Equity Care Onsite Pharmacists, out from behind the counter, delivering wellness for priority populations

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The prevailing healthcare ecosystem is failing to adequately meet the unique needs of several at-risk individual cohorts.  Disparity of access to health infrastructure (e.g. doctor clinics and community pharmacies) and equity of health status in rural/remote and indigenous communities is pronounced and seems resistive to remedial government policy. 

Unintended structural barriers to equity of healthcare delivery are often engrained and the disparity can be multi-generational.  Vulnerable consumer cohorts such as those at risk of homelessness, First Nations Australians, the elderly and disabled also experience higher rates of access barriers to health services.  These at-risk individuals are also inherently at higher risk of health complications due to the circumstances of their age, disease burden or socio-economic status.

Data reveals significant ongoing, and at times growing disparity of health status between the Foundation’s priority at-risk cohorts and the rest of the community.

  • People experiencing homelessness have significantly higher rates of death and chronic illness compared with the general population.
  • People who were homeless die an average of 22 to 33 years younger than those who are housed.
  • 13% of people who experienced homelessness report experiencing a barrier to accessing health care, compared with 4.4% who had not experienced homelessness.
  • People who are homeless experience higher rates of vaccine-preventable disease, including COVID-19, than the general population, and poorer associated health outcomes.
  • Tobacco use in people experiencing homelessness is significantly higher (ranging between 57% and 82%) than the general population.
  • 43% of the homeless population reported that they had alcohol and other drug use problems (a substantially higher rate than the general population).
  • Prescription non-adherence in homeless and crisis accommodation groups is associated with increased emergency department admissions.
  • Women and children leaving domestic violence often sleep rough (even after seeking help), and experience ongoing health risks and instability.
  • Addiction disproportionately impacts at-risk cohorts, including individuals with mental illness, those experiencing homelessness, and Aboriginal and Torres Strait Islander peoples.
  • Alcohol and drug-related harms are leading contributors to preventable illness, injury and death, particularly among socially disadvantaged and marginalised groups.
  • Substance use disorders remain a significant health burden in Australia, with 1 in 20 Australians meeting criteria for a substance use disorder annually.
  • Substance use disorders remain a significant health burden in Australia, with 1 in 20 Australians meeting criteria for a substance use disorder annually.
  • Pharmacist and clinician-led harm reduction programs, including nicotine replacement therapy, opioid substitution programs, pill testing and medicinal cannabis oversight, improve treatment adherence and reduce overdose risk.
  • Well-integrated harm reduction services reduce healthcare costs by preventing hospital admissions linked to overdose, infectious disease, and substance-related injury.
  • Evidence links gambling harm with poor physical and mental health outcomes, including increased rates of depression, anxiety, substance use, and financial stress.
  • Pharmacists can serve as discreet, stigma-free contact points, integrating harm reduction screening tools and education on gambling-related risks.
  • Experience higher rates of hospitalisations, deaths and injury.
  • Have poorer access to, and use of, primary health care services.
  • Men and women in Very Remote areas die 13.6 and 12.7 years earlier than those in Metropolitan areas.
  • The burden of disease increases with increasing remoteness for coronary heart disease, type 2 diabetes, chronic kidney disease, lung conditions and suicide or self-inflicted injuries.
  • Cardiovascular disease is 20% more prevalent in rural/remote Australians.
  • 21.8% of males in outer regional and remote areas smoke daily, compared to 11.4% living in major cities.
  • 1.3 million rural and remote Australians do not take their medicines at all or as intended adding an estimated $2.03 billion to our annual health care costs.
  • The likelihood of receiving a COVID or Flu vaccine is significantly lower for people living in outer regional and remote areas.
  • Life expectancy is 8-9 years shorter than non-Indigenous (and 12.4 years shorter for First Nations people in remote areas).
  • The burden of disease is 2.3 times higher for First Peoples.
  • Among First Nations people aged under 75, almost two-thirds (64%) of the fatal burden of disease was due to potentially avoidable deaths.
  • The conditions contributing most to the gap in rates of potentially avoidable deaths between First Nations people and non-Indigenous Australians were coronary heart disease (26% of the gap in avoidable deaths), diabetes (18% of the gap) and chronic obstructive pulmonary disease (13% of the gap).
  • Over 95% of people living in aged care facilities have at least one problem with their medicines detected at the time of a medicines review; most have three problems.
  • People aged 75+ are prescribed an average of 8 different medications,
    increasing risks of drug interactions, falls, and hospitalisation.
  • 46% of all preventable hospitalisations are for people aged >65 years.
  • The risk of serious illness or death from COVID-19 is higher in older people.
  • Depression affects 10–15% of older Australians and is often underdiagnosed or misattributed to ageing.
  • 86% of Australians aged 65+ live with at least one chronic condition, and nearly half have three or more.
  • Falls are the leading cause of injury-related death in older Australians, and hospitalisation rates for falls are rising by ~3% each year.
  • From age 65+ more than 50% of remaining life will be with a form of disability.
  • Older persons are more vulnerable to social isolation, economic insecurity, inequities in access to care, and systemic neglect.
  • Social isolation can increase health risks by the equivalent of smoking up to 15 cigarettes a day.
  • Life expectancy is shorter with mild intellectual disability (9.3 years), moderate disability (15.7 years) and severe intellectual disability (24.7 years).
  • 31% of adults with disability report high or very high psychological distress.
  • 14% of adults with disability smoke daily, compared to population average of 9.1%.
  • 8.3% adults with disability had sugary drinks daily, compared with 5.6% of those without disability.
  • Across all crisis and transitional accommodation settings, medication nonadherence, fragmented care pathways and limited access to trusted healthcare professionals are consistently associated with poorer health.
  • Individuals residing in crisis and refuge settings experience markedly higher rates of mental illness, trauma exposure and psychosocial distress, with comorbidity common for mental health, substance use and chronic disease.
  • Smoking prevalence is strikingly higher among people living in crisis, refuge and transitional accommodation, often exceeding 50%, compared with around 10% in the general population, compounding other health inequities.
  • Domestic and family violence remains a major public health issue in Australia, with around 1 in 4 women experiencing intimate partner violence and associated long-term health impacts including anxiety, trauma and chronic conditions.
  • Women and children accessing domestic and family violence refuges frequently present with untreated or interrupted healthcare, including medication discontinuity, unmet preventive care and elevated risk of mental health deterioration.
  • Nearly 2 in 5 women using crisis accommodation for DV had both a current mental health issue and problematic alcohol/drug use.
  • People entering prison (and by extension those transitioning from custody into supported accommodation) have a substantially higher prevalence of chronic physical health conditions than the general population (especially for
    asthma: 27% Vs 11%; cardiovascular disease: 13% Vs 5.2%; and pulmonary disease: 7.8% Vs 1.9%).
  • People transitioning from custodial or institutional settings experience high rates of medication interruption, contributing to avoidable emergency department presentations, hospitalisation and re-incarceration.
  • At-risk young people in crisis accommodation experience poor continuity of care, low engagement with primary health services and elevated risk of vaccine-preventable disease and untreated mental health conditions.
  • At-risk youth
  • Palliative care recipients and individuals suffering from a terminal illness
  • Persons navigating transitions of care and fragmented health services
  • Culturally and linguistically diverse persons
  • Persons temporarily residing in regional areas without conventional accommodation
  • Pregnant and breastfeeding women
  • Refugees
  • LGBTQIA+ persons
  • Persons at risk of suicide

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