Impact of Social Determinants on Indigenous People's Health in Australia

The health status of indigenous people of Australia is certainly the worst as compared to Non-indigenous people of Australia (Gwynne & Cairnduff, 2017). Health inequalities faced by indigenous Australians are under scrutinized by different health organizations of the world (O’Faircheallaigh, 2012). Australia’s indigenous people have encountered disparities in all levels of their livelihood such as inadequate access to health care services, nutritious food, and lack of education opportunities (Gwynne & Cairnduff, 2017).

According to a study, life expectancy for the indigenous Australian is estimated to be ten years lower than that of the non-indigenous Australian population in males and around nine years lower in females (Sushames, van Uffelen, & Gebel, 2016). This continuous cycle of crisis in the health of indigenous people is based on neglect, weak public health policy, and discrimination (Gwynne & Cairnduff, 2017).

This ill-treatment of Indigenous people of Australia has put Australian government under enormous pressure from international and local communities to tackle the indigenous health issue (O’Faircheallaigh, 2012).

To improve the image of Australia and to increase the quality of health among indigenous people of Australia the Australian government has created a number of laws, policies and plans to solve the health inequality problem (O’Faircheallaigh, 2012). Even though the government is trying to close the gap of health inequality, indigenous people are still suffering from preventable diseases which are decreasing the life expectancy rates drastically (Gwynne & Cairnduff, 2017).

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This paper will discuss two social determinants and their impact on the health of indigenous people of Australia. Also, how different factors influence the health quality among indigenous people will be presented. Subsequently, influences on health due to cultural beliefs and effects of interrupted culture will be explored. This will be reviewed by shedding light on topics such as cultural safety and competence in relation to indigenous people. Lastly, this paper will discuss different state and national level strategies and health services which are serving indigenous people of Australia.

The indigenous people of Australia are three percent of the Australian total population (HealthInfoNet, 2014). It has been observed from the history that indigenous people of the world no matter from where they belong have been facing discrimination from their government in all field of their lives (Shepherd, Jianghong, Cooper, Hopkins, & Farrant, 2017). Since the colonization of Australia in the year, 1788 different governments have initiated steps and laws against the indigenous population (Short, 2016). For instance, removing Aboriginal and Torres Strait Islander children from their parents, strategically dispossession of land through forced displacement, not including indigenous people in the census until 1967 (Short, 2016). All this inequality towards indigenous people has damaged Australian image of being a civilized country. Subsequently, the Australian government is now trying to improve the overall condition of indigenous people by placing strategies and implementing laws favoring Indigenous people. On February 13^th, 2008 the Australian Prime Minister offered an apology to all Indigenous individuals who have been mistreated in the past (Dominello, 2014). Also, the Australian government has initiated a long-term plan increase life expectancies and quality of health among Indigenous people of  Australia by the year 2030 (Dominello, 2014). The plan is called Closing the Gap, which specifically targets rates of infant mortality and overall indigenous life expectancy (Dominello, 2014). This program also focuses on social determinants of health such as employment and education (Mitrou et al., 2014). The two social determinants which will be discussed in the paper are education and employment.

There is a strong correlation between education and health (Clouston, Manganello, & Richards, 2017). Attainment of education is being acknowledged as an important social determinant of health (McCalmont et al., 2016). It has been observed that individuals with lower secondary schooling have forty-six percent higher probability of dying prematurely as compared to individuals who attain higher education (ABS, 2011). According to a study, education can be associated with developing information and cognitive skills, making good healthy choices and enhancing personal and social resources that are vital for physical and mental health (Cesur, Dursun, & Mocan, 2014). The National Aboriginal and Torres Strait Islander Social Survey (NATSISS) indicates that 18 to 34 years old Indigenous individuals who have attained a higher level of education report less psychological distress, rates their health excellent and chooses good healthy choices in food than people with low level of schooling (ABS, 2011). Also, (NATSISS) explored the importance of education and health literacy among indigenous parents (ABS, 2011). If the parents are educated, they are more likely to benefit themselves and their children by adopting a healthy lifestyle (Anstrom et al., 2017). According to Closing the Gap Prime Minister’s report of 2017, Indigenous individuals who have completed year 12 education have jumped from forty-five percent in 2008 to sixty-one percent in 2014 (Australia, 2018). Despite the increase in education attainment, the retention, enrolment and completion figures are much lower if compared with non-Indigenous students (Nakata, Nakata, Day, & Peachey, 2017). Subsequently, Australian Government’s Closing the Gap scheme also focuses on schools, and health education in schooling system to be initiated (Nakata et al., 2017). As schools are the first education provider for the young generation to gain knowledge and shape their future accordingly. A recent study suggests that schools can be a great service to address health disparities and increase the quality of health by giving quality education on health care (Telford et al., 2012). Thus, it can be said that introducing health education in school can be a positive sign to enhance health literacy among indigenous people.

The second social determinant which influences the health of Indigenous people of Australia is employment. The average household income for indigenous people of Australia is three hundred and sixty-four Australian dollars per week, and for non- indigenous it is five hundred and eighty-five Australian dollars per week (Howlett, Gray, & Hunter, 2015). Also, the employment rate is twenty percent which is triple times more than the non-indigenous population of Australia (Howlett et al., 2015). Less household income means less buying power, less access to health services and medicines. Low level of income also speaks that individuals are living in poor housing condition and in overcrowded areas to fulfill their daily needs. Hence, these living conditions can increase the risk of spreading communicable diseases. Also, not all indigenous individuals are employed. Thus, being unemployed can create a huge burden on maintaining a healthy lifestyle. According to a recent study,  poor health and high disability rates are the reason for low employment rates (van Zon, Reijneveld, Mendes de Leon, & Bültmann, 2016). Subsequently, loss of employment is itself a very stressful experience which can negatively impact on person’s perception of well-being. Job loss is also linked to insomnia, insecurity and anxiety disorders (Coope et al., 2015). Also, mental health status decline with every unemployment experience, triggering the risk of suicidal behaviors, drug use and alcohol abuse to cope (Coope et al., 2015).

There are other social and economic factors which cause ill health in indigenous people of Australia. For instance, imbalanced nutrition is a factor which causes increased levels of obesity, dental issues, diabetes and heart-related diseases among indigenous Australians (Morris, Stewart, Riley, & Maguire, 2016). For growth of the infant, breastfeeding is crucial for the health (Morris et al., 2016). It has been observed that breastfeeding fights against diseases in infants and boosts immunity (Morris et al., 2016). Also, exercise is a necessary factor in establishing better health and decreasing sedentary lifestyle (Mendham, Duffield, Marino, & Coutts, 2015). A sedentary lifestyle can increase risks of obesity and overweight (Mendham et al., 2015). A study on Indigenous children of Australia indicates that sixty-six percent of children aged fifteen years and over were overweight (Kim et al., 2016). Subsequently, overweight and obesity can increase the chance of multiple diseases and other health issues (Halloran, 2014). Also, substance abuse such as alcohol, smoking, and other drug abuse is much higher than non-Indigenous Australians (Graham, Campbell, West, & Clough, 2017). All these factors negatively influence the health of indigenous Australians which lead to poor health, high mortality rate, and increasing rate of mental health issues.

One of the reasons for the low health status of indigenous Australians is due to different cultural beliefs on health (Clifford, McCalman, Bainbridge, & Tsey, 2015). A lack of cross-cultural understanding has caused the increasing level of healthcare differences among Indigenous Australians (Clifford et al., 2015). In order to understand and provide patient-centered care two concepts of cultural safety and competence have been introduced in various healthcare facilities (Penn, 2014). These two concepts play a crucial role in promoting cultural awareness in health care for Indigenous Australians. Cultural safety establishes an environment which is physically and emotionally secure for Indigenous people of Australia (Penn, 2014). Health professionals undergo training to learn about the Indigenous culture (Penn, 2014). The training for health professional is a great step to create awareness of different cultural differences and how to respect them which will eventually reduce negative effects of stereotypical conduct. These cultural training and considerations improve health outcomes by establishing trust between healthcare professionals and Indigenous Australians (Bryce, Foley, Reeves, & Clarke, 2018). Indigenous people from their community often identify someone as their spiritual healer who deals with traditional medicine to cure diseases and health issues (Love, Moore, & Warburton, 2017). Besides spirituality, Indigenous people like to live close together with their family and friends (Porter & Barry, 2015). For Indigenous people, land represents the physical, spiritual, social and cultural connection (Porter & Barry, 2015). In addition, getting support from family, both alive or dead, is another way that Indigenous Australian believes to be contributing to their health (Love et al., 2017). Hence, it is evident that improvement in Indigenous health can occur if health providers are culturally safe and are aware of culture care values, beliefs, and practices of Indigenous people of Australia.

The Australian government has made various policies and strategies to decrease the health inequality for Indigenous Australian, but this was not the case in the past. Due to colonialism, Indigenous people of Australia were discriminated and marginalized at the hands of the legal system. In the year 1902, females in New South Wales (NSW) were given the right to vote, but  Indigenous women were not allowed to vote (Wilkes, Gray, Casey, Stearne, & Dadd, 2014). Even though when voting was made mandatory in NSW in the year 1929, Indigenous people were still not included in the electoral system (Wilkes et al., 2014). Also, in 1837 Indigenous people were promised to offer protection but strategically they were separated and segregated from the white population (Wilkes et al., 2014). Most of the oppressive policies and laws against indigenous people were propagated by church missionaries (Nicoll, 2004). The European style of education was projected for Indigenous children (Bodkin-Andrews & Carlson, 2016). The most oppressive step which started from 1910 to 1970 was forcibly removing Indigenous children from their families (Bodkin-Andrews & Carlson, 2016). All these steps were taken to eliminate the Indigenous race and make the population whiter. Consequently, all these distressing measures have decreased the quality of health for Indigenous people of Australia over the time. As the world was changing and the pressure from an International community built up in relation to the mistreatment of Indigenous Australians. The Australian government in 1967 agreed to make policies for the betterment of Indigenous Australians (Larkin, 2017). In the year 2007 government initiated strategy campaign called Closing the Gap was established to reduce disadvantages among Indigenous Australians in relation to life expectancy, early education for children, child mortality, and employment (Holland, 2014). It is a big step for the Australian government to achieve health equality within twenty-five years time.

In summation, it is a long-standing challenge for the Australian government to improve the health standards of Indigenous people of Australia due to the large gap in health status when compared with non-indigenous population. However, policies and strategies are in place to improve the social determinants of health for Indigenous people. This paper addresses numerous factors, cultural influences and social determinants of health that impact the health of Indigenous Australians. Also, past and present government policies and strategies are described in this paper to give an overview of how different government has treated Indigenous people of Australia. The continuous struggle is required from both Australian government and international health organizations to balance the healthcare system so that Indigenous people receive care which may improve their quality of life in future.

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