Joanne Flavel | The University of Adelaide (original) (raw)

Papers by Joanne Flavel

All provider organisations with aged care funding for residential facilities and home care/home s... more All provider organisations with aged care funding for residential facilities and home care/home support outlets, were invited to participate in the 2016 NACWCS. Over 4,500 facilities and outlets and more than 15,000 aged care workers responded. Additional qualitative data focusing on newly-hired and mature-aged workers was obtained through in-depth interviews with a sample of 100 direct care workers. 2.1.2 Research Design and Implementation Research design The initial potential respondent lists were constructed from a set of Australian Government Department of Health lists of residential and home care and home support service providers within Australia. The lists comprised 2,952 residential services (Residential services, National Aboriginal and Torres Strait Islander Flexible Aged Care and Transition Care Program with residential places) and 5,442 home care/home support services (Home Care Packages program, the new Commonwealth Home Support Program (CHSP), HACC in Victoria and Western Australia, MultiPurpose Services (MPS), National Aboriginal and Torres Strait Islander Flexible Aged care and Transition Care Program with home care/home support places) 3 .

Health Promotion Journal of Australia, Jul 12, 2021

Issues addressedHow health promotion is implemented varies and it is often not clear what activit... more Issues addressedHow health promotion is implemented varies and it is often not clear what activities are in place in a region. Understanding the extent of health promotion activities helps planning activities.MethodsThis research involved a rapid audit of the types of health promotion activities in a suburban region of South Australia. This analysis was guided by the WHO Ottawa Charter's principles. To better understand population needs and which health promoting activities may help, an epidemiological, demographic and social determinants of health profile of southern Adelaide described disease patterns and health inequities.ResultsWhile there was evidence of a range of health promoting activities, most concerned individual or behavioural services. A key finding was the small number of activities that the state health department and local health system were responsible for. Alongside local government, NGOs provided the bulk of health promotion activities. In addition, there were no overarching health promotion strategies or coordinating bodies to evaluate the activities. The epidemiological, demographic and social determinants of health profile found persistent health and social inequities.ConclusionThis rapid audit of health promotion in a region enabled a quick assessment of the current health promotion situation and provided evidence of gaps and areas where policy change should be advocated.So what?The key findings distilled from this research were designed to inform policy priorities to shift health promotion in southern Adelaide onto a trajectory consistent with the Ottawa Charter and prevent further focus on individualised behaviour change strategies known as ‘lifestyle drift’.

The Medical Journal of Australia, Mar 22, 2022

The Lancet Public Health

Background A comprehensive understanding of temporal trends in the disease burden in Australia is... more Background A comprehensive understanding of temporal trends in the disease burden in Australia is lacking, and these trends are required to inform health service planning and improve population health. We explored the burden and trends of diseases and their risk factors in Australia from 1990 to 2019 through a comprehensive analysis of the Global Burden of Disease Study (GBD) 2019. Methods In this systematic analysis for GBD 2019, we estimated all-cause mortality using the standardised GBD methodology. Data sources included primarily vital registration systems with additional data from sample registrations, censuses, surveys, surveillance, registries, and verbal autopsies. A composite measure of health loss caused by fatal and non-fatal disease burden (disability-adjusted life-years [DALYs]) was calculated as the sum of years of life lost (YLLs) and years of life lived with disability (YLDs). Comparisons between Australia and 14 other highincome countries were made. Findings Life expectancy at birth in Australia improved from 77•0 years (95% uncertainty interval [UI] 76•9-77•1) in 1990 to 82•9 years (82•7-83•1) in 2019. Between 1990 and 2019, the age-standardised death rate decreased from 637•7 deaths (95% UI 634•1-641•3) to 389•2 deaths (381•4-397•6) per 100 000 population. In 2019, noncommunicable diseases remained the major cause of mortality in Australia, accounting for 90•9% (95% UI 90•4-91•9) of total deaths, followed by injuries (5•7%, 5•3-6•1) and communicable, maternal, neonatal, and nutritional diseases (3•3%, 2•9-3•7). Ischaemic heart disease, self-harm, tracheal, bronchus, and lung cancer, stroke, and colorectal cancer were the leading causes of YLLs. The leading causes of YLDs were low back pain, depressive disorders, other musculoskeletal diseases, falls, and anxiety disorders. The leading risk factors for DALYs were high BMI, smoking, high blood pressure, high fasting plasma glucose, and drug use. Between 1990 and 2019, all-cause DALYs decreased by 24•6% (95% UI 21•5-28•1). Relative to similar countries, Australia's ranking improved for age-standardised death rates and life expectancy at birth but not for YLDs and YLLs between 1990 and 2019. Interpretation An important challenge for Australia is to address the health needs of people with non-communicable diseases. The health systems must be prepared to address the increasing demands of non-communicable diseases and ageing. Funding Bill & Melinda Gates Foundation.

Health Policy

Previous research on commercial determinants of health has primarily focused on their impact on n... more Previous research on commercial determinants of health has primarily focused on their impact on noncommunicable diseases. However, they also impact on infectious diseases and on the broader preconditions for health. We describe, through case studies in 16 countries, how commercial determinants of health were visible during the COVID-19 pandemic, and how they may have influenced national responses and health outcomes. We use a comparative qualitative case study design in selected low-middle-and high-income countries that performed differently in COVID-19 health outcomes, and for which we had country experts to lead local analysis. We created a data collection framework and developed detailed case studies, including extensive grey and peer-reviewed literature. Themes were identified and explored using iterative rapid literature reviews. We found evidence of the influence of commercial determinants of health in the spread of COVID-19. This occurred through working conditions that exacerbated spread, including precarious, low-paid employment, use of migrant workers, procurement practices that limited the availability of protective goods and services such as personal protective equipment, and commercial actors lobbying against public health measures. Commercial determinants also influenced health outcomes by influencing vaccine availability and the health system response to COVID-19. Our findings contribute to determining the appropriate role of governments in governing for health, wellbeing, and equity, and regulating and addressing negative commercial determinants of health.

International Journal of Environmental Research and Public Health

This paper outlines practical tips for inclusive healthcare practice and service delivery, coveri... more This paper outlines practical tips for inclusive healthcare practice and service delivery, covering diversity aspects and intersectionality. A team with wide-ranging lived experiences from a national public health association’s diversity, equity, and inclusion group compiled the tips, which were reiteratively discussed and refined. The final twelve tips were selected for practical and broad applicability. The twelve chosen tips are: (a) beware of assumptions and stereotypes, (b) replace labels with appropriate terminology, (c) use inclusive language, (d) ensure inclusivity in physical space, (e) use inclusive signage, (f) ensure appropriate communication methods, (g) adopt a strength-based approach, (h) ensure inclusivity in research, (i) expand the scope of inclusive healthcare delivery, (j) advocate for inclusivity, (k) self-educate on diversity in all its forms, and (l) build individual and institutional commitments. The twelve tips are applicable across many aspects of diversity...

Australian Journal of Social Issues

Analyses of the prevalence of homelessness suggest homelessness is increasing in Australia and ot... more Analyses of the prevalence of homelessness suggest homelessness is increasing in Australia and other countries. Yet, difficulties exist in obtaining an accurate picture of homelessness due to a dearth of robust data and inconsistent definitions. This study aimed to build a comprehensive descriptive profile of homelessness and associated health needs in Adelaide. Five data sources were analysed and compared to produce descriptive sociodemographic and health statistics. Across data sources, people experiencing homelessness had a high prevalence of poor health outcomes and service utilisation. Consistent with the international literature, high rates of physical and mental health conditions were reported, including depression, anxiety and dental problems. While there was variability in demographic data, Aboriginal and Torres Strait Islander peoples were consistently over‐represented. Analysing data from multiple sources provided a richer understanding of who is experiencing homelessness...

The Lancet Infectious Diseases

Background The global burden of lower respiratory infections (LRIs) and corresponding risk factor... more Background The global burden of lower respiratory infections (LRIs) and corresponding risk factors in children older than 5 years and adults has not been studied as comprehensively as it has been in children younger than 5 years. We assessed the burden and trends of LRIs and risk factors across all age groups by sex, for 204 countries and territories. Methods In this analysis of data for the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we used clinician-diagnosed pneumonia or bronchiolitis as our case definition for LRIs. We included International Classification of Diseases 9th edition codes 079.6, 466–469, 470.0, 480–482.8, 483.0–483.9, 484.1–484.2, 484.6–484.7, and 487–489 and International Classification of Diseases 10th edition codes A48.1, A70, B97.4–B97.6, J09–J15.8, J16–J16.9, J20–J21.9, J91.0, P23.0–P23.4, and U04–U04.9. We used the Cause of Death Ensemble modelling strategy to analyse 23 109 site-years of vital registration data, 825 site-years of sample vital registration data, 1766 site-years of verbal autopsy data, and 681 site-years of mortality surveillance data. We used DisMod-MR 2.1, a Bayesian meta-regression tool, to analyse age–sex-specific incidence and prevalence data identified via systematic reviews of the literature, population-based survey data, and claims and inpatient data. Additionally, we estimated age–sex-specific LRI mortality that is attributable to the independent effects of 14 risk factors. Findings Globally, in 2019, we estimated that there were 257 million (95% uncertainty interval [UI] 240–275) LRI incident episodes in males and 232 million (217–248) in females. In the same year, LRIs accounted for 1·30 million (95% UI 1·18–1·42) male deaths and 1·20 million (1·07–1·33) female deaths. Age-standardised incidence and mortality rates were 1·17 times (95% UI 1·16–1·18) and 1·31 times (95% UI 1·23–1·41) greater in males than in females in 2019. Between 1990 and 2019, LRI incidence and mortality rates declined at different rates across age groups and an increase in LRI episodes and deaths was estimated among all adult age groups, with males aged 70 years and older having the highest increase in LRI episodes (126·0% [95% UI 121·4–131·1]) and deaths (100·0% [83·4–115·9]). During the same period, LRI episodes and deaths in children younger than 15 years were estimated to have decreased, and the greatest decline was observed for LRI deaths in males younger than 5 years (–70·7% [–77·2 to –61·8]). The leading risk factors for LRI mortality varied across age groups and sex. More than half of global LRI deaths in children younger than 5 years were attributable to child wasting (population attributable fraction [PAF] 53·0% [95% UI 37·7–61·8] in males and 56·4% [40·7–65·1] in females), and more than a quarter of LRI deaths among those aged 5–14 years were attributable to household air pollution (PAF 26·0% [95% UI 16·6–35·5] for males and PAF 25·8% [16·3–35·4] for females). PAFs of male LRI deaths attributed to smoking were 20·4% (95% UI 15·4–25·2) in those aged 15–49 years, 30·5% (24·1–36·9) in those aged 50–69 years, and 21·9% (16·8–27·3) in those aged 70 years and older. PAFs of female LRI deaths attributed to household air pollution were 21·1% (95% UI 14·5–27·9) in those aged 15–49 years and 18·2% (12·5–24·5) in those aged 50–69 years. For females aged 70 years and older, the leading risk factor, ambient particulate matter, was responsible for 11·7% (95% UI 8·2–15·8) of LRI deaths. Interpretation The patterns and progress in reducing the burden of LRIs and key risk factors for mortality varied across age groups and sexes. The progress seen in children younger than 5 years was clearly a result of targeted interventions, such as vaccination and reduction of exposure to risk factors. Similar interventions for other age groups could contribute to the achievement of multiple Sustainable Development Goals targets, including promoting wellbeing at all ages and reducing health inequalities. Interventions, including addressing risk factors such as child wasting, smoking, ambient particulate matter pollution, and household air pollution, would prevent deaths and reduce health disparities.

Australian Journal of Primary Health

Background Studies show widespread widening of socioeconomic and health inequalities. Comprehensi... more Background Studies show widespread widening of socioeconomic and health inequalities. Comprehensive primary health care has a focus on equity and to enact this requires more data on drivers of the increase in inequities. Hence, we examined trends in the distribution of income, wealth, employment and health in Australia. Methods We analysed data from the Public Health Information Development Unit and Australian Bureau of Statistics. Inequalities were assessed using rate ratios and the slope index of inequality. Results We found that the social gradient in health, income, wealth and labour force participation has steepened in Australia, and inequalities widened between the quintile living in the most disadvantaged areas and the quintile living in the least disadvantaged areas. Conclusion Widening income, wealth and employment inequalities have been accompanied by increasing health inequalities, and have reinforced and amplified adverse health effects, leading to increased mortality in...

Medical Journal of Australia

the project: Explaining the increase in health inequities in South Australia: Trialling a case st... more the project: Explaining the increase in health inequities in South Australia: Trialling a case study to understand the influences of social and economic performance.

Health Promotion Journal of Australia, 2021

International Migration, 2021

Employment is a key aspect of resettlement, and research has shown that it is highly valued by pe... more Employment is a key aspect of resettlement, and research has shown that it is highly valued by people with refugee and asylum seeker backgrounds. However, less is known about the employment experiences and programmes available specifically to women from these backgrounds. This commentary paper draws upon three data sources – the Building a New Life in Australia longitudinal survey, a desktop review of employment programmes and interviews with service providers – to explore these issues for women with refugee and asylum seeker backgrounds in Australia. Specifically, we discuss the relatively poor record of employment for refugee women compared to men, and highlight the limitations of current employment programmes, in particular, the lack of available programmes specifically targeted to women. We conclude that there is an urgent need to consider specific ways to support women with refugee and asylum seeker backgrounds to enter the workforce in Australia.

International Journal of Care and Caring, 2018