Social Determinates of Health for Indigenous Australians

Social determinates of health for indigenous Australians • • • • • • • • • • • Lack of equal access to primary health care Lower standards of health (such as healthy housing and food sanitation) estimated gap of approximately 17 years between Indigenous and non-Indigenous life expectation in Australia For all age groups below 65 years, the age-specific death rates for Indigenous Australians are at least twice those experienced by the non-Indigenous population Do not have equal opportunity to be as healthy as non-indigenous Australians. Live in conditions that do not support good health Do not enjoy equal, access to primary health care and health infrastructure - This includes safe drinking water, effective sewerage systems, rubbish collection services and healthy housing The inequality in health status experienced by Aboriginal and Torres Strait Islander peoples is linked to systemic discrimination. Historically, Aboriginal and Torres Strait Islander peoples have not had the same opportunity to be as healthy as non-Indigenous people. This occurs through the inaccessibility of mainstream services and lower access to health services, including primary health care, and inadequate provision of health infrastructure in some Aboriginal and Torres Strait Islander communities. The Royal Australasian College of Physicians describes these health inequities as ‘both avoidable and systematic’ Poverty: - At the 2001 National Census, the average gross household income for Indigenous peoples in Australia was $364 per/week, or 62% of the rate for non-Indigenous peoples ($585 per/ week) - At the 2001 Census, the unemployment rate for Indigenous peoples was 20%: three times higher than the rate for non-Indigenous Australians - Nationally in 2004, Indigenous students were also half as likely to continue to year 12 as non-Indigenous students Education - Poor education and literacy are linked to poor health status, and affect the capacity of people to use health information - Poorer income reduces the accessibility of health care services and medicines Lifestyle - Overcrowded and run-down housing is associated with poverty and contributes to the spread of communicable disease - Poor infant diet is associated with poverty and chronic diseases later in life. - Smoking and high-risk behaviour is associated with lower socio-economic status - Research has also demonstrated that poorer people also have less financial and other forms of control over their lives Psychological • Lack of control -> stress - This contributes to greater burden of unhealthy stress where prolonged exposure to psychological demands where possibilities to control the situation are perceived to be limited and the chances of reward are small Chronic stress can impact on the body’s immune system, circulatory system, and metabolic functions through a variety of hormonal pathways and is associated with a range of health problems from diseases of the circulatory system. Especially heart disease - In the National Aboriginal Health Strategy (1989), Indigenous peoples stated that their health status is linked to ‘control over their physical environment, of dignity, of community self-esteem, and of justice. A report in 2014 found "dramatic" increases in Aboriginal rates of youth suicide, anxiety and depression, as well as cognitive disability and mental health among offenders, and perinatal mental health. [5] More than a quarter of Aboriginal people, and almost a fifth of all Torres Strait Islanders, reported having a mental condition in 2018-19. A 2020 report found that Aboriginal people experience depression (52%) and anxiety (59%) at much higher levels than non-Aboriginal Australians (32% and 47%) n 2018-19, 31% of Aboriginal people and 23% of Torres Strait Islanders over 18 years reported high or very high levels of psychological distress. 68% had experienced at least one stressful event in the past year, and, alarmingly, so did almost the same proportion of children. - • • • Biological • • • • In Australia, the rising number of people affected by type 2 diabetes is most likely driven by increasing rates of obesity, decreased rates of physical activity, dietary changes, and an ageing population There is no evidence to show that Aboriginal people had diabetes, or other conditions affected by lifestyle such as heart and blood vessel disease, obesity, or high blood pressure, when they lived a traditional lifestyle. Now, with fewer Aboriginal people living a traditional lifestyle, and more being exposed to today’s Westernised lifestyle, with foods that are low in fibre and rich in fat and sugar, alcohol, cigarette smoking and a sedentary lifestyle, their once-efficient metabolism may now be acting against them The genetic make-up that enabled Indigenous people to survive when food was scarce may now be a big disadvantage, promoting weight increases, diabetes, and associated conditions such as high blood pressure and heart disease. • • • • • • • Research has shown that Aboriginal people who live a Westernised lifestyle have high rates of obesity, impaired glucose tolerance, high blood pressure, high levels of triglycerides (fats) in the blood, and excessively high insulin levels in the blood. Aboriginal and Torres Strait Islander Australians are more likely than other Australians to have, be hospitalised for, and die from cardiovascular disease, diabetes, and chronic kidney disease-and at younger ages-according to a new report from the Australian Institute of Health and Welfare (AIHW) The report, cardiovascular disease, diabetes and chronic kidney disease-Australian facts: Aboriginal and Torres Strait Islander people, shows that in 2011-13, 27% of Indigenous adults had cardiovascular disease, compared with 21% of non-Indigenous adults. 'The difference was even greater for diabetes and chronic kidney disease. While just 5% of non-Indigenous adults had diabetes, 18% of Indigenous adults had the condition. For chronic kidney disease, 10% of non-Indigenous adults had the disease, but for Indigenous adults, this was 22%,' said AIHW spokesperson Diabetes contributed to 21% of all Indigenous deaths, compared with 10% of nonIndigenous deaths. For chronic kidney disease, these rates were 16% and 10%. Not only are Indigenous Australians more likely to have each of these conditions individually, but they are also more likely to have all 3 and die from them. 'For example, more than 10% of Indigenous deaths had all 3 conditions listed as causes of death. For non-Indigenous Australians, all 3 conditions were recorded in just 3% of deaths.' For all three factors • Compared to their non-Indigenous counterparts, Indigenous Australians were more like to smoke daily (42% and 16% respectively), be overweight or obese (72% and 63%), and have high blood pressure (25% and 21%).