The association between life expectancy and postcodes, neighbourhood locations or train stations has been demonstrated in many different locations around the world. These include London and Glasgow in the UK and across the US including California.
These studies paint a powerful picture of health inequalities across neighbourhoods and cities. They also concisely communicate the importance of social determinants of health. More simply, they tell us that health starts where we live, work, learn and play.
In an earlier article, we have argued that the liveability of an area is closely associated with the social determinants of health. A liveable neighbourhood should include the following key ingredients:
is safe, socially cohesive and inclusive
environmentally sustainable and supported by trees and biodiversity
has affordable and diverse housing supported by public transport, walking and cycling
is linked to employment, education, public open space, local shops, health and community services, leisure, arts and culture.
So what happens if you live in an area with more or less of these key ingredients?
The answer is postcode-related differences in health outcomes. These differences can be measured by death rates and life expectancy.
This has led to the development of clever communication tools that map life expectancy to train stations. Until now, such maps have not been produced for Australian cities.
Living on the line in Melbourne
Community Indicators Victoria at the University of Melbourne seeks to translate data into action. The project has developed a map that demonstrates the existence of health inequalities across Melbourne using data from the Australian Bureau of Statistics (ABS). We have mapped area-level disadvantage using the Index of Relative Socio-Economic Disadvantage (IRSD) with age-standardised death rates and linked these data to the Melbourne metropolitan rail network.
Large cities in the UK and US have large populations that enable the development of life expectancy data for small areas. In Australian cities we don’t have the population numbers to reliably create these same life expectancy statistics at very small neighbourhood areas.
We have chosen age-standardised death rates as the best statistical approximation to life expectancy to create our map for Melbourne. The map investigates the relationship between area-level deprivation (IRSD), death rates (taking into account age differences for areas) and nearest train station as an approximation for location.
The map shows that areas with greater disadvantage (shown in darker grey) tend to have higher death rates. This is most easily seen in the western and northern areas of Melbourne, but can also be seen along the Dandenong-Pakenham train line. In comparison, the majority of areas across the eastern suburbs have both low death rates and low levels of area-based disadvantage.
Mapping other cities
With the support of publicly available ABS data, such maps can be reproduced for cities across Australia. These will no doubt produce more interesting and thought-provoking results, which should stimulate future debate about area-based health inequities across the country.
Health-based inequities occur for many reasons. They are exacerbated, however, by a lack of access to job opportunities and services – such as public transport and mental and physical health care – which determine health outcomes.
These services are harder to access in outer suburb growth areas such as those in the western, northern and southern areas of Melbourne. Without these services people’s livelihoods and health suffer as shown in the Melbourne version of the “Living on the Line” map.
Such maps are a powerful reminder that good health planning should be integrated across government portfolios. Health budgets also need to be spent on broader public health promotion and planning that extends well beyond hospital funding and basic health service provision.