Academic journal article Social Alternatives

Health Equity and the Social Determinants of Health in Australia

Academic journal article Social Alternatives

Health Equity and the Social Determinants of Health in Australia

Article excerpt

The situation of the Aboriginal and Torres Strait Islander (ATSI) peoples of Australia provides us with a good starting point for an examination of the issues of health inequalities and the social determinants of health in the country. The lamentable gap in life expectancy between this community and the non-Indigenous population is a stark illustration of both inequalities in health and the role of the social determinants in the lives of all Australians. Paradoxically, however, the philosophy and understanding of health of ATSI peoples provides all Australians with a more holistic view of health and strengthens our understanding of the social determinants. We have a unique chance to learn with and from the Indigenous population, including gaining insights into the role of spirituality and sense of belonging to 'country', making us different to other Anglophone societies. An Aboriginal understanding of health helps Australia to critically examine the western medical model of health and deepen our understanding of comprehensive Primary Health Care.

Introduction

The growing acknowledgement around the world of the role of the social determinants of health, and therefore of the link between social inequalities and inequalities in health status is reflected in the language currently being used in the Australian health system, although mainly in the context of Indigenous peoples' health (Hindel and Williams 2009). The Australian government tends to speak more of 'health determinants' and 'risk factors', like smoking and 'environmental factors' (AIHW 2008) rather than embracing the broader social determinants approach of the World Health Organisation (WHO). This article has a focus on the Aboriginal and Torres Strait Islander (ATSI) peoples of Australia with the conviction that such a perspective is a good starting point for an examination of the issues of health inequalities and the social determinants of health in the country and paradoxically, with helpful lessons for the whole country and beyond.

Central to what we can call the 'social determinants' approach is the axiom that the health status of a population is improved at least as much by addressing all those factors in the social environment which impinge on health, not least of all social inequalities, as it is by investing in medical technology. An acceptance of this truth implies a more rational balance between treatment and prevention, between medico-technical interventions and the maintenance of environments which foster health. Consistency with these insights would involve a commitment to enactment of policies which promote resource redistribution and a tight control on expenditures on medical interventions in order to ensure investment in the creation of health (rather than only the treatment of disease).

The health reforms at present being promoted by the Australian government state clearly the intention to move the country in the direction of such a balance. In the words of the Australian Government's National Health and Hospitals Reform Commission (NHHRC):

[w]e face significant challenges, including large increases in demand for and expenditure on health care, unacceptable inequities in health outcomes and access to services, growing concerns about safety and quality, workforce shortages, and inefficiency (NHHRC 2009).

Despite Australia's generally high level of average health (for many indicators Australia ranks in the "top third" of the Organisation for Economic Co-operation and Development (OECD) countries although in the worst third for infant mortality, prostate cancer, obesity and AIDS) (AIHW 2008), inequalities in health are obvious in the country. The health situation of the Indigenous population, the Aboriginal and Torres Strait Islander (ATSI) peoples, illustrates both the need to address the social determinants in order to reduce inequalities as well as illustrating the obstacles in the way of such a balance being found, either for that population or the country as a whole, notably in the poorer suburbs of the major towns and large parts of the rural, regional and remote areas. …

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