1. Groups Experiencing Health Inequities Generally speaking Australians health status is improving. However, this is not shared Australia-wide. There are fundamental differences in the level of health for particular groups. Groups within Australia experience inequities (unfair differences in levels of health status). Aboriginal and Torres Strait Islanders Socio-economically disadvantaged People living in rural and remote areas Australians born overseas Elderly People with disabilities

2. Major inequalities exist in the health status of Aboriginal and Torres Strait Islander peoples. - Die younger - Reduced quality of life - More likely to experience disability The nature and extent of health inequities - Lower life expectancy - Infant mortality is 3 times higher than the national average. However, the gap is closing due to better maternal and infant health care. - Poorer mental health - Higher hospitalisations - Poorer sexual health - Higher incidence of diabetes - Higher mortality rates for cardiovascular disease, injuries, respiratory diseases, cancer, endocrine disorders and digestive disorders

3. The socio-cultural, socio-economic and environmental determinants of health Socio-cultural - including family, peers, media, religion, culture, social connectedness, community, legislation, policies, political stability Socio-economic - employment, education, income Environmental - geographic location, access to health care services Socio-culturalSocio-economicEnvironmental Low community self-esteem Loss of dignity with communities Feeling of little control over their physical environment Experiencing a restriction in their ability to connect with their traditional culture - develop low morale Racism - stressor affecting mental and physical health History of discrimination and inequalities Domestic violence (not feeling safe in homes and community) Lower average gross household income ($364 compared to $585) - poorer income (reduce access to health care) Unemployment 3 times higher than non-indigenous Indigenous students half as likely to complete Year 12 Poor literacy (affect capacity to use health information) Poorer living conditions - overcrowded and run-down housing Limited safe drinking water in some remote communities Inaccessibility of mainstream health services Inadequate provision of health infrastructure Lower access to health care services Living in remote areas

4. The Roles of Individuals, Communities and Governments in Addressing the Health Inequities Modern approaches to healthcare and health promotion acknowledge the fact that Indigenous health status results from the interaction of multiple determinants. An “inter-sectoral” approach is required based on partnerships between people and agencies at many levels and in a variety of sectors. Government The Office of Aboriginal and Torres Strait Islander Health (OATSIH) www.health.gov.au/oatsih The National Aboriginal Community Controlled Health Organisation (NACCHO) www.naccho.org.au The Aboriginal Health and Medical Research Council of NSW (AH&MRC) www.ahmrc.org.au Government agencies aim to improve the access of Indigenous people to primary health care services. Communities Aboriginal Community Controlled Health Services (ACCHSs) and Aboriginal Medical Services (AMSs) are primary healthcare services initiated and operated by local Aboriginal communities (clinical care, health education, promotion, screening, immunisation, counselling, trasnport to medical appointments, hearing health, sexual health, substance use and mental health).

5. Individuals There is a strong focus in many Aboriginal Health Services on providing education and support for Indigenous mothers and children, on increasing the number of Aboriginal health workers, community support workers and medically trained staff and on increasing capacity by empowering individuals. www.health.gov.au/internet/h4l/publishing.nsf/Content/respack-exemplarsite

6. The Nature and Extent of the Health Inequities People or groups who are characterised by the following, are said to be socio-economically disadvantaged (experience financial limitations): - poor levels of education - Low income - Poor housing - Unskilled work - Long periods of unemployment People from a lower socio-economic background have significantly lower levels of health than higher socio-economic groups. Lower socio-economic groups have higher mortality and higher levels of illness. Socio-economically disadvantaged people: - Higher infant mortality - Lower life expectancy - More likely to die from cardiovascular disease, respiratory disease and lung cancer - Higher levels of blood pressure - Higher body-mass index for males and females (overweight) - More likely to smoke - More likely to suffer from mental health problems, diabetes and circulatory diseases - Less likely to engage in preventative health behaviours e.g. dental checks, “pap” smears, immunisation, family planning - Sick more often - Less informed about health - Sedentary behaviour

7. The socio-cultural, socio-economic and environmental determinants of health SocioculturalSocioeconomicEnvironmental Single parent family structure Family breakdown Social problems (often resulting from unemployment and sense of despair and helplessness) - crime, drug use, violence, vandalism. Low level income Poverty Higher levels on unemployment (youth unemployment) - reduced alternatives for employment Low skill level base Lower levels of education Medium and high-density housing developments - experience higher levels of social problems (often where disadvantaged people are gathered) Reduced alternatives for housing The Roles of Individuals, Communities and Governments in Addressing the Health Inequities Government Federal and State governments are committed to making improvements in funding and policies to reduce health inequities. Strategies by the government aim to improve the access of socioeconomically disadvantaged people to better health. Examples: Medicare, Pharmaceutical Benefit Scheme (PBS), immunisation programs funded by the government, funding oral health checks for children and adolescents (for low income families), subsidised fees for childcare (pre-schools) for low income families.

8. Communities and Individuals Development of an increasingly community-based health workforce that focuses on prevention of disease and the management of illness. There many community agencies that provide: - community health care - Childhood services - Parenting and maternity services - Community language services - Housing assistance - Employment training - Home care - Meals - Migrant services - Adult education

9. The Nature and Extent of Health Inequities Approximately 34% of the Australian population live in rural and remote areas. People living in rural and remote areas: - more likely to smoke - more likely to drink to hazardous levels - More likely to be overweight - Lower levels of education - Engage in more sedentary behaviour - Engage in risky occupations - Lower life expectancy (decreasing life expectancy with remoteness) - High death rates for coronary heart disease, other circulatory diseases and motor vehicle accidents - Higher deaths rates for injury (motor vehicle accidents and suicide) mostly in males - Higher levels of depression or psychological distress in males - Females have higher levels of diabetes and arthritis - Poorer dental health

10. The socio-cultural, socio-economic and environmental determinants of health Socio-culturalSocioeconomicEnvironmental Pressure’s on those working on the land Feelings of despair and helplessness with the lack of opportunities Lower income Fewer employment opportunities Fewer educational opportunities (e.g. tertiary education) Hazardous occupations Lack of access to health services (travel long distances to health care services) Poorer overall living conditions due to harsher environment Less access to basic necessities The Roles of Individuals, Communities and Governments in Addressing the Health Inequities Governments Rural Health Priority Taskforce provides advice to the NSW Government about improving health services to people in rural and remote areas. Priorities: -Attract and retain more health professionals in rural and remote communities -Provide sustainable quality health services -Make health services more accessible via initiatives such as “Telehealth”, a visual telecommunications system for clinicians and patients. Examples: Medical Specialist Outreach Assistance Program and Multi Purpose Service (MPS) Program

11. Communities Multipurpose services running in NSW rural communities. Aim to integrate services, better match services to community needs, achieve gains in productivity, reduce administration and share resources.

12. The Australian population comprises 24% of people born overseas. Within the population of people born overseas, there is a great diversity of group characteristics and health status. The Nature and Extent of the Health Inequities In general, immigrants on arrival to Australia have better health than the Australian born population (mainly due to the government selecting people based on health, education and job skills). This is known as the “Healthy Migrant Effect”. As time goes on the new residents health declines with length of stay. This can be attributed to: - socio-economic status - poor language skills - stress associated with re-settlement Overseas born people: - Less likely to exercise - More likely to be overweight - Less likely to report medical conditions - Less likely to immunise children

13. The Socio-cultural, Socio-economic and Environmental Determinants Socio-culturalSocio-economicEnvironmental Language barriers Stress resulting from relocation - unfamiliar culture and lack of contact with those from their original culture Different understandings of health and illness, and varying expectations of health care Relatively well off when they arrive in Australia but socio- economic status may fall depending on opportunities for employment, housing etc. Unfamiliar surroundings - knowledge of where health services are The Roles of Individuals, Communities and Governments in Addressing the Health Inequities Governments Government providing translation and language services within Culturally and Linguistically Diverse (CALD) communities. NSW Multicultural Health Communication Service (MHCS) works with health services to provide non-English speakers with access to important health information. Support is also given to health services within areas that are experiencing a growth in the number of new arrivals and refugees.

14. Communities and Individuals 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. Training and education of CALD community members to support and work with health care professionals is very important.