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An analysis of health and socio-economic indicators in Southern Adelaide, comparing them with Greater Adelaide, South Australia, and Australia. data on housing tenure, median weekly household income, educational attainment, labour market indicators, and health outcomes such as premature mortality and chronic conditions. The authors acknowledge the contributions of various organizations and people in conducting this research.
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CRICOS No. 00114A
Healthy South: Testing the feasibility of the rapid translation of Health in All Policies (HiAP) ideas to create healthy urban environments, create health promoting health services and stem the non-communicable disease epidemic in the Southern area of Adelaide received one-year funding through approved disbursements from the Medical Research Future Fund (MRFF) Rapid Applied Research Translation Program. The Healthy South Project wishes to acknowledge the MRFF and Commonwealth Department of Health and Health Translation SA in supporting the aim to adapt a whole of community approach to creating health, wellbeing and low risk environments for non-communicable diseases.
Suggested citation: Flavel J, Baum F, Musolino C, Freeman T, van Eyk H. Healthy South: Population Health and Social Determinants in Southern Adelaide. Southgate Institute for Health, Society and Equity. 2020. https://www.flinders.edu.au/content/dam/documents/research/southgate-institute/Population-health- and-social-determinants-in-southern-adelaide-report.pdf
Enquiries or comments about this report should be addressed to:
The Southgate Institute for Health, Society and Equity, GPO Box 2100, Adelaide, SA, 5001
Phone: +61 8 7221 8428 or email: joanne.flavel@flinders.edu.au
The authors would like to acknowledge the following organisations and people for their contributions:
We also thank Healthy South project team members Maria Barredo, Matt Fisher, Colin MacDougall, Michael McGreevy, Anna Roesler and Carmel Williams for their advice.
ABS Australian Bureau of Statistics
AIHW Australian Institute for Health and Welfare
IEO Index of Education and Occupation
IER Index of Economic Resources
IRSD Index of Relative Socio-economic Disadvantage
LGA Local Government Area
LHN Local Health Network
PHA Population Health Area
PHN Population Health Network
PHIDU Public Health Information Development Unit
SALHN Southern Adelaide Local Health Network
SAMSS South Australian Monitoring and Surveillance System
SAPHS South Australian Population Health Survey
SEIFA Socio-Economic Indexes for Areas
SLA Statistical Local Area
experts id.com.au. The .id sourced content is a derivative of ABS Data from the Census of Population and Housing, which can be accessed from the Australian Bureau of Statistics at www.abs.gov.au, and licenced on terms published on the ABS website. The authors have verified these data against the relevant ABS Census of Population and Housing statistics where relevant.
The epidemiological profile highlights the worse health outcomes experienced by people living in disadvantaged circumstances. The major non-communicable diseases and risk factors affect people with lower socioeconomic status, lower income and/or lower education at higher rates. Median age of death is higher in Southern Adelaide than the median for Australia, and average rates of premature mortality are comparatively lower, but there is a social gradient in both health indicators. The epidemiological profile also illustrates the likely adverse implications of the ageing population for burden of disease in the South. Older age groups have higher rates of many chronic diseases. This report was completed amidst the COVID-19 pandemic and we note that the emerging evidence globally indicates that people with chronic
Social determinants of health and health inequity
The profile of social determinants of health sheds light on probable drivers of health inequities in Southern Adelaide.
Higher variations in socioeconomic status, more limited access to resources and fewer social and economic opportunities can influence the health of people living in areas of disadvantage within these LGAs. There is a clear need to address equity and social determinants of health to improve population health in Southern Adelaide.
This report describes demographics, disease patterns and social determinants of health in southern Metropolitan Adelaide. The South of Adelaide is an area with relatively low average incidence of socioeconomic disadvantage, high average life expectancy and has areas with lower premature mortality than the South Australian average. The South is however, faced with challenges. The population in Southern Adelaide is older than the national average, older than Greater Adelaide, and the age profile is projected to become increasingly older at a faster rate than for the rest of the state. The older population brings an increasing burden of age-related diseases. Non-communicable diseases are on the rise, and variations in health outcomes result in people living in lower socioeconomic areas experiencing the poorest outcomes.
The South of Adelaide is comprised of four Local Government Areas (LGAs): Holdfast Bay, Marion, Mitcham and Onkaparinga. This is the government region definition and local health network classification. These classifications place the LGA of Unley as part of the Central Adelaide region but Unley’s geographical location south of the city of Adelaide and the Unley-Mitcham regional approach to planning for public health situate Unley as part of Southern Adelaide. For these reasons this report profiles all five LGAs, examining differences between the Southern LGAs and differences between average characteristics in the South compared with Greater Adelaide, South Australia and Australia.
This report is part of the Healthy South project which was funded for 12 months in 2019 by the Medical Research Future Fund (MRFF) Rapid Applied Research Translation Program and led by the Southgate Institute for Health, Society and Equity at Flinders University. The purpose of this report is to provide an epidemiological profile of the population in Southern Adelaide to describe disease patterns and health inequities in order to inform health promotion efforts. It is structured in three parts each presenting a different profile:
There are relationships and interdependencies between each part of the report, and the range of indicators and analysis of these indicators reflects this.
The Area and Population As per 2018 ABS estimates, the total resident population of Southern Adelaide is 407,277 (Table 1). The largest LGA in terms of both size and population is Onkaparinga. Unley and Holdfast Bay are the most densely populated LGAs, followed by Marion and then Mitcham. The traditional custodians of Southern Adelaide are the Kaurna Aboriginal people.
Table 1: Population, Land Area and Population Density of southern Adelaide LGAs, 2018 (Data source: Regional Population Growth, Australia, ABS, 2017-18)
Population Land Area (Km 2 ) Population Density (persons per Km 2 ) Holdfast Bay 37,032 13.8 2683. Marion 92,308 55.6 1660. Mitcham 67,253 75.5 890. Onkaparinga 171,489 518.1 331. Unley 39,145 14.3 2737. Southern Adelaide 407,277 677.3 601. Note: Population numbers are Estimated Resident Population
In the 2016 Census 51.5 per cent of people in Southern Adelaide were female and 48.5 per cent were male (4). There were 4,373 Aboriginal and Torres Strait Islander peoples, representing 1.1 per cent of the population. In Southern Adelaide 28.3 per cent of people were born overseas, and the highest proportions of overseas countries of birth were England, China (excluding SARs^1 and Taiwan), India, Scotland and New Zealand (4). Within Southern Adelaide the LGAs of Marion, Holdfast Bay and Unley are
(^1) SARs are special administrative regions of China.
Key findings: Demographic Profile
predominantly residential areas, while Mitcham is a residential and semi-rural area and Onkaparinga is an urban and rural area (5).
Summary Measure of Socioeconomic disadvantage The ABS Index of Relative Socio-Economic Disadvantage (IRSD) ranks areas in terms of relative socioeconomic disadvantage. A low score on this measure for an LGA indicates a high proportion of people living in relatively disadvantaged circumstances within that area. The ABS broadly defines relative socioeconomic disadvantage as “people’s access to material and social resources, and their ability to participate in society” (6). The IRSD is therefore a useful summary indicator of area disadvantage and can provide insights into socioeconomic disadvantage and its relation to social outcomes, which in turn influence the social gradient in health.
Table 2 presents IRSD scores and rankings for LGAs in the South of Adelaide in 2016. Higher IRSD rankings represent relatively lower incidence of disadvantage. There are 544 LGAs within Australia, and 70 LGAs within South Australia. Holdfast Bay, Mitcham and Unley are areas with a relatively low incidence of people living in disadvantaged circumstances. Unley, Mitcham and Holdfast Bay have very high IRSD rankings. All three LGAs are in the 10 th^ (least disadvantaged) decile within South Australia, and Mitcham and Unley are both in the 10 th^ decile within Australia. Onkaparinga and Marion have relatively lower IRSD rankings, but their scores still put them in the 6 th^ and 7 th^ deciles.
Table 2: LGA Index of Relative Socio-economic Disadvantage for southern Adelaide LGAs, 2016 (Data Source: Socio-economic Indexes for Australia (SEIFA), ABS, 2016)
Ranking within Australia Ranking within SA Score Rank Decile Percentile Rank Decile Holdfast Bay 1043 480 9 89 64 10 Marion 1001 377 7 70 48 7 Mitcham 1068 508 10 94 67 10 Onkaparinga 987 318 6 59 42 6 Unley 1066 507 10 94 66 10 Note: Higher numbers for both scores and rankings represent a lower incidence of relative disadvantage. There are 544 LGAs within Australia, and 70 LGAs within South Australia.
The IRSD scores provide an indication of the average relative levels of socioeconomic disadvantage for the five LGAs but there are variations in socioeconomic disadvantage within each LGA. The highest and lowest ranked SA2^2 in each LGA illustrates the uneven and unequal distribution of resources within LGAs (6).
(^2) SA2 is statistical areas level 2, an ABS classification that replaced statistical local areas (SLAs) in 2011. SA2s are designed to represent gazetted suburbs or rural localities.
Box 1.2: Interpreting deciles
Deciles divide the population areas into ten equal groups which are then ranked according to levels of disadvantage in each group. The 1 st decile represents areas with the highest level of disadvantage while the 10 th^ decile contains areas with the lowest level of disadvantage.
Box 1.1: Interpreting SEIFA rankings
Higher scores in SEIFA rankings of disadvantage represent a lower level of disadvantage in an area. Higher rankings likewise represent a lower level of disadvantage. For example, an LGA that is ranked in the 94 th^ percentile has lower disadvantage than 94 per cent of LGAs in Australia. Mitcham is ranked 67 out of 70 LGAs in Australia, which means that Mitcham has a incidence of disadvantage that is lower than 66 of the LGAs within South Australia.
Figure 1: Age Distribution of Southern Adelaide, 2001 and 2016 (Data source: Adelaide PHN Community Profile)
The population in Southern Adelaide was older than that for Greater Adelaide^5 and for Australia as a whole in 2016 (5). Population projections suggest that the age profile of the population in Southern Adelaide will become increasingly older^6. The overall population is projected to increase by 10 per cent by 2031, but the 70 years and older age group is projected to increase by 62 per cent by 2031 (10) This is higher than the projected increase for Adelaide (52 per cent) or South Australia (51 per cent) (10).
There are differences in age structure of LGAs within Southern Adelaide. All five LGAs had a higher proportion of people in the older age groups aged 60 and over in 2016 compared to Greater Adelaide and Australia.
There are important differences in the age profile of some groups within the Southern Adelaide population. The median age of Aboriginal and Torres Strait Islander people was 21 years in 2016 (10).
Household Types A consideration of household types in conjunction with age structure provides a better picture of age- related demographics. The distribution of household type in Southern Adelaide in 2016 was similar to
(^5) Greater Adelaide is the region bordered by Victor Harbor and Goolwa in the south, the Barossa Valley in the north,
the Gulf of St Vincent in the West, and the River Murray in the East. (^6) Projections are for the Southern Adelaide Local Health Network area and therefore exclude Unley.
-5.
-9.
-8.
-9.
-13.
-22.
-12.
-7.
-9.
-2.
25 20 15 10 5 0 5 10 15 20 25
0 to 4
5 to 11
12 to 17
18 to 24
25 to 34
35 to 49
50 to 59
60 to 69
70 to 84
85 and over
2001 2016
that for Greater Adelaide (Table 3). The high proportion of lone person households is noteworthy, particularly given the ageing population that suggests an increase in the number of older people living alone. The baby boomer generation is the first generation with high rates of separation and divorce which has resulted in a higher proportion entering their older years without a spouse (9).
There was a higher proportion of lone person households in Southern Adelaide (26.1 per cent) compared to the Australian average of 22.8 per cent. The proportion of lone person households in Australia increased between 1986 and 2016, from 19 per cent to 24 per cent (11).
The proportion of couple families has fallen, and there has been an increase in single parent families in Australia, from 6.5 per cent in 1976 to 10 per cent in 2016 (11).
Table 3: Household Type in Southern Adelaide, Greater Adelaide and Australia, 2016 (Data Source Adelaide PHN Community Profile)
Southern Adelaide Greater Adelaide
Australia
Household type Number % % % Couples with children 45,479 28.8 28.7 30. Couples without children 40,912 25.9 24.8 24. One parent families 16,719 10.6 11.1 10. Other families 1,728 1.1 1.2 1. Group household 5,451 3.5 3.8 4. Lone person 41,190 26.1 26.2 22. Other not classifiable 5,126 3.2 3.4 4. Visitor households 1,309 0.8 0.9 1. Total households 157,914 100.0 100.0 100. Note: Enumerated households. Excludes persons counted in non-private dwellings (e.g. residential aged care facilities)
Holdfast Bay had the highest share of lone person households of the five Southern Adelaide LGAs in 2016 (Table A2 in Appendix 1).
A third of all households in Holdfast Bay were lone person households, much higher than the average for Greater Adelaide and Australia. Unley and Marion also had relatively high shares of lone person households (29 per cent a 28 per cent respectively) (5). Onkaparinga had the highest proportion of single parent families in Southern Adelaide, at 12.7 per cent (5). This is also higher than the average for Greater Adelaide and for Australia.
Mitcham had the highest share of couples with children in Southern Adelaide (34 per cent) (5). These differences in distribution of household type between LGAs have implications for social determinants of health and will be discussed further later in the report.
The trend of more people living alone, especially with age, has been noted as of particular concern as this heightens risk of poverty and housing stress (12). The proportion of the baby boomer generation living alone is twice as high as the previous generation (9). Baby boomers have lower rates of home ownership compared to the previous generation, resulting in a higher percentage who are renting than was the case
Table 6: Dwelling Type in Southern Adelaide LGAs, per cent, 2016 (Data Source: Adelaide PHN Community Profile)
Dwelling type Holdfast Bay Marion Mitcham Onkaparinga Unley Separate house 49.1 67.6 78.8 88.1 57. Semi-detached, townhouse, etc.
Flat or apartment 11.4 0.0 0.6 0.2 3. Caravans, cabin, houseboat 0.2 0.1 0.0 0.5 0. Other 0.3 0.1 0.1 0.1 0. Not stated 0.3 0.3 0.4 0.2 0. Total Private Dwellings 100.0 100.0 100.0 100.0 100. Note: Enumerated dwellings
Housing tenure in an area can be an indicator of housing affordability and socioeconomic status. The level of outright home ownership in Southern Adelaide in 2016 was a little higher than that of Greater Adelaide and the Australian average, and Southern Adelaide had a slightly higher proportion of households with a mortgage (Table 7). The proportion who are renting in Southern Adelaide was lower than for Greater Adelaide and the Australian average, and particularly for private rental. This may reflect a mix of age structure, household types and dwelling types. Lower density housing can be associated with a lower share of renters, and an older population composed of older couples and families might indicate a larger proportion purchasing or owning their home. The decline in home ownership in Southern Adelaide between 2001 and 2016 followed the national and South Australian trend and was only partially offset by an increase in the proportion of households with a mortgage (4). The increase in the total share of households renting (private and social housing) has been driven by an increase in households in the private rental market. The level of social housing fell in Southern Adelaide between 2001 and 2016, again mirroring the national and South Australian trend.
Table 7: Housing Tenure in Southern Adelaide, 2001 and 2016 (Data source: Adelaide PHN Community Profile)
2001 2016 2016 Tenure type Number % Number % Greater Adelaide %
Australia % Fully owned 55,141 39.3 48,721 30.8 29.6 29. Mortgage 46,387 33.0 58,179 36.8 35.1 32. Renting-All 32,645 23.2 39,648 25.1 28.0 29. Social Housing 9,549 6.8 7,880 5.0 6.2 4. Private 22,586 16.1 31,202 19.8 21.4 24. Other tenure type 2,255 1.6 2,780 1.8 1.6 0. Not stated 4,050 2.9 8,601 5.4 5.7 7. Total 140,478 100.0 157,929 100.0 100.0 100. Note: Enumerated households
Housing tenure by Southern Adelaide LGAs in 2016 is included in Appendix 1 (Table A3). There are higher shares of outright home ownership in Mitcham (37.1 per cent), Holdfast Bay (34.7 per cent) and Unley (33.3 per cent), which are much higher than the average for Greater Adelaide or for Australia. Onkaparinga has a higher proportion of households with a mortgage compared with the other Southern Adelaide LGAs (41.4 per cent). Holdfast Bay, Unley and Marion have higher shares of renters, but the composition of renters differs between the LGAs. Marion has the highest share of households renting social housing of the four LGAs (9 per cent), while Holdfast Bay and Unley have higher shares of private
renters (26.3 per cent and 26.1 per cent respectively). The figures for Holdfast Bay and Unley may in part reflect higher density of housing in these LGAs, particularly the much higher share of high density housing compared with the other Southern Adelaide LGAs.
It was estimated that 1,041 people were homeless in Southern Adelaide in 2016 (13). A ranking of all LGAs by greatest number of homeless people puts Onkaparinga fourth highest within South Australia, with an estimated 485 homeless people in 2016 (13). Half of all homeless people in South Australia have a personal income below $400 per week.
Aboriginal and Torres Strait Islander peoples are overrepresented, comprising 15 per cent of South Australia’s homeless (compared with representing 2 per cent of the South Australian population) (13).
Men make up 60 per cent of South Australia’s homeless people, and almost a quarter of all homeless people are aged 18 or younger (13). Although a large proportion of the homeless are younger people, there are growing concerns about the risk of homelessness for older people. Sixteen per cent of South Australia’s homeless are aged 55 and over (13). The reduction in public housing stock and lower home ownership rates in South Australia compared with 2001 are contributing to rental stress and homelessness amongst older people (12).
Income and Housing Costs Median income, mortgage repayments and rent provide some insight into affordability of housing and the standard of living in an area. All five Southern Adelaide LGAs had a median weekly household income in 2016 that was approximately equal to or higher than that for Greater Adelaide (Table 8). South Australia was below the national average for every indicator of income in 2015-16 (14). It is therefore unsurprising that median household incomes in all Southern Adelaide LGAs except Mitcham and Unley are below the Australian average. Onkaparinga has relatively lower household income but also has the lowest median mortgage repayments and rent in the south. Onkaparinga has comparatively lower mortgage repayments than Greater Adelaide and median rent equal to that of Greater Adelaide. Median mortgage payments and rent are above the Greater Adelaide median for each of the other four southern Adelaide LGAs. Mitcham and Unley have higher median weekly mortgage repayments than the Australian median, offset by higher incomes.
Table 8: Median Weekly Household Income, Mortgage Repayment and Rent in Southern Adelaide LGAs, 2016 (Data Source: Census of Population and Housing, 2016)
Median Weekly Household Income
Median Weekly Mortgage Repayment
Median Weekly Rent
Holdfast Bay $1,359 $397 $ Marion $1,260 $375 $ Mitcham $1,601 $417 $ Onkaparinga $1,190 $330 $ Unley $1,629 $449 $ Greater Adelaide $1,261 $354 $ Australia $1,438 $393 $
Education The Index of Education and Occupation (IEO) scores and rankings for 2016 are presented in Table 10. This is a summary measure of educational and occupational aspects of socioeconomic advantage and disadvantage and focuses on the skills of people within the LGA, including both formal qualifications and skills required to perform different occupations (6). Four out of the five Southern Adelaide LGAs have relatively high average IEO scores and rankings. High scores represent a high incidence of people with high qualifications and/or highly skilled jobs within an area (6). Onkaparinga is in the 5 th^ decile within Australia, suggesting a relatively average proportion of people without qualifications, without jobs and/or with low skilled jobs. Onkaparinga’s IEO ranking rose between 2011 and 2016, from the 46 th^ percentile within Australia to the 50 th^ and from the 5 th^ decile and 32nd^ rank within South Australia to the 6 th^ decile and 36 th^ rank (out of 70).
Table 10: LGA Index of Education and Occupation for Southern Adelaide LGAs, 2016 (Data Source: Socio- economic Indexes for Australia (SEIFA), ABS, 2016)
Ranking within Australia Ranking within SA Score Rank Decile Percentile Rank Decile Holdfast Bay 1074 490 9 90 62 9 Marion 1015 440 9 81 59 9 Mitcham 1101 503 10 93 66 10 Onkaparinga 958 272 5 50 36 6 Unley 1127 517 10 95 67 10 Note: Higher scores and rankings represent a lower incidence of relative disadvantage. There are 544 LGAs within Australia, and 70 LGAs within South Australia.
There is lower variation in IEO rankings by SLA2 within each LGA compared with the IRSD and the IER. All SLAs in Holdfast Bay are ranked in the 8 th^ decile in Australia with the exception of Plympton which is ranked in the 7 th^ decile. Most SLAs in Marion are ranked in the 6 th^ decile, and the highest ranked SLA in Marion is Marion-Seaview Downs (ranked in the 8 th^ decile). All SLAs in Mitcham and Unley are ranked in either the 9 th^ or 10 th^ decile with the exception of the SLA of Panorama in Mitcham (ranked in the 7 th decile). Onkaparinga is the only LGA with wide variation in IEO rankings. Christie Downs, Morphett Vale- West and Hackham West-Huntfield Heights are the lowest ranked SLAs in this LGA (all ranked in the 1 st decile). The other SLAs in Onkaparinga have a range of rankings placing them in the 2 nd^ through to the 9 th decile (the highest ranked SLA is Coromandel Valley).
Table 11: Educational Attainment and Labour Market Indicators for Southern Adelaide LGAs, Per cent, 2016 (Data Source: Census of Population and Housing, 2016)
Tertiary qualification
Vocational qualification
Unemployment rate
Labour force participation rate Holdfast Bay 27.2 17.1 5.7 58. Marion 22.1 19.7 7.0 60. Mitcham 35.1 14.3 6.0 61. Onkaparinga 13.4 25.8 7.7 59. Unley 40.7 10.5 5.8 61. South Australia 18.5 20.1 7.5 58. Australia 22.0 18.8 6.9 60.
Educational attainment and labour market indicators for Southern Adelaide support the IEO rankings (Table 11).
All five Southern Adelaide LGAs had higher labour force participation rates in 2016 compared with the average for South Australia, and Holdfast Bay, Marion, Unley and Mitcham had relatively lower unemployment rates and higher attainment of tertiary qualifications.
Holdfast Bay, Unley and Mitcham also had better educational attainment and employment outcomes than the Australian average. Onkaparinga had a comparatively lower proportion with tertiary qualifications but a much higher share of the population held a vocational qualification.