Social determinants of health (SDH) broadly refer to the conditions in which people are born, live, work and age. These consist of a number of overlapping factors that determine health and wellbeing. Using the ten categories of the ‘SDH Assessment Circle’ as a guide (McMurray & Clendon, 2015, pp. 55-58), describe the health of a community of your choice. You may choose 5 SDHs to discuss in your report.
Education and literacy
The social determinants of health (SDH) are used to denote the underlying relationship between health outcomes and working and living conditions (social environment). SDH associated with socio-economic position helps to illustrate the gaps in the average health condition of the indigenous and non-indigenous Australians (Australian Institute of Health and Welfare [AIHW], 2016a). According to McMurray and Clendon (2015), the SDH Assessment circle mainly highlights 10 different categories: Biological or the genetic indicators of population; Culture and gender of the groups; Physical environment like climate, water supply and transportation; Social environment; Indicators of the health of the child; Education and literacy rates; Employment and the financial condition; Social support networks; Access to health service and resources and Health practices and health literacy. The following report will mainly highlight the health of the indigenous Australian community based on the five main aspects of social determinants of health as highlighted by McMurray and Clendon (2015).
Figure: Main Social Determinants of Health as per the Assessment Circle
(Source: McMurray & Clendon, 2015)
Education attainment is associated with quality health outcome throughout the life. Education helps people to obtain stable employment and thereby securing income and stable health of the family members (AIHW, 2016b). However, the rate of education and literacy is poor among the aboriginals of Australia. According to the reports published by AIHW (2017), indigenous students consistently secure poor grades in the National Assessment program – literacy and Numeracy tests (NAPLAN) in comparison to the non-indigenous students. The precent trajectory and performance indicates that indigenous students are not on track in order to satisfy the literacy target of 2018. Moreover, this score of literacy and numeracy decrease substantially along with the increase in the remoteness. Apart from unemployment, this lack of proper education creates gaps in knowledge which in turn promotes lack of proper health awareness.
According to AIHW (2016b), social environment has high effect on health equity via its influence over the local resources, safety and behaviour. The neighbourhoods or communities which ensure adequate access to basic goods and services are regarded as socially cohesive and in turn promote psychological and physical wellbeing. The house designs cited in remote communities are not as per to the tropical climate and the Australian indigenous culture. Moreover, housing situation is over-crowded. This over-crowding in house leads to the increase in the occurrence of communicable disease among Australian aboriginals (Buergelt et al., 2017). Moreover, the majority of the aboriginals are homeless and this in turn promotes poor social determinants of health as they are devoid of basic amenities of living (Chamberlain, Johnson & Robinson, 2014).
This lack of proper employment and stable source of income makes the aboriginals and Torres Strait Islanders the victims of poor SDH. Unemployment has higher risk of death, illness and disability in comparison to those who are employed. The mental stress of unemployment people also cast a severe impact on mental and physical well-being (AIHW, 2016b). The reports published by Department of the Prime Minister and Cabinet, Australian Government (2014), during the last 20-year there has been prominent rise in the rate of employment among the indigenous Australians. However, since 2008, this gain has decreased and the overall gap with the non-indigenous employment has increase considerably. Moreover, the majority of the indigenous population who are employed are labours who are exploited in terms of poor wages and high workload. This rate of unemployment or lack of proper employment widens the socio-economic gap and creates the tendency of criminal actions and substance abuse among the aboriginals (Lancaster & Ritter, 2014).
The reports published by Hall et al. (2017) highlighted that proper water and sanitation are not comprehensive among the aboriginal communities of Australia. Contamination coming from drinking water remains a risk in the areas where surveillance is not strict or rigorous. Moreover, the use of bore water is popular among the aboriginals are also not safe because it contains naturally high concentration of chemical and microbial contaminants. The overall status of sanitation has improved in the aboriginal communities with increase in the overall installation of centralised waste water treatment via the successful replacement of onsite septic tanks. However, concerns still remains in the domain of proper monitoring regime, incompatible items flushed down through toilets and increased turnover rate of the waste water management staffs. Moreover, overcrowding lack of proper information about menstrual hygiene and trachoma further increase the ill-effects of poor sanitation and leading to the outbreak of infectious diseases. This high rate of infectious disease is another driving force behind decrease life-expectancy in Australian aboriginals.
There exists high rate of health inequalities among the Australian aboriginals, and Torres Strait Islanders. According to the Australian Human rights Commission (2018), on an average Australian aboriginals and Torres Strait Islander have 10-17 years shorter life-expectancy than the Australians. The infants from aboriginal or Torres Strait Islander community have mortality rate twice high than the Australians. Moreover, the adult race of the indigenous population suffers from numerous chronic diseases in comparison to the non-indigenous population. Lack of proper access to healthcare, lack of proper disease awareness or education, social stigmatization, lack of employment among the Australian aboriginals are the main reason behind the prevailing health inequality. This inequality in health further forced the indigenous Australian population under poor socio-economic condition (Godding, 2014).
Thus from the above discussion, it can be concluded that the Australian aboriginals or the indigenous population of Australia are the victims of the poor SDHs. This poor SDH is highlighted in the domain of education, residential environment, living condition, employment or work culture, water or sanitation problems and inequalities in the healthcare services. These poor SDHs affect the overall health of the community at large. The aboriginal population suffers from low life-expectancy, high rate of occurrence of infectious and communicable disease and increase rate of substance abuse and poor mental health conditions. All these in turn hamper the health, well-being and quality of life of the indigenous population of Australia.
Australian Human Right Commission (2018). Aboriginal and Torres Strait Islanders: Australia’s First Peoples. Access date: 7th August. 2018. Retrieved from: https://www.humanrights.gov.au/education/students/hot-topics/aboriginal-and-torres-strait-islanders-australia-s-first-peoples
Australian Institute of Health and Welfare. (2016a). Social determinants of Indigenous health. Access date: 7th August. 2018. Retrieved from: https://www.aihw.gov.au/getmedia/d115fe0f-9452-4475-b31e-bf6e7d099693/ah16-4-2-social-determinants-indigenous-health.pdf.aspx
Australian Institute of Health and Welfare. (2016b). Australia's health 2016. Access date: 7th August. 2018. Retrieved from: https://www.aihw.gov.au/reports/australias-health/australias-health-2016/contents/determinants
Australian Institute of Health and Welfare. (2017). Australia's welfare 2017: in brief. Access date: 7th August. 2018. Retrieved from: https://www.aihw.gov.au/reports/australias-welfare/australias-welfare-2017-in-brief/contents/indigenous-australians
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Chamberlain, C., Johnson, G., & Robinson, C. (Eds.). (2014). Homelessness in Australia. UNSW Press. Retrieved from: https://books.google.co.in/books?hl=en&lr=&id=gfKLBQAAQBAJ&oi=fnd&pg=PT8&dq=homelessness+in+australia&ots=k-QUTCb5tf&sig=c5FOGEO-e_TghKNYA6vW3urTsR0#v=onepage&q=homelessness%20in%20australia&f=false
Godding, R. (2014). The persistent challenge of inequality in Australia's health. The Medical journal of Australia, 201(8), 432. doi: 10.5694/mja14.c1020
Hall, N., Barbosa, M. C., Currie, D., Dean, A. J., Head, B., Hill, P. S., ... & Willis, J. (2017). Water, sanitation and hygiene in remote Indigenous Australian communities: A scan of priorities(No. ISSN: 2207-9602, pp. 1-54). Retrieved from: https://gci.uq.edu.au/filething/get/13903/UQ_WASH%20scan%20in%20Indig%20Communities-FINAL-LR-2.pdf
Lancaster, K., & Ritter, A. (2014). Examining the construction and representation of drugs as a policy problem in Australia's National Drug Strategy documents 1985–2010. International Journal of Drug Policy, 25(1), 81-87. https://doi.org/10.1016/j.drugpo.2013.07.002
McMurray, A., & Clendon, J. (2015). Community Health and Wellness-E-book: Primary Health Care in Practice. Elsevier Health Sciences. https://books.google.co.in/books?hl=en&lr=&id=C4-bBgAAQBAJ&oi=fnd&pg=PP1&dq=SDH+Assessment+Circle%E2%80%99+as+a+guide+(McMurray+%26+Clendon&ots=Z6a4YSbsZm&sig=N-tX6Nd54g-La9q06qVaA2Z54CE#v=onepage&q=SDH%20Assessment%20Circle%E2%80%99%20as%20a%20guide%20(McMurray%20%26%20Clendon&f=false
Prime Minister and Cabinet, Australian Government (2014). Aboriginal and Torres Strait Islander: Health Performance Framework 2014 Report. Access date: 7th August. 2018. Retrieved from: https://www.pmc.gov.au/sites/default/files/publications/indigenous/Health-Performance-Framework-2014/tier-2-determinants-health/207-employment.html.
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