfare, as well as sensing community sentiment.

A case in point is the difficulty experienced by social policy planners in targeting services in the gentrifying suburbs of inner Melbourne and Sydney.  These areas often demonstrate the features of:

• rapid population growth through residential in-fill of former industrial areas, and construction of high-density housing
• declining average age of the community through the internal migration of young adults
• increasing overall socio-economic profile through higher income levels and educational attainment.

At face value it all looks rosy. However, hidden in the good overall figures are the sustained populations of highly disadvantaged people.  A key output from the census is the publication of the Socio-Economic Indexes for Areas (SEIFA).  These indices rank areas in Australia according to their relative socio-economic advantage and disadvantage.  Tracking the indices over time clearly shows the reduction in relative disadvantage across many inner-city areas, but leaving pockets of the most disadvantaged. 

What can be done to address this?

The use of “place based” approaches to addressing disadvantage have been used as program design feature across many jurisdictions.  Place based approaches target services to communities most at need, often through coordination of delivery across multiple agencies.  Some of the programs are undoubtedly successful, but sustainable change and improvement in health outcomes across the communities remains difficult to prove – often hidden in the broader demographic change across these communities, and the long lead time for translation of primary prevention initiatives to improved health status.

It is time for new thinking – and the release of 2016 census information could be a stimulus for renewed action.  The question to pose now is, how can policy makers stimulate a new approach to the planning and delivery of services – that targets the delivery of services to those most in need?

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Stephen Gow is the founder and Managing Director of Open Advisory Pty Ltd which a specialist health system planning advisory service based in Melbourne. Open Advisory works with clients to explore system planning, workforce, and design questions, drawing from professional insights derived from extensive work across Australia and internationally. Stephen Gow can be contacted at stephen@openadvisory.com.au and followed on twitter at @gow_stephen.