Disproportionate epidemiology: differential impact of disease and flood on the socio-economically marginalised

Abstract

This thesis presents four projects completed to fulfil the core competencies of the MAE. My field'placement was the University Centre for Rural Health (UCRH) in Lismore (Bundjalung Country). The UCRH builds rural health workforce capacity and conducts research relevant to the health needs of rural communities. Strategic research priorities of the UCRH focus on rural population health, health equity and health systems and service research. Data Analysis (A cross-sectional analysis of post-flood social capital in a diverse Australian rural community): In partnership with Community Advisory Groups in the Northern Rivers region of NSW, I conducted a cross-sectional analysis to examine the association between the components of social capital (community participation and personal social cohesion) and psychological distress six months after the 2017 major flood event and how this association may have varied for marginalised groups relative to other participants. While marginalised groups reported lower levels of social capital compared to other groups, the analysis showed that informal social connectedness and feelings of belonging were important factors for all, associated with reduced risk of psychological distress post-flood. Research Project (Longitudinal cohort study of mental health outcomes after flooding in a rural community): Following on from the data analysis project, I led the design and implementation of a two-year survey for participants who consented to follow-up with the primary aim of assessing long-term psychological outcomes following the 2017 major flood including the impact of secondary stressors (e.g., persistent damage, insurance disputes etc) and levels of social capital. We found that secondary stressors were more proximally associated with psychological morbidity after two years compared to the flood event itself. Informal social connectedness, belonging and optimism were again important predictors of reduced mental health harm over the 18-month study period. These findings are useful for mental health service planning needs for communities affected by flood over the longer-term. Outbreak investigation (Recurrent outbreaks of acute post-streptococcal glomerulonephritis (APSGN) in the Northern Peninsula Area (NPA), Qld in 2019): In partnership with Qld Health and local NPA health staff, I assisted with an outbreak investigation of APSGN in the NPA, Qld. APSGN results from the body's response to repeated Streptococcus pyogenes (a group A streptococci - GAS bacteria) infection usually via skin or upper respiratory tract. My role involved designing and maintaining spreadsheet information to monitor population screening and treatment of skin and throat sores for all children (aged 1 to <17 years) in the NPA. As this was the second outbreak to occur within six months, the investigation highlighted the need for sustained health promotion programs to minimise the occurrence of skin conditions and in the long term, improved socio-economic, community infrastructure and housing conditions to reduce inequities in GAS infections (and APSGN) between Aboriginal and Torres Strait Islander and non-Indigenous populations. Surveillance system evaluation (Tuberculosis surveillance in NSW - developing data systems for effective contact investigations): In partnership with NSW Health Protection, I facilitated the development of a generic contact investigation module for tuberculosis (TB) disease for the NSW Notifiable Conditions Information Management System (NCIMS). TB Coordinators across NSW were consulted to: evaluate the current contact investigation data system; assess gaps; and develop data specifications for a new NCIMS module that would meet their needs for effective contact tracing and reporting. While implementation of the new module did not occur within the MAE project timeframe, discussion initiated by this work contributed to development of a NCIMS contact tracing data system for COVID-19 in 2020. Show more