Imagine you are a newly appointed health professional responsible for servicing the Penda community. Consider the unit information, and other sources that apply to the Penda community. Explore the social determinants of health on the Penda community’s health and wellbeing and discuss how health and community systems seek address these. Consider the impact of concepts such as stakeholders, co-design and co-production, and peak bodies in your responses.
Now answer the following 2 points;
Describe how public policy has influenced the community of Penda.
Describe the social determinants of health that are impacting the Penda community.
Case Of Penda
Penda is an old Aboriginal mission in NSW with a population of 199 of whom 196 identified as Aboriginal at the 2016 Census. This was a reduction in population from the 2011 Census of 226 persons of which 225 identified as Aboriginal. The community falls within a larger regional LGA, The Plains, the main centre of which is located 133 Kilometres from Penda.
The original mission was established in 1912 and relocated to the current location in 1937. In 1975 the mission land was converted to freehold title with the title being held by the NSW Aboriginal Lands Trust, however the mission manager did not relinquish responsibility until 1977. In 1984 the Local Land Council was granted a 99 year lease under the Aboriginal Land Rights Act 1983 for the land and houses in the community. All the property, except the Public Primary School, is managed and owned by the Lands Council with residents renting their property from them. At the 2016 Census there were 46 standalone houses.
The only services in the community are a health clinic with a nurse and Aboriginal community worker and a primary level school with no other early education or child care services. There is no public transport available except a school bus going to another small community with a High School approximately 30 Kilometres away called Penda Hills. There is a private bus company that travels to the capital city to the north which travels through Penda Hills to the service centre community called Plains. There is an afternoon service on Monday to Thursday and Sunday with an evening service on Fridays. The return journey is only able to be undertaken in the morning Monday to Thursday with a middle of the day service on Friday and Sunday. Residents from Penda are dependent upon personal transport if they wish to do a day trip to Plains.
Penda’s 2011 Socio-Economic Indexes for Areas (SEFIA) score for relative socio-economic disadvantage and advantage was in the 1st percentile making it one of the most disadvantaged communities in Australia. The 2011 index of education and occupation again placed the town in the 1st percentile further highlighting the community as being one of the most disadvantage communities in Australia. Other key characteristics are from the 2016 Census are:
- Only 14 of the 46 homes have a fixed internet connection.
- The median age of the population was 21 years which is an increase from 18 years at the 2011 Census.
- Only 21.48% of the population over 15 are married or in a de-facto relationship compared to 43.88% in 2011.
- There was a low level of people with post-secondary school education, only 3 persons have a Bachelor Degree, 3 with a Diploma and 14 with Certificate 3 or 4 level qualification. Examination of the employment categories suggests the education and health staff are the people with tertiary education.
- Similarly with the employment, only 11 people are employed on a full time or part time basis with 3 people registered as unemployed. However, in 2011 there were 18 people employed on some basis and 30 people registered as being unemployed.
Penda has been the focus of numerous inquiries and interventions by both Federal and State Governments. The initial inquiry was held just over 10 years after the community changed from being a mission managed community to being managed by the Lands Council. The inquiry was triggered by “race riots“ in Plains. These riots were triggered by the bashing of an Aboriginal man by four white community members. The following evening a group of people from Penda and Penda Hills travelled to Plains to find the four persons responsible and to mete out “justice” to those responsible as it was felt that the Police were not taking any action. The inquiry commenced approximately 18 months after the “riot”, which was approximately the same time the Black Death in Custody Royal Commission commenced.
Some of the issues raised at the inquiry were poor housing and sanitation, leaking sewerage, lack of educational opportunities and unmaintained dirt roads. Following the inquiry these issues were addressed with improvements made to the infrastructure to the community. The infrastructure was maintained via the implementation of a Community Development Employment Project (CDEP) scheme in Penda. Under CDEP more than 100 residents were employed within the community, this included the running of the Co-Op store, town maintenance and work in with an Aboriginal paper and craft manufacturing business. The Co-Op also run a community bus that allowed residents to access Penda Hills and Plains at low cost. The CDEP program was ended in Penda in 2010 when the federal government ended the program within communities that it deemed to be non-remote. The cessation of CDEP resulted in the closure of the Co-Op loss of the community bus and a general deterioration of the infrastructure of the community as there were no funds or crews provided from the Council or State Government to maintain the infrastructure. The Lands Council as owner of the infrastructure was responsible for the maintenance via private contractors. The result beginning another inquiry and intervention by Australian Defence Force (ADF) engineers to rebuild some of the community infrastructure. As a part of this decline in the community and lack of access to basic goods from the Co-Op and lack of transport options the school canteen was repeatedly broken into and food stolen. The school canteen has closed with a mobile service based out of Penda Hills attending the school on a daily basis.
However, whilst the infrastructure was being maintained during the period of CDEP there was still a range of social issues experienced. The closest State Government child protection agency was located in Plains. For a period of four years there was a child protection task force based in the community, during this time there were reports that the community was safer and decreases in maltreatment. Despite a report recommending the continuation of the task force the responsible Minister announced that it would end. Prior to the establishment of the task force there were community reports of children engaging in prostitution at the truck rest stop on the main north south highway in Penda Hills. Whilst there was community knowledge of the child maltreatment there was limited reporting to Police and Child Protection Services. There was also signs of community resilience and informal protective measures evident.
The main service centre of The Plains LGA, Plains is serviced by an airport which has 5 return flights to Sydney each day. There is also a daily train service to Sydney, as well as daily, except Saturday, bus service to Brisbane which travels via Penda Hills. On a Monday, Wednesday and Friday morning there is also a bus service to Manfred Harbour with a return to Plains on a Tuesday, Thursday and Saturday morning.
The Plains LGA has experienced a decline in population from 13,973 persons in the 2006 Census to 13,159 persons at the 2016 Census. However there has been an increase in the Indigenous population from 2,703 persons (19.34% of population) at the 2006 Census to 2,845 persons (21.62%) of the population in 2016. Other changes overtime in The Plains LGA are highlighted in the following demographics:
- Population born overseas increased from 603 persons (4.32%) in 2006 to 688 persons (5.23%) in 2016.
- Language spoken at home other than English increased from 292 persons (2.10%) in 2006 to 465 persons (3.53%) in 2016. The Asian based languages such as Hindi, Tagalog/Filipino, Tamil and Thai all had (significant) increases in speakers from the 2006 Census. Whereas, the European languages such as Italian, Serbian and Croatian had a decrease. There was also an increase in African languages such as Sinhalese and Afrikaans.
- The number of houses owned outright or being paid off via a mortgage decreased from 2,735 homes in 2006 to 2,529 in 2016. Over the same period there was an increase in the number of homes rented from 1,880 in 2006 to 1,921 in 2016.
- There was an increase in people aged over 15 who had a postgraduate qualifications from 0.62% in 2006 to 1.11% in 2016. An increase also occurred for bachelor qualifications, 6.75% in 2006 to 7.97% in 2016. Similarly, for cert 3 and 4 qualifications there was an increase from 13.25% in 2006 to 15.92% in 2016.
- However, there has been a decrease in the percentage of the population aged over 15 who are employed. For 2006 there were 39.52% in full time work and 14.06% in part time work compared to 2016 were 36.66% were in full time work and 13.51% in part time work.
- The Plains LGA has an ageing population with the median age moving from 34 years in 2006 to 38 years in 2016. With the population under age of 14 decreasing from 24.73% in 2006 to 21.90% in 2016. Indicative of a decline population the median household size decreased from 2.7 persons in 2006 to 2.5 persons in 2016.
- The median household income for 2016 was $1,220.00, the median weekly rent $170.00 per week and monthly median mortgage was $1,300.00.
- The Plains has experienced a decrease in population turnover since 2006 were 41.47% of the population were residing elsewhere 5 years previously as compared to 34.50% in 2016.
- The Plains LGA SEIFA score in 2011 for relative advantage and disadvantage was compared nationally on the 19th This was a decline upon 2006 were the LGA was nationally on the 43rdpercentile.
- The 2011 index of education and occupation compared nationally was on the 28th Again this was a decline compared to 2006 were the LGA was on the 29thpercentile.
In summary, Penda is a community showing structural and demographic decline as is the whole of The Plains LGA, which is a situation replicated in many areas of rural Australia. Whilst there are significant societal problems and social/economic disadvantage in Penda there is a level of resilience and desire within the community to ensure it is able to overcome its limitations with targeted and appropriate support. This was seen during the CDEP and child protection task force period and the engagement with the latest intervention to repair the infrastructure. As part of the understanding of the development trajectory of Penda the elders of the community and senior member of the Lands Council were raised under the Mission structure and as a result have not benefited from a high level of education or governance training in how to successfully manage a community.