Aboriginal and Torres Strait Islander peoples

The nature and extent of the health inequities

Australia is considered one of the healthiest nations in the world, yet there is a large disparity between the life expectancy of Indigenous and non-Indigenous Australians. On average, Indigenous Australians are expected to live between 10 to 17 fewer years and the infant mortality rate of this community is almost 3 times higher than the national average.

There have been some notable improvements in health and wellbeing for First Nations people in recent years- including a decrease in age standardised death rate for cardiovascular diseases, reduced rates of smoking (includig during pregnancy) and improved attendance at antenatal care. 

Death rates among FN people have been falling in most age groups over the past 10 years. However, there has been significant change in infant and child death rates over this time. 

FN males born in 2020-22 could expect to live 71.9 years and fe,males 75.6 years. 

Cancers are the most common group of diseases causing deaths among Fn people, overtaking Cardiovascular diseases as the most common group in recent years. CVD rate shave significantly declined, whilst cancer mortality rates have risen. 

Burden of disease: 

The diseases that contirbute to the most burden among FN people in 2018 were: 

The main causes of poor health in indigenous communities can be attributed to:

1 – mental and substance use disorder

2- Injuries

3- Cardiovascular disease

4- Cancer

5- Muskuloskeletal conditions

The sociocultural, socioeconomic and environmental determinants

So, why do these health inequities exist?

Since the arrival of the first fleet, there have been many circumstances which have lead to the current level of poor health for Indigenous Australians, including, but not limited to oppression, segregation, forced assimilation and poor integration.

Additionally, European settlers introduced a variety of diseases and infections to Australia and the indigenous population. These diseases had a devastating impact on many communities, as Indigenous Australian had no previous exposure to these illnesses, meaning that they had no immunity.

The current health inequities in Indigenous and Torres Strait Islander communities can be attributed to lower levels of education and higher rates of unemployment, resulting to lower income levels.

Another contributing factor is that a majority of indigenous Australians live in rural and remote areas where community members have poor access to health providers, low quality care facilities and preventative strategies, such as immunisation, a less consistently implemented.

Lower education levels often result in high risk lifestyle choices such as a unhealthy diet, inadequate exercise, poor drinking habits, smoking and, in some cases, illicit drug use, all of which are be detrimental to physical and mental health. This is attributed to a insufficient health awareness and a lower standard of education, both of which have lead to a poor understanding of the correlation between these behaviours and poor health.

In summary, there are three specific determinants which have led to the vast inequalities experienced by Indigenous Australians:

Analysis of data for 2017–19 showed that an estimated 35% of the health gap was explained by social determinants, and a further 30% by selected health risk factors. First Nations people have lower access to health services than non-Indigenous Australians, for a range of reasons including barriers such as cost and a lack of accessible or culturally appropriate health services. For First Nations people to have better health outcomes, improvements in the health system and determinants beyond the health sector are required. A large part of the disparity in health outcomes between First Nations people and non- Indigenous Australians is also explained by disparities in social determinants (in particular income, employment, housing and education)

The roles of individuals, communities and governments in addressing the health inequities

So, what can be done to eliminate these health inequities?

Individuals, communities along with federal and state governments all have a role to play in improving access to health care and the quality of life for all Aboriginal and Torres Strait Islander Groups.

Every ATSI individual needs to be, and feel, empowered to take responsibility for their health and make decisions that will improve their quality of life. This means that there needs to be drive to increase education and awareness of good health practices in indigenous communities. Long term objectives include increasing the quality of education, offering community support, recruiting elders to role model healthy behaviours and providing greater access to health services and facilities so that individuals have the opportunities and benefits afforded to other groups living in Australia.

The role of the community is to ensure that Indigenous Australians are aware of cultural and reconciliation programs offered locally. Local officials can work with tribal elders to empower Indigenous communities to become self-sufficient and autonomous when promoting services, raising awareness and breaking down the barriers to health care access.

The Government is responsible for overseeing the protection and implementation of Indigenous health care on a national scale. They are also responsible for creating initiatives such as Close the Gap; a preventative health service for Aboriginal and Torres Strait Islanders. Through the creation of this program and others like, government agencies demonstrate that they are aware of health within Indigenous communities and recognise that improving quality of life for ATIS groups is a priority. The NRL has also promoted and supported this initiative by creating the Indigenous all star game, which aims to raise awareness of indigenous health issues.

Activity:

Describe three trends in the mortality rates of Indigenous Australians

Analyse the impact of a range of health determinants on the health status of Indigenous Australians

Rural and Remote people 

Use the table above and Jacaranda Plus to assist you with your notes 

Socioeconomically disadvantaged people

Socioeconomic status refers to the status or position of an individual or group of people and is typically determined by:

– Where a person lives

– Their employment status

– Their household income

The nature and extent of the health inequities

People who have better access to healthcare services and resources are typically healthier than people who don’t have the same access, opportunities or financial stability. Consequently there is a correlation between individuals with a lower healthcare status and people who live in low SES areas.

People in low SES groups generally have a higher rates of mortality, morbidity and infant mortality. Additionally, individuals in this group have a lower life expectancy and are more likely to develop mental illness, asthma, diabetes and CVDs. There is also a link between low SES and poor educational levels and people with possess little to no knowledge of good health practices are more likely to engage in high risk behaviours and adopt and unhealthy lifestyle.

The sociocultural, socioeconomic and environmental determinants

Low SES and low health status are strongly connected. People who reside in lower SES areas tend to exhibit one or more of the following traits:

– An inactive lifestyle

– High risk behaviours

– Poor eating habits

– Poor access to, or disinterest in, healthcare services

– Dependency on government assistance

While low SES can lead to poor health, poor health can also lead to low SES. For instance, if a 40-year-old person suffers an injury or illness, it could impact their ability to perform their job requirements, leading to reassignment, a reduction of hours or dismissal. They may also require expensive medical products or procedures to treat their injury or illness.

The roles of individuals, communities and governments in addressing the health inequities

To improve the equity and overall health of people living in low SES areas individuals, communities and governments must take on certain responsibilities and commitments.

Individuals living in low SES circumstances must learn better health practices and pass these behaviours on to their children. These individuals must take responsibility for their dietary choices and exercise habits, to empower them to live healthier, better quality lives. The danger of high risk behaviours such as drinking, smoking and drug use should also be emphasised, long with the importance of life long learning and educational health.

The community should encourage the efforts of individuals by providing a range of government-funded, supportive initiatives. Childcare, community healthcare, primary care, education, employment training and migrant services are all examples of programs that can promote good health behaviours and alleviate the strain on low SES individuals.

The role of the government is to supply subsidies and funding to negate the high costs of health education and promotion. The government must recognise and respond to the inequalities people within this group, recognising that the costs associated with both bad heath and improving lifestyle behaviours may be prohibitive for individuals living in the low SES areas. Consequently, an array of government programs – public housing, pension cards, concession cards, Centrelink and Austudy – must be sustained and improved to relieve the pressure on low SES groups. Initiates like the Pharmaceutical Benefit Scheme and Medicare were created for this exact purpose; to decrease the gap between low and high SES groups by providing a service directed toward people who had most need for it.

Overseas-born people

The nature and extent of the health inequities

24 percent of the Australian population were born overseas and a majority suffer from inequities, including a lower level of health.

There are two primary reasons for this disparity. The first is that many migrants suffer from higher level psychological pain, especially those with no English language skills or individuals seeking refuge or asylum from politically or socially unstable nations. A  second cause of poor health is that exposure to Australian lifestyle behaviours and risk factors often results in higher the rates of both morbidity and mortality in individuals who were born overseas.

The sociocultural, socioeconomic and environmental determinants

To understand why inequalities occur it’s important to consider the socioeconomic, sociocultural and environmental factors. In Australia migrants are exposed to dangerous risk factors such as CVD or other illnesses that they are unlikely to encounter in their birth country. Migration, especially asylum seeking, has also been associated with decreased opportunities for employment and education, resulting in lower income and socio-economic status.

The roles of individuals, communities and governments in addressing the health inequities

To address inequities amongst any group it’s important to consider how governments, communities and individuals can collaborate and take on specific roles to produce long-term, sustainable solutions.

Individuals must overcome their reluctance or hesitance to access and take advantage of the health related services available to them, such as translators. They should also learn to utilise the support offered by communities.

Communities must offer support and services to overseas-born people such as multi-language services as well as educational and training opportunities. Communities must also promote and maintain open and friendly relations with new migrants, encouraging them to seek assistance and utilise relevant services.

The government can employ cost-effective methods such as free transportation and language services to ensure better communication and access to healthcare services for migrants.

CVD Worksheet 

The Protective Factors :

Protective factors are behaviours or practices people can adopt to maintain good health and reduce the likelihood of conditions like CVD from occurring. Practicing a healthy diet (low in salt, fats and alcohol), exercising regularly, managing stress and attending regular check ups with a GP are all examples of protective factors.

The sociocultural, socioeconomic and environmental determinants

Socioeconomic factors are the combination of employment, education and social status, which impact and shape a person’s attitudes, experiences and lifestyle. For example, an individual with a a low-level of education and income is likely to be aware of health risks or be able to afford healthy food or medical services.

People who live in rural or remote areas, particular ATSIs, are more likely to develop CVD. Individuals in these location have less access to healthcare facilities and are often poorly educated, without a stable income. These factors can also lead to high risk behaviours, like smoking, and other health problems, like depression or anxiety.

Groups at risk

The people most at risk from CVD include those who:

– Smoke

– Are obese

– Eat poorly or overeat

– Have a family history of CVD

There are also several demographic groups with high rates of CVD including:

– Indigenous communities

– Migrants and refugees

– The socioeconomically disadvantaged

– Residents of remote/rural areas

Cancer Worksheet  

Cancer AIHW 

Activity: Speed dating brainstorm:

Questions:

Skin Cancer - risk factors, groups at risk, protective factors

Breast Cancer - risk factors, groups at risk, protective factors

Lung Cancer - risk factors, groups at risk, protective factors

Websites: Lung Cancer , Skin Cancer , Breast Cancer  

Risk factors

Breast cancer rates are particularly high for women, although the condition can also affect men. 

Other factors which can increase the chances of developing breast cancer include:

– Family history of the disease

– Weight gain and/or obesity/high fat diet

– Age (40 years old and older)

– Late age at first full-term pregnancy or childlessness

– Use of contraceptive pills / late menopause

Groups at risk

Women are the primary group at risk of breast cancer, especially if they are over 40 and never had children.

Protective factors

Women who are over forty or have a family history of breast cancer should see their GP for regular checkups from their doctor. Individuals who fall into any of the high risk categories can also conduct regular breast examinations at home. Maintaining a healthy weight can also reduce risk.

• The number of females smoking has fallen only slightly in the past few years, so the future incidence of lung cancer in women is unlikely to fall as much as it has in men. 

• Most lung cancers take considerable time to develop, but then the mortality rate is high once lung cancer has been detected. A large proportion of people die within the first five years of diagnosis.

• The risk of developing lung cancer is 10 times higher among smokers than among non-smokers. 

Risk factors

There are certain factors and behaviours which can increase the risk of developing lung cancer including:

• Active or passive smoking

• Carcinogen exposure (asbestos)

• Air pollution

Groups at risk

The main demographic groups at risk of lung cancer are:

– Smokers

– People who live with smokers

– People who work in an asbestos environment

Protective factors

There are a number of protective behaviours individuals can adopt to reduce the risk of developing lung cancer. The simplest positive change a person can make to their lifestyle is to stop, or never start, smoking and avoid areas where people smoke. Individuals should also limit their exposure to dangerous particles and wear protective gear, like face masks, when using harmful inhalants to prevent breathing them in.

There are three types of Diabetes:

• Type 1: typically presents early in life and is treated via a regular injection of insulin, as well as carefully monitored diet and exercise.

• Type 2: generally presents later in life and has been closely linked to poor diet andlack of exercise. Treated with medication.

• Gestational Diabetes: occurs during pregnancy and must be closely monitored.

Possible long term effects of diabetes include vision impairment and kidney disease. Research suggests that there is also a strong link between the development of CVD and diabetes.

Extent of the problem (trends)

Diabetes is the world’s fastest growing disease. The age it is being diagnosed is also Type 2 Diabetes is being diagnosed is decreasing, which may be due to the unhealthy lifestyles of families.

Risk factors and protective factors

The modifiable, or changeable, risk factors of Diabetes include:

– being overweight of obese

– having gestational diabetes

– having CVD

– high blood pressure

– poor diet

The non-modifiable, or fixed, risk factors include:

– being over 55 years old

– being over 35 and ATSI

– family history

Protective factors

Individuals can lower the risk of developing diabetes by maintaining a healthy weight and lifestyle, which involves regular exercise and good food. A low GI diet and small meals are recommended. Decreasing the consumption of alcohol can also improve health and decrease the chances of becoming diabetic.

The sociocultural, socioeconomic and environmental determinants

The socioeconomic determinants which can impact the rate of diabetes include low levels of education and employment. People who live in low SES, rural or remote areas, have less awareness of health promotion and prevention strategies due to lower levels of education. These individuals are also less likely to eat well or exercise regularly as they are poor in funds and time.

Australia’s ageing population is a major sociocultural determinant of the high rate of diabetes. The casual cultural attitudes towards drinking in Australia also negatively impact health. The long work hours and low salaries of many Australians have led to poor time management resulting in poor choices relating to diet and exercise.

People who live in rural or remote areas, including ATSI, have less access to medical services, which is significant environmental determinant. Increased levels of technology use, leading to sedentary behaviours and fast food advertising, which encourage unhealthy eating habits, are also an issue.

Groups at risk

Groups in Australia who are particularly at risk of diabetes include the elderly

and ATSI. There are also high rates of diabetes in rural, remote and low SES regions.

Risk factors and protective factors

Modifiable, or alterable, risk factors of respiratory disease include:

– Taking preventative medication for asthma or stress

– SmokingPassive smoking (especially in enclosed areas)

– Non-Modifiable (or fixed) risk factors include environmental changes in weather. For example, high pollen levels in spring.

Individuals can take protective measures to reduce the risk of contracting a respiratory illness. For example, raising awareness of triggers for asthma sufferers, increasing health education, and not smoking, are all effective ways to improve health and decrease risk.

The sociocultural, socioeconomic and environmental determinants

Individuals who live in low SES, rural or remote areas are more likely to contract respiratory diseases. People in the areas, along with ATSI, are more likely to smoke, contributing to poor health and reducing the amount of money available for preventative medicine and treatment. Smoking and passive smoking can also irritate asthma and affect the health of entire families.

Family history is also a sociocultural determinant of respiratory illness. Pollution, exposure to passive smoking and residing in remote areas, with no easy access emergency services, are all considered to be environmental determinants.

Groups at risk

The groups most at risk of respiratory problems are smokers and people who are exposed, without the proper protective masks, to harmful chemicals or gases in the workplace.

People aged 65 and over, ATSI and people who have a low SES are also more likely to develop respiratory diseases. Living in rural and remote areas can also increase the severity or harmfulness of respiratory conditions. People who are unable to conveniently access to emergency services have an increases chance of dying from typically non fatal conditions, like asthma attacks. Young children are particularly at risk as they have higher incidences of asthma.

The nature of the problem

An injury is any hurt, whether it’s intentional or not, which is occurs due to an internal or external factor. Falls, burns, vehicle accidents and drowning are all injuries. While most injuries are minor and easily treated, more serious damage can result in permanent disability or death.

Extent of the problem (trends)

Inn the last few years, injury mortality rates have dropped. The number of accidents have also dropped, perhaps due to advertising and awareness campaigns. However, the amount of injuries amongst the elderly has actually increased

Risk factors

The most common risk factor relating to injury is age. The older a person is, the more at risk they are from injury, particularly falls. Babies and young children are also at high risk of drowning.

A person’s occupation can also increase the risk of injury. For example, truck drivers are more likely to experience a vehicular accident due to the size of their vehicle and the time they spend on the road.

Similarly, certain environmental factors carry an additional element of risk. Extreme weather, conditions, outdoor work and drug use (legal or illegal) can affect safety and a person’s ability to handle themselves.

Protective factors

Individuals can reduce the chances of injury happening by employing common sense, acting responsibly, reading warning labels and other safe behaviours. This is particularly important when in unknown or dangerous situations or scenarios.

The sociocultural, socioeconomic and environmental determinants

Socioeconomic status, which is determined by income, employment and education levels, is determinant of injury.

For example, a person with a low SES is more likely to not insure their vehicle or home, due to financial strain. Driving a vehicle they can’t afford to maintain or repair to ensure safe working order (motor, brakes, air bags etc.) increases the chances of accident and injury. Individuals with low incomes may also not have the funds to apply safety measures like cupboard locks, which keep children safe from injury.

People with low education levels are more likely to participate risk-taking behaviours due to lack of knowledge or care. For example, speeding, failing to use contraceptives or not using seat belts.

Environmental factors can also impact on the risk of injury. There is a higher chance for road accidents in remote or rural locations. Another example are the laws, which govern regulations for facilities like pools and Workplace Health and Safety.

Groups at risk

There are a number of groups who have particularly high rates of injury. Elderly individuals are prone to accidents and are more likely to have falls. Aboriginal and Torres Straight Islanders are more likely to be involved in a road accidents or inflict self harm and people who live in rural and remote areas are at risk from work place hazards

There are high rates of road accidents and suicide amongst males, while children face danger from drowning or be poison. Young Adults are more like to be involved in road accidents, be injured during sport and recreational activities or self-harm.

Mental health problems and illnesses

The nature of the problem

Mental health issues affects a person’s cognitive, emotional and social wellbeing. 

Some examples of mental health problems are:

• Anxiety

• Bipolar disease

• Depression

• Dementia

• Schizophrenia

Mental illness may last for a short period, but if a condition persists it may be diagnosed as chronic or a disorder.

Extent of the problem (trends)

Mental health issues can be attributed to a small amount of mortality rates. But, more and more cases of dementia are being diagnosed in the ageing population.

Risk factors

Mental health issues contribute to a low number of mortalities. However, there have been an increase in cases of dementia amongst the elderly population.

Some of the internal and external risk factors that contribute to mental illness include:

– Lack of attachment to parents/caregivers

– Cultural discrimination

– Victimisation due to social exclusion or bullying

– Violence within the home

– A single-parent family

– Academic failure

Protective factors

In order to reduce the chance of mental illness, a person needs a good support network and positive relationships. Involvement in a variety of activities, clear boundaries and a sense of purpose can help with mental health.

The sociocultural, socioeconomic and environmental determinants

The environment a person lives in can affect their ability to deal with problems that arise. Living conditions, education level and economy can all determine the mental state of an individual.

People need to learn strategies for how to handle social an emotional problems as they get older. Unemployment, grief and other stressful events can cause mental instability. With the right knowledge and education individuals can apply the coping skills needed to get through those times.

Although life expectancy is increasing, physical and mental health problems still affect millions of Australia.

For example, there is a rise in morbidity rates for arthritis, cancer, CVD, dementia and more. Australia’s ageing population will need to use the hospitals more often, putting pressure on an already strained health care system. As a result hospitals will need to hire more staff and upgrade their facilities to handle the increased burden. Government funding will need to increase to cover these costs and help address the shortage of caregivers and facilities.

Groups at risk

– ATSI

– Males

– People 25 to 40 years of age

Past Paper Questions: 

1. 2010 b) Outline TWO socioeconomic determinants that contribute to health iniquities experienced by ATSI peoples 

(3 Marks)

2. 2011 a) Breast cancer and lung cancer are two common cancers in Australia. What are the determinants of these cancers and why do they put some groups more at risk than the general population?   

     (7 Marks)

According to the Australian Human Right commission:

A growing and ageing population

Like many first world nations, Australia is facing a series of challenges caused by the steady rise of life expectancy and an ageing population.

Specifically, Australia needs to develop long term strategies and solutions to deal with:

– The strain on the health care system as hospitals struggle to find the resources to treat the elderly, without impacting the services available for other patient.

– Staff shortages caused by the demands of the job and low salaries.

– The urgent need for upgraded facilities to handle the increased burden.

– Inadequate government funding as health costs rise.

– The increased demand for healthcare services, which has lead to a shortage of caregivers and facilities

– The rise in morbidity rates for arthritis, cancer, CVD, dementia and other diseases where age is a risk factor.

Healthy ageing

There are a multitude of benefits associated with ensuring the health of an ageing population. 

Elderly Australians who are healthy enjoy their retirement more, don’t have as many healthcare needs and are more likely to be active participants in their communities.

Healthy ageing has two components: the availability of health services and the behaviours of individuals. 

People who take a proactive and healthy stance in regards to their lifestyle increase the quality of their life as they get older. A healthy lifestyle includes social activities, physical exercise, eating a healthy diet, mental stimulation and regular medical checkups.

Increased population living with chronic disease and disability

A majority of the health problems elderly Australians experience are a result of poor lifestyle choices. Eating a diet high in fat, salts and sugars, drinking too much alcohol, smoking, failing to exercise regularly or neglecting mental health can all have a serious and detrimental impact on long term health, especially for those who are older.

As well as significant improvements in the number of people surviving heart attacks, strokes and cancers, our ageing population has led to an increase in the number of Australians with a chronic disease or disability. Chronic, non-communicable diseases account for approximately 80 per cent of the total burden of disease in Australia and it is estimated that they will be responsible for about three-quarters of all deaths by 2020 

Availability of carers and volunteers

The number of Australians, aged 85 and older, who need specialised care has doubled in the last few years. This ‘burden of care’ falls on one of both of the following groups:

– Family and/or friends

– Government organisations

Examples of the various groups and organisations, which provide elderly care and support are listed below.

Government Organisations

– PBS (Pharmaceutical Benefits Scheme)

– State-run hospitals

– Bulk billing

– Money for nursing homes

Community Groups

– Church groups

– Meals on wheels

– Community nurses

– Transport

There is strong evidence to suggest that the strain on health providers and caregivers will continue to rise as the need for specialised care for the elderly increases. Unfortunately, care workers receive low salaries and little societal respect, despite the demands of their job. More incentives, especially financial ones, are needed to ensure that existing carers can sustain their career and that more people are attracted to the industry.