1. Session 3: Explaining Health Inequalities

2.   In your group, think of all the reasons that are used to explain why Indigenous people suffer from these health problems at higher rates than non-Indigenous people   Include reasons that may be perceived as ‘racist’ and reasons that you don’t agree with. Mark these ‘racist’ reasons with an asterisk.   Don’t include medical conditions (e.g. renal failure caused by diabetes and high blood pressure)

3. 1) More non-healthful behaviours leading to excess chronic disease 2) Higher rates of renal disease 3) Poor housing and infrastructure 4) Less antenatal care

4. 1) Non-healthful behaviours leading to excess chronic disease “ The excess mortality of the Indigenous population is largely due to higher rates of cardiovascular disease. Behavioural factors such as smoking, poor diet and lack of exercise are major causes of cardiovascular disease.” Think of as many reasons as possible to explain why Indigenous people have higher rates of these unhealthful behaviours than non-Indigenous people

5. 2) High rates of renal disease “Aboriginal people in the NT have some of the highest rates of renal disease in the world. Diabetes and other ‘Syndrome X’ conditions of hypertension, high lipids and obesity are implicated as direct causes, as well skin infections in children and intrauterine factors.” Think of as many reasons as possible to explain why Indigenous people have higher rates of renal disease than non-Indigenous people

6. 3) Poor housing and environmental health “Poor housing is thought to be a significant contributor to high rates of infectious diseases that in turn cause poor hearing, rheumatic heart disease, and possibly renal disease, in additional to their impacts on quality of life and productivity.” Think of as many reasons as possible to explain why Indigenous communities continue to have poor housing and infrastructure

7. 4) Poor antenatal care “Indigenous women do not have the same level of antenatal care as non-Indigenous women, despite their greater need for it. This leads to higher rates of all types of obstetric complications and poorer outcomes for infants.” Think of as many reasons as possible to explain why Indigenous women have less antenatal care than non-Indigenous people

8. 1) More non-healthful behaviours leading to excess chronic disease 2) Higher rates of renal disease 3) Poor housing and infrastructure 4) Less antenatal care TWO EXAMPLES FROM THE MEDIA

9. Mapping exercise

10.   Biogenetic   Socioeconomic   Sociocultural   Sociopolitical An approach to explaining health inequalities

11.   Biogenetic   Socioeconomic   Sociocultural   Sociopolitical An approach to explaining health inequalities

12. Bio-genetic   Genetics particular to Indigenous people cause their ill-health through gene-environment interactions

13. Socio-economic   Lower class, employment, income, occupation, as well as high levels of poverty cause ill-health for Indigenous people. Race is only a mediating factor in this relationship rather than a cause in its own right.

14. Socio-cultural   Aspects of Indigenous cultures, including their lifestyle and behaviour, cause Indigenous ill-health   Or, erosion of Indigenous culture causes ill-health

15. Socio-political   Historical and contemporary forms of racism, oppression, and discrimination are the cause of Indigenous ill-health

16. Evidence for these explanatory categories   Strong evidence that race & genetics are only weakly related and are very rarely health-related   Evidence shows that Indigenous Australians are disadvantaged in terms of health at every level of socio- economic position   Evidence for gradient of Indigenous health with remote Indigenous health the worst. Different aspects of Indigenous culture are both healthy and unhealthy.   Strong evidence that a history of racism is related to poor Indigenous health

17. Diagrams exercise

18. Structure and Agency   The term ‘structure’ refers to the patterns of society which transcend individuals. These patterns are created by and produce the individuals that exist within them.   The term ‘agency’ refers to the choices made by individual(s) in a society which are constrained or enabled by structures.

19. Structure and Agency (example: school attendance)   Some constructions emphasise Indigenous agency: Indigenous parents choose not to send their children to poor-quality or culturally-inappropriate schools   Whilst others emphasise ‘structure’: There are no schools, or the educational system has failed to engage indigenous communities   ‘Agency’ can be constructed as an expression of structural culture: Parents don’t force indigenous kids to attend school because autonomy is a strong aspect of indigenous culture

21. Are inequalities bad for everyone’s health?   “Oppression is the greatest calamity of humanity: it diverts and pollutes the best energies…of oppressor and oppressed alike” (Memmi 1965 p. xvii)   Some studies have found that income inequality in itself is bad for everyone’s health (Subramanian & Kawachi 2006)   Whilst other studies have found that such inequalities are not detrimental to dominate social groups (such as white people) (Nuru-Jeter)

22. Are health inequalities bad for everyone?

23.   Do we have scarce resources to go around or unlimited possibilities in a world of fairness & peace?   To empower others we may have to be disempowered ourselves and our health may suffer!   Or will working equitably in a fair and just society be beneficial to all members of that society

24. Are health inequalities bad for everyone?   Be aware of the interplay between utilitarian and moral arguments implicit in these contrasting views   Utilitarian arguments can be a good strategy to ‘prove’ that action is in everyone’s best interests but it is then by definition amenable to ‘disproof’   Moral arguments need no ‘proof’ but they may not be good catalysts to real action in and of themselves