Social Determinants of Health Impact on Housing for Indigenous Australians

This policy submission discusses the social determinants of health that impact housing for Indigenous Australians in the Northern Territory. It provides recommendations for improving housing conditions to enhance health outcomes.

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Table of Contents
Background..................................................................................................................................................3
Policy Recommendations............................................................................................................................5
1. Increase investment in housing for adequate houses for Indigenous Australian............................5
2. The building housing project should be culturally appropriate for Indigenous Australians.............6
3. The housing policy should be accompanied with housing related health promotion programs.....7
Conclusion...................................................................................................................................................9
References.................................................................................................................................................10

Social Determinants of Health that
Impact Housing for Indigenous
Australian-A Northern Territory
Government Policy Submission
Introduction
Housing is a long recognized social determinant of health and the government need to implement
appropriate housing plans that improves health outcomes. Poor housing is a major cause of
illness and unwell-being among Indigenous Australians as compared to non-indigenous
Australians in Northern Territory (Shepherd, Li, and Zubrick, 2012). Poor or inappropriate
housing refers to a wide range of issues that include overcrowding in a house, homelessness,
housing with poor physical conditions, insecure dwellings, and deprived neighbourhood.
Housing impacts health when it not appropriately designed, poorly located, not affordable,
cannot be accessed and not secure (Henwood, et al., 2013). Appropriate policy for housing will
improve housing conditions that will minimize healthy system costs and improve indigenous
people of Australia participation in education and employment.
Background
According to Jones (2018), 27% of indigenous people live in overcrowded houses with some
houses having more than 17 people living under one roof. It recorded that 60% of indigenous
People of Australia live in severally overcrowded dwellings in Northern Territory. A survey by
Badland in 2014 found that 90% of homeless individuals in Northern Territory are Aboriginal. In
another research by Altman in 2018 showed that Indigenous people are 15 times likely to sleep
in rough or live in improvised tents or dwellings. Housing affects individual health and
wellbeing either directly or indirectly through physical, biological, economic, chemical and
social factors pathways (McDonald, 2011). The health effects can be immediate to the time of
exposure or they may happen later in life (Zhao, et al., 2013).

Social Determinants of Health Impacts on Housing to Indigenous Australian’s
Health in NT
Housing is impacted by social determinants of health such as education, economic stability, and
social and community context. Housing impacts indigenous People health in several dimensions.
Economic Stability
Economic stability impacts housing in terms of an individual’s income and social status.
Economic stability factors are employment, income, debts, expenses, medical bills and financial
support that affects an individual or community ability to make purchase. An individual incomes
and social status determines the type of a house one can afford and the neighbourhood (Benach,
et al., 2014). Indigenous Australians lack money to buy or construct houses that negatively their
place of residence, size of the houses and access to amenities. Individual or community
economic instability has extensive impact on childhood development. Early childhood
development is an important foundation to physical health, emotional and social wellbeing of a
person. According to Priest, Mackean, Davis, Briggs, and Waters, (2012) housing problems
increase children’s ill health risk by 25% in their childhood and young adults. Overcrowding has
a direct link to tuberculosis (TB) infections and other respiratory problems in childhood (Massey
et al., 2011). McTurk, et al. (2011) noted that overcrowding cause slow growth in children that
increases risk for coronary heart disease later in an individual’s life. Housing physical conditions
are also associated to almost 50% of childhood accidents. Therefore, economic stability
influences an individual or community housing that impact their health.
Education
Education has impact to an individual’s ability to make or take quality and informed health
decisions and opportunity for a job employment (Braveman, Egerter, and Williams, 2011).
Education also enhances healthy behaviours that enable an individual to avoid or stop activities
or practices that has negative impact to their health. Education impacts how a person makes
housing decisions and health decisions such as how and when to receive treatment. One critical
aspect of health that education affects is seeking treating for mental health and emotional and
social wellbeing. Housing insecurity and overcrowding is associated with mental illness such as
anxiety, depression and suicide (Campbell, et al., 2011). Davis, et al. (2011) found that social
stress as a result of overcrowding contributes to sexual and family violence in Indigenous
communities. According to a survey undertaken between 2012 and 2013 showed that one in

every ten indigenous adults finds overcrowding to cause stress in their life (Baum et al., 2013).
Education builds capacity of a person or community to use and maintain healthy infrastructure in
the house and improve hygiene to help in the reduction of physical and mental illness. Education
also impacts how Indigenous Australians are able to access high paying job and job opportunities
in their life. Good jobs and availability of job opportunity enhances an individual ability to earn
salaries that improve standards of living creating a good impact to one’s health.
Social and Community context
Social and community context impacts housing in terms of cultural influences. Indigenous
Australians live in extended families and relative ties are highly maintained and they pay visit to
one another frequently. Survey shows that more than 21% of Indigenous Australians visit their
relatives in cities for more than two weeks in every twelve months (Wensing, and Porter, 2016).
Mourning of dead takes several days and families have to stay until the last day of the burial
ceremony. More that 50% temporary visits among Aboriginals are because of cultural reason
with only 25% visiting due to holidays (Herring et al., 2013). The families crowd the homestead
and they have to share few bedrooms, one bathroom, and toilet available that increase risk of
infections spread due to low hygiene (Ennis, Finlayson, and Speering, 2013). Social structures
and traditions of the Indigenous Australians increase housing impact to their health.
Overcrowding increases risk of transmission of communicable diseases such as bacterial ear
infections, bronchiectasis, rheumatic heart disease, and scabies. Another impact of social
practices that concentrate people together in one household is exposure to smoke, dust and
tobacco smoke. Overcrowded and poorly designed houses exposes people to tobacco smoke, dust
and cooking fire smoke (May, Carey, and Curry, 2013). Aboriginal’s people and Torres Straits
Islander contribute to 12% health burden diseases caused by tobacco smoking in Australia
(Bentley, Baker, & Mason, 2012). Smoke and dust contribute to a range of respiratory conditions
with adverse effects to children. Therefore, lacking of adequate and well designed housing
among Indigenous Australians impact their health by increasing risk and contributing to illness,
social and emotional unwell being.
Health Impact to Housing
Health, in return impacts the issue of housing. Poor health impacts indigenous people capacity to
have adequate and well designed housing. First, health impacts the ability of Indigenous
Australians from having high educational attainment. Bailie et al. (2011) noted that poor health

limits a child ability to perform well in school that lead to low education attainment and
consequently low paying jobs or completely lack of a job. This leads to low income that cannot
afford a proper housing. Another impact of health on housing is increased health burden that lead
to poverty. Illness and chronic conditions cause social and financial burden to an individual and
the family (Ramamoorthi, et al., 2015). This leads to poverty forcing families to live in a small
house that they can afford or homelessness of individuals and their families. Therefore, health
also impacts housing to individual, families, and communities.
Policy Recommendations
There is need for the government to take action to make the policy healthier to improve health
outcome for Indigenous Australians. There are three policy recommendations for SDOH that
impact housing for Indigenous Australians;
1. Economic empowerment of Indigenous Australian –Economic Stability
The government need to have economic empowerment for Indigenous Australians to enhance
their ability to purchase. Economic empowerment will enable Indigenous Australians buy and
construct houses that meet their accommodation needs currently and for the future. Appropriate
and adequate housing are important for improved health outcomes (Jamieson, et al., 2011).
Increasing supply for culturally housing will address the Indigenous Australians housing issues.
The ownership of houses will reduce homelessness and overcrowding that will have a direct link
to improved health outcome. First, the ownership of house will support childhood development
of Indigenous Australians. Children will have a safe and spacious space that will reduce
children’s contraction of diseases such as tuberculosis and other communicable diseases. A
house will also provide a space for the children to read and do their homework increasing their
chances for high education attainment (Allen, et al., 2014). Secondly, the affordability and
ownership of housing will address the issues of mental health, emotional and social wellbeing.
Having a house will reduce life stress for Indigenous Australians hence enhancing their mental
health. This will reduce the anxiety and depression that is linked to lack or unfit housing of an
individual (Mason, et al., 2013). Having a safe and spacious house will also reduce family
violence and sexual cases. According to Smallbone, and Rayment‐McHugh, (2013) family
conflicts among the Aboriginals and Torres Straits Islanders are contributed by overcrowding

and frustrations of homelessness. Thirdly, ownership of houses will promote physical health
among indigenous Australians. The Indigenous Australians will have safe and spacious houses
that will reduce risk of infectious diseases spread that are caused by overcrowding and
homelessness. Jones (2018) noted that proper housing is helps in preventing, promoting, and
treating illnesses. Affordability of spacious houses will also reduce health burden as a result of
tobacco smoking, dust, and firewood smoke. Tobacco smoking among Indigenous Australians is
high and contributes up to 20% deaths (Bentley, et al., 2011). Tobacco smoking also has a health
burden of 12%. Both active and passive tobacco smokers are at risk of contracting infections that
are contributed by tobacco. According to Gould et al. (2013) overcrowding as result of poor
housing lead to increased tobacco smoking habits and family influences as children imitate what
their elders do. They also noted that dust and smoke as a result of poor housing get inhaled by
individuals that damage lungs’ airways and alveoli.
From the research on the literature, surveys and my knowledge, I recommend that the
government empowers Indigenous Australians to afford to buy and build houses that will
improve their health outcome. The house will ensure their have a place to live with their families
reducing the impact of homelessness and overcrowding to their health. Affording housing will
ensure all Indigenous Australians have a place that is secure and spacious that can prevent
promote and treat health. Therefore, investing in supply of housing in Northern Territory for
Indigenous Australians will make the housing policy healthier by meeting basic health need of
having a house.
2. The housing policy should be accompanied with housing- related health
promotion programs. -Education
There is a need to educate Indigenous People about the importance of the housing and how it
will benefit them in terms of improved health outcomes. Health education will build Indigenous
Australians’ capacity to make healthy decisions and have healthy behaviours. The health
promotion will increase people’s control and improve their utilization of the houses to enhance
quality of life and consequently good health. The program should involve the Indigenous
environmental health workers to ensure the health promotion is socially and culturally
appropriate to Indigenous people (Downing, Kowal, and Paradies, 2011). The health promotion

should build capacity for households to use and maintain healthy infrastructure in the house and
improve hygiene to help in the reduction of diseases caused by housing. The health promotion on
housing should also involve community members to ensure cultural relevance. Baum et al.
(2013) recommends that health promotion program for Indigenous Australians should be a
practical learning opportunity instead of using didactic teaching styles. The program should
acknowledge cultural practices and beliefs. Ware (2013) noted that although a practice like
sleeping in the same bed might contribute to increased risk of infections spreading, the practice
promotes emotional and social benefits. The topic of hygiene should be treated with caution
because of the sensitive perception among Indigenous Australians. Indigenous People living in
remote communities are aware of how non-Indigenous Australians perceive them and therefore
the topic might cause shame (McDonald, Cunningham, and Slavin, 2015). The health promotion
should avoid using approaches that are intrusive or shaming the Indigenous People of Australia.
Another issue in housing health promotion is that Indigenous Australians should not be blamed
for the current health situation. Awofeso (2011) suggest that promotional messages should
empower individuals and the community to adopt maintain and improve housing to support
quality health.
The health promotion program on health will engage Indigenous in the implementation and
adoption of the housing policy in improving health outcomes. Health promotion will improve
health decisions made and adoption of healthy behaviours (Vass, Mitchell, and Dhurrkay, 2011).
Health decisions are important to as they influence an individual overall wellbeing. The
indigenous Australians will be able to decide on the best alternatives to reduce infections
contributed by poor housing and instead adopt decisions that prevent and promote health.
Healthy behaviours are also important aspect to improving housing health outcomes. The health
promotions will encourage Indigenous Australians to engage in practices that promote and
prevent illness.
From my knowledge and research from literature, I recommend the government to accompany a
housing related health promotion to empower individuals’ and the community to informed health
decisions and behaviours. This will ensure the policy outcomes are healthier through the
engagement and empowerment of the Indigenous Australians.

3. Designing and building houses that are culturally appropriate for
Indigenous Australians- Social and Community Context
It is crucial to incorporate the Indigenous Australians culture in the designing and construction of
the houses. The housing need to meet accommodation needs for each household. In order to meet
the needs of Indigenous Australians, the design need to be culturally appropriate to fit Aboriginal
way of living (Fien and Charlesworth, 2012). They recorded that Aboriginals live together as
extended families has compared to non-Indigenous Australians who live in small nuclear
families. This means that the housing project should consider the Indigenous ways of living and
build large houses to accommodate large families. Fien, et al., (2011) in a survey noted that some
household have more than 17 people together with visitors and they all slept together. Most
families choose to live in multi-generational households and large households even when other
houses are available in the community (Priest, et al., 2012). The issue of overcrowding can also
be temporarily; first, overcrowding happens when families or members of a family pay a visit to
one another or during mourning of a family member. Therefore, the government policy need to
consider the Indigenous Australians way of life by implementing regional approach that
understands their relationships with remote communities and the ones in town camps. Cultural
appropriateness is also important for the Indigenous Australians accepting it. The policy needs to
facilitate and encourage cultural practice (Broffman, 2015). This means that the policy will not
improve the health outcome but instead worsen the current situation when housing is
contributing to undesirable health outcomes.
From the research and surveys done in the past, there is importance of incorporating Indigenous
Australians culture when undertaking housing project. As a result of cultural obligations,
Indigenous People need difference housing solutions that accommodate their relatives either
staying temporarily or permanently. Therefore I recommend the houses to be large and have
several rooms, bathrooms, and toilets to accommodate large family staying over for the housing
policy to be healthier.
Conclusion
The following submission concludes that the government should build houses for Indigenous
Australians. Housing is a major contributor to negative health outcomes among Indigenous
People. Inappropriate housing impact early childhood development, physical health, mental

health and social and emotional wellbeing. They increase risk for infection spread, poor
development, and later in life chronic conditions. Housing SDOH is related to education,
economic and social context. The submission recommends; increased investments for supply of
houses, designing of culturally appropriate houses to Indigenous Australians, and accompanying
housing-related health promotion program to enhance healthier policy outcomes.

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