What are the priority issues for improving Australia's health?

Groups experiencing health inequities Although the mortality statistics indicate a generally improved health status for Australians, unfortunately this is not shared Australia-wide. There are some fundamental differences in the level of health of particular groups in our society. These differences exist in terms of: The unequal distribution of some illnesses or condition throughout the population (across different cultures, geographic locations, ages and genders) Health inequities – the unjust impact on the health status of some groups due to social, economic, environmental and cultural factors such as income, education, availability of transport and access to health services. Health is, to a large extent, the result of people’s decisions about health behaviours (eg regular exercise), and their everyday experiences. An individual’s level of health is also determined by a broader range of factors such as: sociocultural, socioeconomic and environmental factors.

Groups experiencing health inequities Health is not only the responsibility of the individual. Governments and health authorities recognise that people cannot always choose a particular lifestyle. Health promotion and illness prevention campaigns attempt to address the determinants that impact on health or affect people’s ability to make good decisions about their health. These can be classified as: Sociocultural determinants of health – including family, peers, media, religion and culture Socioeconomic determinants of health – including employment, education and income Environmental determinants of health – including geographical location, and access to health services and technology The main groups that experience health inequities in Australia are: Aboriginal and Torres Strait Islander peoples Socioeconomically disadvantaged people People in rural and remote areas Overseas-born people Elderly people People with disabilities

Aboriginal and Torres strait islander peoples The nature and extent of the health inequities No greater contrast in the extremes of health status can be found in Australia than that between Aboriginal and Torres Strait Islander peoples and the rest of the Australian population ATSI die at a much younger age and are more likely to experience disability and reduced quality of life because of ill-health The life expectancy of Indigenous Australians is approximately 10 years less than the overall Australian life expectancy The life expectancy at birth of a male is approximately 67 years and for a female is approximately 73 years. Death rates for Aboriginal and Torres Strait Islander peoples are higher for every specific major cause of death Infant mortality (estimated at two to three times higher than the overall Australian figure) and higher mortality rates.

Aboriginal and Torres strait islander peoples The nature and extent of the health inequities The leading causes of death in the ATSI population are circulatory diseases, cancer, diabetes and respiratory diseases. Indigenous females and males are, respectively, four and five times as likely to die from avoidable causes. Indigenous people are five times as likely to die from heart attack Twice as likely to die from cancer 18 times as likely to die from diabetes Twice as likely to die from suicide. Indigenous Australians are more likely to die from transport accidents, intentional self-harm and assault than other Australians. Injury rates are around three times those of the total Australian population http://www.youtube.com/watch?v=vIuK_F80X08 http://www.oxfam.org.au/explore/indigenous-australia/close-the-gap

Aboriginal and Torres strait islander peoples The nature and extent of the health inequities Trauma and grief related to the history of a new settlement invading Indigenous communities, the impact of colonisation by Europeans, loss of land and culture, high rates of premature mortality, high levels of Jail, family separations and Aboriginal deaths in custody have been identified as underlying the great burden among Indigenous people of ‘mental health problems’, which may lead to ‘mental illness’. Diabetes is a major health problem among Indigenous people. Overall, diabetes is around three-and-a-half times more common among Indigenous people than among other Australians. Only around one-half of people with diabetes know they have the condition. One in three Indigenous people have eye and/or sight problems, such as refractive error (requiring glasses for correction), cataract (clouding of the lens), trachoma (a bacterial infection that can lead to blindness if untreated) Nearly twice as many Indigenous six-year-olds as non Indigenous six-year-olds have tooth decay.

Socio-cultural, socio-economic and environmental determinants for ATSI Low community self esteem Loss of dignity with community Feeling little control over their environment Restriction to connect with their traditional culture Racism – stress affecting mental health History of discrimination Domestic Violence in communities Socio-economic Unemployment 3 times higher Lower average income ($364 compared to $585) Being poorer leads to lower health care Lower health care leads to more risk of disease Indigenous students half as likely to finish yr 12 education. Poor literacy – leads to reduced capacity to use health information Environmental Poorer living conditions Overcrowded and run down housing Lower safe drinking water in remote communities Large distance from health services Living in remote areas often has higher mental issues, less recreational opportunities

Roles of Individuals, communities and governments in addressing health inequities There are two peak agencies which coordinate Indigenous health services at the federal government level, while a third peak body in New South Wales oversees Indigenous health at a state level. The Office of Aboriginal and Torres Strait Islander Health (OATSIH ) Delivery of mainstream health services Administering and funding ATSI community controlled health services The National Aboriginal Community Controlled Health Organisation (NACCHO) Body that advocates for improvements to ATSI health The Aboriginal Health and Medical Research Council of NSW (AH&MRC) Body for Aboriginal health in New South Wales

Their strategies working in partnership with the community Roles of Individuals, communities and governments in addressing health inequities Community Indigenous Australians do not access primary healthcare services. Mainly due to: lack of availability of services, transport and distance to services, cost and language or cultural barriers OATSIH, NACCHO and the AH&MRC all aim to improve the access. Their strategies working in partnership with the community Aboriginal Community Controlled Health Services (ACCHSs) Aims to deliver holistic, comprehensive and culturally appropriate healthcare to the community that controls it. Services include clinical care, health education, promotion, screening, immunisation and counselling, as well as specific programs such as men’s and women’s health, aged care, transport to medical appointments, hearing health, sexual health, substance use and mental health.

Roles of Individuals, communities and governments in addressing health inequities An individual’s capacity to reduce their risky health behaviours and to increase their protective health behaviours or promote good health in others is influenced by a variety of factors including: Age Family History Community support Education Role modelling Access to health services SES Education and access appear to have the greatest impact. Health services focus on improving the knowledge and skills of community members. Women and mothers are often targeted as custodians of health knowledge and practice.

ATSI Revision Discuss why the financial resources devoted to improving Indigenous health have so far had little impact. Apart from financial support, identify other strategies that have been introduced to improve Indigenous health. Evaluate how effective they have been. Propose alternative strategies that could be introduced to reduce health inequities in the Indigenous population.

Socio-economically disadvantaged people Nature and extent of inequalities A person’s socio-economic status is determined by several factors: Income Occupation Education Socio-economically disadvantaged people are those who, as a result of one or more of these factors, experience significant financial limitations. Inequalities occur as a result of socioeconomic differences in material resources, access to educational opportunities, safe working conditions, effective services, living conditions in childhood, racism and discrimination Socio-economically disadvantaged people: have reduced life expectancy are more likely to die from cardiovascular disease respiratory disease and lung cancer have higher infant mortality have higher levels of blood pressure are more likely to smoke are more often generally sick.

Socio-economically disadvantaged people Nature and extent of inequalities SES disadvantaged people are more likely to suffer from long-term health conditions, such as diabetes, diseases of the circulatory system (which include heart disease and stroke), arthritis, mental health problems and respiratory diseases (including asthma) Socio-economically disadvantaged people are far less likely to engage in preventative health behaviours, such as having ‘Pap’ smears and dental check-ups. Unemployment is also a major issue because it is significantly higher than the national rate. Unemployment can lead to a sense of helplessness, and is therefore linked to social problems, including drug use, violence, vandalism and crime. It a factor contributing to depression and suicide in young people. Department housing often experience higher levels of social problems. EG. domestic violence, vandalism and family breakdown. Low income and education can reduce alternatives regarding employment, housing and nutrition, and can generally affect the ability to raise standards of living. Socio-economic disadvantage is considered to be the most important indicator of poor health in Australia

Socio-cultural, socio-economic and environmental determinants for SES Often single Parent structure Loss of dignity with community Family breakdowns Often high stress from financial barriers Social problems resulting from unemployment and low education include low self esteem, and helplessness. Domestic violence in communities Socio-economic Unemployment higher Lower income Being poorer leads to lower health care Lower health care leads to more risk of disease Lower levels of educations Low education leads to lower skill base for trades etc Poor literacy – leads to reduced capacity to use health information Less access to health care Environmental Poorer living conditions Overcrowded and run down housing Often live in populated areas with higher levels of pollution and lower levels of sanitation.

The roles of individuals, communities and governments in addressing the health inequities Federal and state Government committed to making improvements in funding and policies to reduce health inequities. Strategies by the government aim to improve the access of SES people to better health. These services include: Medicare Pharmaceutical Benefit Scheme (PBS) Immunisation programs Oral checkups Subsidised child care for low income families Community The nature of the services provided varies from one community to another, though generally they include clinical care, health education, promotion, screening, immunisation and counselling, as well as specific programs such as men's and women's health ,aged care, transport to medical appointments, hearing health, sexual health, substance use and mental health. Individuals Educational services are provided to individuals to help them help themselves. Health services focus is on improving their knowledge and community skills. Empowering the individual to make wise decisions is ultimately the main aim

FYI - People in rural and remote areas Nature and extent of health inequities More likely to suffer acute and chronic injury Experience lower life expectancy Reported less likely to have good health More likely to have high levels of psychological distress amongst males Sociocultural, socioeconomic and environmental determinants People living in rural and remote areas were more likely to: Drink risky amounts of alcohol Be overweight/obese Ate less fruit Experience lower birth weight, particularly among teenage mothers Roles of individuals, communities and governments in addressing the health inequities Government State health Plans are needed to: Attract and retain more health professionals in rural and remote communities Provide sustainable quality health services Make health services more accessible Communities In order to run health services, it is essential that rural communities are able to attract and retain properly trained staff.

FYI - Overseas-born people Nature and extent of health inequalities Suffer higher levels of psychological distress ( due to wars, or language problems) Hospital rates 20% lower than other Australians Are hospitalised for diseases according to country of birth, at greater levels than others. E.g. heart attacks are more likely to happen to people born in India whilst breast cancer is more common for women from England and Northern Ireland. Lower deaths than Australian – born people. Sociocultural, socioeconomic and environmental determinants Current daily smoking – Oceania Lower levels of exercise – North Africa and Middle East Consume less fruit and veg than others Overweight and obese – Oceania and southern and eastern Europe Roles of individuals, communities and governments Government The main approach by governments to the health of people born overseas is to provide translation and language services to improve communication of health issues and access to health services among culturally and linguistically diverse communities (CALD). Communities The critical role of communities is to provide support for their members by advocating, promoting and engaging in the use and delivery of culturally appropriate health services. The training and education of CALD community and members to join and support the healthcare profession is the most enabling of all strategies.