Melbourne School of Population and Global Health - Theses
Permanent URI for this collection
Search Results
1 - 1 of 1
-
ItemComparing health services access across regions of Melbourne: a case study of diabetes services( 2017)Introduction Melbourne, located in Victoria, has some of the fastest growing municipalities in Australia with the population in Melbourne growing from a current 4.5 million residents to an estimated 8 million by the year 2050. Much of this population growth is occurring in urban growth areas up to 50-100kms away from the central business district (CBD), as well as infill areas across inner and middle suburbs of Melbourne. Infrastructure in urban growth areas, such as health services, may be lacking if they are not built and delivered simultaneously alongside housing. Access to health services is a key social determinant of health (SDOH). As urban growth areas develop, there will be greater requirement for health infrastructure and services to be located in these areas in order to meet the increasing demand of the growing population and to ensure equitable access to services. Primary health care services, such as general practitioners and pharmacists, serve the majority of health care needs for consumers across Melbourne. However evidence suggests that a higher density of such services exists within inner and middle suburbs of Melbourne. This means residents living more centrally likely have greater access to primary health care services compared with those living in outer suburbs and urban growth areas. Previous studies have shown inequities of access to health services exists in rural compared with city areas, however there is little published research about access to health services in urban growth areas compared with established areas of cities. Type 2 diabetes mellitus (T2DM) is a major chronic health condition in Australia, with some of Melbourne’s urban growth areas having some of the highest prevalence across Australia. People with T2DM are required to frequently access a number of primary and secondary health care services. Using T2DM as a disease case study, this research explores travel times to diabetic health care services for populations residing in inner, middle and outer suburbs of metropolitan Melbourne. Currently, little is known about differences in travel times when using private and public transport to access primary and secondary health care services across Melbourne generally and Melbourne’s urban growth areas. Therefore, this research aims to examine the extent to which inequities exist when accessing health services for T2DM across Melbourne for both private and public transport. Method A literature review was undertaken which considered access to health care services in urban growth areas with a focus on spatial and social access. Penchansky and Thomas identify five domains of health care access being: availability, accessibility, accommodation, affordability and acceptability. This research focused on spatial accessibility to health services for T2DM. The study area was metropolitan Melbourne divided into five regions of inner, middle, outer established, outer urban growth areas and outer fringe areas. Diabetic health services of interest were identified through Diabetes Australia Victoria and included general practitioners, optometry, pharmacy, podiatry, dieticians, endocrinologists, diabetic educators and physiotherapists/exercise physiologist. Following this geographic information systems (GIS) software was used to map the location of selected diabetic primary and secondary health care service providers across metropolitan inner, middle, outer established, outer urban growth and outer fringe areas of Melbourne. An origin-destination matrix was used to estimate travel distances from point of origin (using a total of approximately 50,000 synthetic residential addresses) to the closest type of each diabetic health care service provider (destinations) across Melbourne. ArcGIS was used to estimate travel times for private transport and public transport, and comparisons were made by area. Results This research indicated increased travel times to diabetic health services for people living in Melbourne’s outer urban growth and outer fringe areas compared with the rest of Melbourne (inner, middle and outer established). Compared with those living in inner city areas, the median time spent travelling to diabetic services ranged between 2.46 and 23.24 minutes (private motor vehicle) and 12.01 and 43.15 minutes (public transport) longer for those living in outer suburban areas. Compared with middle suburbs it was 1.1 minutes and 21.22 minutes (private motor vehicle) and 8.29 minutes and 40.62 minutes longer (public transport) for those living in outer suburban areas. Irrespective of travel mode used, results indicated that those living in inner and middle suburbs of Melbourne have shorter travel times to access a range of diabetic health services, compared with those living in outer areas of Melbourne. Private motor vehicle travel times were approximately four to five times faster than public transport modes to access diabetic health services in all areas. Discussion Plan Melbourne refresh, Melbourne’s foremost strategic land use document, outlines the need for a 20-minute city. This is where essential services such as primary health care can be accessed within a 20 minute trip across Melbourne; this research highlights health services inequity gaps when accessing essential primary health care services. Key social infrastructure planning documents such as the Australian and Social Recreation Research (ASRR) document Planning for Social Infrastructure in Growth Areas and the Growth Areas Social Planning Tool (GASPT), consider health services planning in a broader context of planning for social services. Neither tool has been validated to test their efficacy when planning health services in urban growth areas. Evaluation of these tools is required to help plan for equitable access to health services in urban growth areas. Those living in urban growth communities spend considerably more time travelling to access essential diabetic health services, particularly specialists’ services, than those living in established areas across Melbourne. To increase equity of access more specialist diabetic services, in particular, are required in outer suburban areas. Given that Melbourne is in a time of planning for its forecasted population growth, examining current access to health services for common and increasing non-communicable diseases could ensure equitable health services access. To reduce health services access inequities gaps, integrated planning is needed, where health services are planned alongside transport system and land use planning. Integrated planning allows for health services provision closer to people’s homes thus reducing travel times and increasing equity of access for those who rely on public transport, additionally integrated planning will provide better access to these services by public transport. As the population in urban growth areas continues to expand and the demographic profile changes, further investigation is warranted to explore alternative ways to delivery diabetic health services to people living in these areas.