The World Health Organization (WHO) defines health inequality as the “differences in health status or in the distribution of health determinants between different population groups” (WHO, 2017, para. 2). When looking at Australia’s health inequities it is evident that Aboriginal and Torres Strait Islander People experience significantly lower life expectancy than Non-Indigenous people. More specifically recent statistics indicate that the life expectancy of Indigenous Australians is 10 years lower than that of non-Indigenous Australians (Australian Institute of Health and Welfare, 2016). This essay aims to explore the possible biological and psychosocial factors that contribute to this inequity and therefore analyse the possible solutions to reduce the disparities between the population. Furthermore, this essay aims to add to literature on Ingenious Australian health and to gain a more in depth understanding of health inequities by a particular group of people.
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To begin this essay, it is important to explore the health status of Aboriginal and Torres Strait Islander in Australia compared to that of non-Indigenous Australian’s. Aboriginal and Torres Strait Islander people experience significantly more ill health than other Australians. Across a wide range of determinates of health, the indigenous population is disadvantaged. Infant morality rates are almost two times higher than the rest of the population. (Australian Institute of Health and Welfare, 2015). They experience higher rates of unemployment, lower incomes, lower education levels, poorer housing and lower levels of home ownership. (Australian Institute of Health and Welfare, 2015). All these factors can be seen to have a relationship between the lower life expectancy experienced by this population. More specifically, literature on biological, behavioural, social and physical environmental factors will be investigated to determine why these statistics are evident.
Biological determinants of health are factors that relate to the body which impact on health. (Brown, Carrington, McGrady., Lee, Zeitz,, Krum and Stewart, 2014). For example, Obesity is a biological factor that is prevalent among indigenous Australians and can contribute to lower life expectancy. “It has been reported that Indigenous Australian men are 1.6 times more likely to be obese than non-Indigenous men and that Indigenous women are 2.2 times more likely to be obsess than their non-Indigenous counterparts”. Birch (2015) discusses the links between obesity and health problems and concluded that “individuals who are obese are more at risk of suffering from heart disease, diabetes and some forms of cancers”. This is especially the case for Indigenous Australians whereby nearly 50 percent of the population who are obese suffer from diabetes and over 43 percent suffer from heart and circulatory diseases (Australian Bureau of Statistics 2008) “There have been many medical studies that have examined the factors associated with obesity.
A key finding from this literature is that obesity is a result of genetic factors and heritability are the main determinants of an individual’s susceptibility to obesity, accounting for 80 percent of the prevalence of obesity.(Swarbrick, 2002; Wardle, Carnell, Haworth, and Plomin, 2008). “Most medical studies, however, fail to explain why the prevalence of obesity has increased so dramatically in recent years, given that genetic factors tend to change slowly over time” (Chou, Grossman and Saffer, 2004). “In an aim to reduce the percentage of Aboriginal and Torres Strait Islander people suffering from obesity, “The Council of Australian Governments has highlighted the need to address poor Indigenous health through the Closing the Gap in Indigenous Disadvantage initiative and has set a target aim to close the gap in life expectancy by 2031”. “In 2010–2012, the gap in life expectancy was 10.6 years for men and 9.5 for women” (Holland, 2014). “The increased likelihood of suffering from various health conditions caused by obesity has been reported to lower life expectancy by up to 8 years for men and 6 years for women” (Grover, Kaouache, Rempel, Joseph, Dawes, Lau,and Lowensteyn, 2015). “Hence, reducing the higher rate of obesity for Indigenous Australians is paramount to closing the gap in life expectancy between Indigenous Australians and the rest of the Australian population.”
Behavioural determinants of health are defined as people’s choices that influence on their health and thus related to their lifestyle. (Laws, Grayson, and Sullivan, 2006). One of the major behavioural determinates that lowers the life expectancy of Aboriginal and Torres Strait Islander people is that of tobacco smoking. “When compared to the overall Australian population, Aboriginal and Torres Strait Islander peoples have a substantially higher prevalence of smoking for all age groups among both men and women.” (The Cancer Council Australia, 2019). “Thirty-nine per cent of the combined Aboriginal and Torres Strait Islander population aged 15 and over were daily smokerscompared with 14% in the general population.”(Van der Sterren, Greenhalgh, Knoche, and Winstanley 2018) “After adjusting for differences in age structure, Aboriginal and Torres Strait Islander peoples aged 15 years and over were almost three times as likely as non-Indigenous people to be daily smokers.” (The Cancer Council Australia, 2019). “Prevalence appeared to be slightly higher among Aboriginal peoples” (39%) “than Torres Strait Islander people” (35%) (The Cancer Council Australia, 2019). “More importantly a study with pregnancy Australian indigenous women reported smoking prevalence rates between 50% and 67%, approximately three time that in non-indigenous population.” (Passey, D’Este and Sanson-Fisher, 2012) “Smoking during pregnancy is associated with increased risk of maternal and infant adverse outcomes.” (Laws, Grayson, and Sullivan, 2006). “”For the mother, these include higher rates of placental abruption, placenta praevia, premature labour and premature rupture of membranes” (Laws Grayson and Sullivan, 2006). “For the baby, adverse outcomes include low birth weight, preterm birth, intrauterine growth retardation, perinatal death and Sudden Infant Death Syndrome” (Laws, Grayson, and Sullivan, 2006). Examination of population-level data confirms these adverse outcomes among Aboriginal women. (Chan A, Keane RJ, Robinson, 2001) A study conducted by Passey, D’Este and Sanson-Fisher (2012) found that lower levels of education and socio-economic status was associated with higher rates of women smoking during pregnancy and therefore smoking cessation knowledge was essential in Aboriginal and Torres Strait Islander communities. Since conducting smoking cessation knowledge and educating the Indigenous community on the effects of tobacco smoking “there have been progressive decreases in smoking prevalence among Indigenous Australians over time. The prevalence of current (i.e., daily and less often) smoking among Indigenous adults declined by 2.4% between 1994 and 2004, from 54.5% to 52.1%.”(The Cancer Council Australia, 2019). There were also declines in more recent years, from 49.8% in 2008, to 44.5% in 2015. %”.”(The Cancer Council Australia, 2019) “Since 2000 the Townsville Aboriginal and Islander Health Service’s Mums and Babies Project increased the numbers of women presenting for antenatal care”(from 40 to over 500 visits per month in 1 year). “The number of antenatal visits made by each woman has doubled, with the number having less than four visits falling from 65% to 25%. Pre-natal deaths per 1,000 reduced from 56.8 prior to the program to 18 in 2000”; “the number of babies with birth weights less than 2,500 grams has dropped significantly; and the number of premature births has also decreased” (Australian Human Rights Commission, 2019)
Social determinants refer to aspects of society and the social environment that influence on health. They generally relate to contact with other people in someone’s community. (Marmot ,2011) One social determinant that can be seen to have a relationship with lower life expectancy among indigenous Australians is that of lower levels of education. (Marmot ,2011). “There is a correlation between lower levels of education among Aboriginal and Torres Strait Islander people and engaging in risky behaviours such as unprotect sex which can lead to sexually transmitted diseases.” (Wand, Bryant, Worth, Pitts,Kaldor, Delaney-Thiele, and Ward, 2017). “Aboriginal people make up 3% of the Australian population; however, in 2014, they accounted for 34% and 21% of all gonorrhoea and chlamydia notifications respectively.” (Wand, Ward, Bryant, Delaney-Thiele ,Worth, Pitts, Kaldor, 2016) “Further, socioeconomic conditions, such as inadequate access to health care, low levels of STI testing within mainstream primary health care settings, high community prevalence and high mobility between communities, also make Aboriginal young people particularly vulnerable to STIs.” (Wand, et. Al, 2017) “Overall the prevalence of regular alcohol intake per week was higher in the indigenous community than non-indigenous community” (49% in males and 37% in females) “can be seen to have a relationship between the number of sexual encounters experienced within the community”. (Wand, et. al, 2016)
“One of the most robust results from the present study is the strong association between early onset sexual activity and subsequent risky sexual behaviours that have been established to be associated with STIs, The results showed that young Indigenous men and women who initiated sexual activity at earlier ages were significantly more likely to engage in risky sexual behaviours. 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.”((Australian Rights Commission, 2019) “The Northern Territory Well Women’s Program, which operates in a region with a high proportion of Aboriginal women and has a long history of engagement with women and local Aboriginal Health Services, has achieved a high rate of cervix screening (61%) in the Alice Springs remote area, which is comparable to the rate for Australian women generally” (62%).
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Lastly, Physical environment determinants refer to the impact of the physical surrounding in which we live, work and play on our health. (Healey, 2008). “Indigenous peoples do not have an equal opportunity to be as healthy as non-Indigenous Australians. The relative socioeconomic disadvantage experienced by Aboriginal and Torres Strait Islander people compared to non-Indigenous people places them at greater risk of exposure to behavioural and environmental health risk factors”. (Australian Human Rights Commission, 2019) as does the higher proportion of Indigenous households that “live in conditions that do not support good health”. (Booth and Carroll, 2005). In 2006, 31% of houses in Indigenous communitie required major repair and replacement. (Booth and Carroll, 2005). These posed health risks including risk of injury or disease “Indigenous peoples also do not enjoy equal access to primary health care and health infrastructure” (including safe drinking water, effective sewerage systems, rubbish collection services and healthy housing) (Healey, 2008). These physical environments have been seen to have an impact on mental health and therefore has been seen to have a relationship with lower life expectancy in Indigenous communities. (Healey, 2008). “High rates of mental health problems also indicate chronic stress in a population group.” (Australian Human Rights Commission, 2019) “In 2003-04, Indigenous people were up to twice as likely to be hospitalised for mental and behavioural disorders as other Australians.” (Australian Human Rights Commission, 2019) A mental health project was introduced at the Geraldton Regional Aboriginal Medical Service reduced psychiatric admissions of Aboriginal and Torres Strait Islander people to Geraldton Regional Hospital by 58%. (Australian Human Rights Commission, 2019)
In Conclusion, this essay explored the health inequities between Aboriginal and Torres strait Islander people to the rest of Australians. It was discussed that life expectancy was significantly lower in Indigenous people due to various biological, behavioural social and physical environment determinants. Therefore, this essay explored the ways in which life expectancy can be increased by referring to existing literature and through suggestions for the future.
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