There exist significant inequalities in health between non-indigenous and indigenous Australians. The social and economic conditions in which they reside in shape the health disadvantages that are experienced by the indigenous Australians. Indigenous Australians presently experience more disability, injury and illness compared to other Australians. They also die at younger ages which are evidenced by research on the life expectancy between the Indigenous and non-indigenous people. In this paper, some of the risk factors that are closely related to the social and economic determinants of health are discussed. These include some socioeconomic status such as income, employment, and education that provide a health gap of around a third and nearly half of the population in Australia. The determinants of health are therefore outlined and discussed below. (Aboriginal and Torres Strait Islander Health Performance Framework 2010 report, 2011)
Healthy behaviors are represented and recognized as proximal determinants of health. Among Aboriginal individuals, the most relevant behaviors of health include the over misuse of alcohol which relates to the increased cases of mortalities and unreasonable smoking. The health consequences are expressed clearly in the high incidences of heart illnesses and lung cancer. Poor care in the prenatal period, as well as smoking and drinking during pregnancy, has been associated with poor emotional, intellectual and physical development among children of aboriginal origin. Finally, insufficient exercise and poor nutrition have been linked to the epidemic of type ii diabetes in adults of first nations and increased prevalence among first nation’s youth. These behaviors influence health and must be considered within the socio-political context of aboriginal peoples lives lest a person-centered perspective predominate the analysis. (Baum, 2013)
The nutritional status and wellbeing of indigenous people are related to the socioeconomic disadvantages, social, geographical, and environmental factors. Poor nutrition is a predominant risk factor for overweight and obesity, malnutrition, cardiovascular diseases, type ii diabetes, osteoporosis, tooth decay and certain cancers. (Baum, 2014) Fruit and vegetable diet is strongly linked to preventing chronic diseases and to better health hence the nutritional status of the Australian people is usually outlined by the assessment of the amount of the consuming of vegetables and fruits on a daily basis. A study conducted on 2004 provided data on the consumption of salt and milk by people of the indigenous background. The study showed that people aged 13 years or older,87% reported to usually adding salt after cooking compared with 75% of those living in non-remote areas. The level of consumption of whole milk for non-indigenous people was slightly more than one-half of the level of consumption of the aboriginal, indigenous people. (Baum, Newman and Biedrzycki, 2012)
People living in rural and remote places of Australia are often restrained in their food choices because of transport, geographical or climate conditions and cost of food hence creating barriers for the adequate and accessible supply of food. An environmental health study conducted in 2008 found that 15% of Indigenous people reported a lack of access to fresh food, fruit, and vegetables which were a reduction from the 19% of the communities that had been surveyed in 2005. (Caltabiano and Ricciardelli, 2013)
The national health council and medical research has recommended consumption of daily intake of at least two serves of vegetables and fruits and also to limit the use of saturated fats, moderation of total fat intake and choice of low salt foods. This is because, in 2002, low vegetable and fruit intake contributed to about 3.7% of the total disease burden and 5.8% deaths among the indigenous people. Therefore, it can be affirmed that the unhealthy behaviors practiced by the people of aboriginal background affect their health negatively compared to the non-indigenous people. (Carson, 2012)
The possession of a job and income have shown to have a positive influence on the individual health and wellbeing of a person. A long duration of unemployment characterized by the absence of the labor market force and the frequent changes in the status of employment have been revealed to possess detrimental effects on an individual’s health. This can also be seen by the above association with poverty and prior ill health. However, there exists complexity in the impact of the participation of the labor workforce on the wellbeing of Torres Strait Islander individuals and is more likely to be influenced by factors that are different to those affecting and influencing non-indigenous people. (Chronic diseases and associated risk factors in Australia, 2012, 2013)
The nature of employment and the experience of employment by the indigenous people may also have an impact on the health advantages they gain through the employment. The positive health effects have been shown to diminish due to the little control of the individuals with short term, low paid and low skilled jobs. (Comfort and McCausland, 2013) This has been facilitated also by the racism experience and discrimination in the place of work hence pointing out evidence that shows that Aboriginal and Torres Strait Islander jobs are mainly influenced by these factors.
Conversely, the low health profile of the indigenous people of aboriginal background has shown to act as a barrier to the increase in the population rate. Studies have revealed that the poor health of members of the family was a basic reason for the lowered and reduced labor workforce participation among women. Men also showed that their diminished health also restricted their overall cooperation. In 2009, 55% of Indigenous Australians were fully employed compared to the 77% of the non-indigenous people. (Commers, 2013) The Council of Australian state has set a target aimed to halve the gap in the job employment within a decade where an additional of about 100,000 indigenous Australians will have jobs by 2019 to achieve this target.
There exists substantial evidence from local and international studies that associate low socioeconomic status to bad health. Low income has been linked with a larger range of disadvantages that include shorter life expectancy, poor health, misuse of substances, and poor education. There also exists some manifestations of reduced participation in social activities and presence of violence and crimes. In 2009, about half of indigenous people existed in the bottom 21% of the average family incomes. The cost has been classified as a barrier to the access of health care by these people, therefore, having a little income which is combined with high food costs in the remote areas, has seen people choose low-cost alternatives which are likely unhealthy than fresh vegetables and fruit and protein-rich meats which are more costly. This impacts their health negatively compared to those non-indigenous individuals who have better income and employment opportunities. (Dixon, 2012)
Early childhood has been seen to be a critical period in human development. Studies have shown that the experiences children experience in the early life set biological and neurological pathways that exhibit lifelong impacts on learning, behavior and their overall health. The Council of Australian government has made the universal access to early childhood education for all children a priority and commitment. This commitment also includes ensuring all four-year-olds children in the indigenous communities have access to the early childhood learning within the next five years i.e. by 2013. (Communicating the economics of social determinants of health and health inequalities, 2013)
Research has shown education to be a principal factor in the improvement of health and wellbeing. For example, greater levels of learning are associated with a better perception of lifestyles that are healthy and optimal health care practice. The high mortality rate is seen with those of lower education level particular for those with smoking associated illnesses. Those who remain at school tend to drink less alcohol, exhibit more activeness and smoke less than those not in school which reduces the risk factors of chronic conditions and illnesses in adults. (Hughes, 2012)
Currently, most children in the Aboriginal and Torres Strait Islander background do not satisfy the set least standards for numeracy, reading, and writing. Few students in the indigenous population complete year 12 compared to children from other backgrounds. The Council of Australian government has set a commitment and objective to halve that gap in writing, reading, and numeracy by 2019 and also half the 12-year gap or equivalent rates of attainment by 2020s. (Mikkonen and Raphael, 2010)
Having better outcomes at school supports further employment and education prospects. The advocacy of strong networks both at home and through involvement in the education system is vital for the improvement of the attendance of school hence improving education outcomes. The council agreed to introduce several reforms in education to improve the positive outcomes for the Torres Strait Islander children hence minimizing inequalities. This includes the incorporation of the aboriginal education action plan and the partnership on early childhood development as well as various reforms that will improve the quality of early childhood services and schools. This actions will promote better outcomes for the universities and training providers.
There is a well-established association between education and the achievement of good health. The need for the schools to become culturally effective and safe for Aboriginal children has been highlighted by the significant lower literacy and numerical skills found in this children. Some of the strategies to improve the community’s health and wellbeing through education include, having a positive expectation of students, promoting strong Aboriginal identities and incorporating indigenous cultures, knowledge, and languages in the education curricula and policies. Provision of extensive and intensive support services for the students will ensure access to high standards and quality primary health care. This support in education approaches will provide a positive impact on the health of the indigenous population of Australians.
Research studies have shown that living in low quality, insecure or unaffordable houses can be associated with low levels of health. The stress that is related to overcrowding, lack of housing affordability and difficult in-house access has been seen to adversely affect health. Healthy transport means the reduction of car and vehicle use and increments in walking, cycling, and public transport system. Facilities close to home facilitate modes of healthy transport hence increasing health promotion. Healthy transport ensures healthy food, facilities, services and social contact. (Nelson, 2014)
The factors related to housing which include homelessness, overcrowding, tenure in housing and infrastructure have significant impacts on the health of a population. This infrastructure includes a reliable supply of power and a clean water sewerage system. The housing factors above are related to the infectious diseases such as tuberculosis, meningitis and skin and respiratory diseases. The latest study on overcrowding reveals that in 2007 almost 26% of the Aboriginal Australians lived in congested households. This overcrowding was mostly present in the remote and distant areas. Residing in a crowded homestead also makes it difficult for students to get a quiet and suitable environment to study. A healthy home is vital in the precondition of a healthy population. The Australian government has set objectives through partnerships in remote Indigenous housing and homelessness which will initiate various housing and health programs. (Rine, 2016)
Physical environments, therefore, play a significant role in determining the health of a population. The most pervasive conditions and outcomes of this surroundings include poor quality of existing homes and shortages in substantial housing. Numerous on reserve homes tend to be overcrowded hence lacking appropriate ventilation resulting in excessive moulds which have been associated with several health conditions such as allergies and severe asthma among aboriginal children. These conditions affect their health negatively. It is therefore assumed that improving the health safety hardware of houses would consequently promote better health hence the incorporation of important aspects of various programs that include focusing on improving physical infrastructure related to sanitation, and the preparation of adequate water and food supply. Securing the support and collaboration of the housing associations and the aboriginal communities is also important. It is, therefore, essential that these programs enable indigenous families to remain in their homes and prevent these families from becoming homeless. These initiatives will enhance a positive impact on their health and wellbeing. (Williams, 2013)
Being of health shapes an individual’s economic and education success and also influences their family and broader community wellbeing. So it is essential that programs and initiatives continue to be focused on health as well as situations in which people live and work in. Improvements to optimum health take time. All stakeholders that include Aboriginal individuals and communities, indigenous health care providers, Torres Strait Islander government, and groups – should work together to improve the wellbeing and health of all people. Therefore, the improvement of health requires the government to partner with service providers and Torres Strait Islander individuals in coming up with the most appropriate solutions hence effecting change. The government, therefore, need to implement a health plan that will take into account the main issues which affect the Aboriginal and Torres Strait Islander peoples’ health.
Aboriginal and Torres Strait Islander Health Performance Framework 2010 report. (2011). 1st ed. Canberra, A.C.T .: Australian Institute of Health and Welfare, pp.17-34.
Baum, F. (2013). Comprehensive primary health care and social determinants as top priorities. The Medical Journal of Australia, 199(4), p.233.
Baum, F. (2014). Comprehensive primary health care and social determinants as top priorities. The Medical Journal of Australia, 200(2), pp.86-87.
Baum, F., Newman, L. and Biedrzycki, K. (2012). Vicious cycles: digital technologies and determinants of health in Australia. Health Promotion International, 29(2), pp.349-360.
Caltabiano, M. and Ricciardelli, L. (2013). Applied topics in health psychology. 1st ed. Chichester, West Sussex: John Wiley & Sons, pp.78-95.
Carson, B. (2012). Social determinants of indigenous health. 1st ed. Crows Nest, N.S.W.: Allen & Unwin, pp.114-135.
Chronic diseases and associated risk factors in Australia, 2012. (2013). 1st ed. Canberra, A.C.T.: Australian Institute of Health and Welfare, pp.16-24.
Comfort, J. and McCausland, K. (2013). Health priorities and perceived health determinants among Western Australians attending the 2011 LGBTI Perth Pride Fairday Festival. Health Promotion Journal of Australia, pp.78-112.
Commers, M. (2013). Determinants of health. 1st ed. Dordrecht: Springer, pp.6-12.
Communicating the economics of social determinants of health and health inequalities. (2013). 1st ed. Geneva: World Health Organization, pp.17-32.
Dixon, J. (2012). Social Determinants of Health. Health Promotion International, 15(1), pp.87-89.
Hughes, R. (2012). A Socioecological Analysis of the Determinants of National Public Health Nutrition Work Force Capacity. Family & Community Health, 29(1), pp.55-67.
Mikkonen, J. and Raphael, D. (2010). Social determinants of health. 1st ed. [Toronto]: [York University, School of Health Policy and Management], pp.98-112.
Nelson, M. (2014). Comprehensive primary health care and social determinants as top priorities. The Medical Journal of Australia, 200(2), p.86.
Rine, C. (2016). Social Determinants of Health: Grand Challenges in Social Work’s Future. Health & Social Work, 41(3), pp.143-145.
Williams, G. (2013). The determinants of health: structure, context and agency. Sociology of Health & Illness, 25(3), pp.131-154.
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