ATSI Health: SDOH, Diabetes, and Intervention Program Analysis

This report elucidates the social determinants of health (SDOH) that contribute to the susceptibility of Aboriginal and Torres Strait Islanders (ATSI) to diabetes mellitus in Australia. It highlights factors such as poor educational attainment, low socioeconomic status, unemployment, food insecurity, lack of social support, poor diet, inappropriate physical environment, and working conditions, all of which increase their risk. The report also describes the Aboriginal Road To Good Health Program, designed to decrease diabetes risks within this indigenous population by promoting healthier lifestyle choices, improving diet, and increasing physical activity. The program addresses the impact of food patterns on health, emphasizes the selection of healthy and affordable foods, and educates on managing food expenditures and interpreting food labels. By focusing on these elements, the program aims to mitigate health inequalities and improve the overall well-being of ATSI communities.

Running head: REPORT
Social determinants of health (SDOH) in Australia
Name of the Student
Name of the University
Author Note

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Executive summary
The report elucidates the social determinants of health that makes the Aboriginal and
Torres Strait Islanders susceptible to diabetes mellitus, a chronic metabolic condition. The
report highlights that these indigenous people have poor educational attainment, low
socioeconomic status, unemployment, food insecurity, lack of social support, poor diet,
inappropriate physical environment and inappropriate working conditions, all of which
increase their risk of suffering from diabetes. The report also describes the Aboriginal Road
To Good Health program that has been framed in order to decrease diabetes risks in the
indigenous population.

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Table of Contents
Introduction...............................................................................................................................3
Impact of SDOH on health, wellbeing and disease....................................................................3
Aboriginal Road to Good Health Program.................................................................................6
Conclusion..................................................................................................................................8
References................................................................................................................................10

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Introduction
Australia has an extremely developed healthcare system, however, owing to the
enormous size of the nation, the services are unevenly distributed to all residents.
Healthcare services in Australia are generally delivered by both private and government
companies that are typically covered by Medicare. The government funds healthcare in
Australia to a large extent at the state, national and local levels, nonetheless the price of
healthcare is also supported by the not-for-profit organisations, with a noteworthy charge
being tolerated by charity or individual patients (Dixit &Sambasivan, 2018). The reports from
the Australian Bureau of Statistics highlight the absence of appropriate healthcare amenities
for the Aboriginals and Torres Strait Islander (ATSI) population, resulting to poor health
outcomes and increase in the health-related disparities (Hyde et al., 2018). Consistent to
several other nations around the globe, there is a scarcity of qualified healthcare
professionals in Australia notwithstanding the development in workforce in preceding years.
The scarcity is also reflected in trained and quality ATSI work force in healthcare (Hyde et al.,
2018). This report will elaborate on the impact of social determinants of health (SDOH) on
one of the prevalent lifestyle disease among the ATSI population in Australia that is the
major cause of health inequality, diabetes mellitus. The report will also mainly evaluate how
‘The Aboriginal Road To Good Health Program’ can motivate and encourage the indigenous
communities for decreasing their risk factors related to diabetes and thereby decreasing the
health-related inequalities.
Impact of SDOH on health, wellbeing and disease
The overall health of the Australian population has markedly improved during the
twentieth century. Nonetheless, the health gains are not shared equally across different

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sections of the population. The eight priority regions in Australia are namely, arthritis and
musculoskeletal conditions, cancer control, asthma, diabetes mellitus, cardiovascular health,
mental health, obesity, and injury prevention and control (AIHW, 2006). Around 1 in 12
Aboriginal and Torres Strait Islander individuals (85) reported about being affected with
diabetes mellitus in 2012-13 and the indigenous females demonstrated an increased
likelihood of being affected with the metabolic condition, compared to their male
counterparts (10% versus 7%). In the same year, the prevalence varied from 7% in regional
and major cities to 12% in remote areas (Australian Bureau of Statistics, 2013). Furthermore,
even after adjustment for differences related to age structures, the Aboriginal and Torres
Strait Islanders (ATSI) have been three times susceptible for be diagnosed with diabetes,
compared to non-Indigenous people. SDOH generally refer to the conditions in which
people take birth, lie, grow, and age, and they play a significant role in shaping the health
and wellbeing of the population.
Diabetes mellitus has been identified as an essential component of a cyclical
procedure:, owing to the fact that it both contributes to and is the direct result of adverse
outcomes. Some key factors that make the ATSI susceptible to diabetes are namely,
material deprivation, poverty, with the former resulting in inadequate resources for
addressing the prerequisites of health. The ATSI have been identified as one of the most
disadvantaged and impoverished communities all across the globe and poverty creates an
impact on healthcare utilisation, thus increasing the rates of diabetes. Moreover, poor
socioeconomic status also contributes to diabetes onset and prevalence since it leads to
poor metabolic control and underuse of preventive care services, all of which make the ATSI
adopt lifestyles that increase their risk of suffering from diabetes (Taylor &Gaminiratne,

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2018). For these disadvantaged persons, the constant challenge to make their ends meet
leads to chronic stress, thereby disrupting both biologic and psychological responses.
Chronic stress also results in the onset of anxiety and depression that oftenaugments
the probability of self-destructive behaviourslike alcohol and tobacco consumption and
intake of unhealthy foods, thus increasing diabetes risk (Butler et al., 2017). Having
educational degree has been associated with a decreased risk of suffering from diabetes,
compared to people with education of less than nine years (Oakley et al., 2018). This can be
accredited to the fact that most education is based on identification of risk factors for
chronic diseases like diabetes and obesity. A better education generally contributes
toaugmentedhealth-related quality of life through improved understanding of the disease
nature, better coping, and ultimatelyimproved diabetes care.
Though the national proportion of ATSI completing year 12 has significantly
increased to 22% from 18%, the numbers are still low when compared to the general
population, thus explaining the high diabetes prevalence (Australian Bureau of Statistics,
2011). The ATSI commonly report a strong craving for association and a sense of belonging,
are subjected to departure from bonded relationship, and also have to encounter
stigmatising attitudes of the non-indigenous people. Family breakdown is a common
phenomenon in the indigenous households that leads to social isolation of the people,
further decreasing social support (Abbott et al., 2018). However, evidences show that social
support plays an important role in diabetes onset and can also contribute to effective
disease management. It helps the affected people to show adherence to dietary and
physical changes, thus facilitating diabetes control (Gray, Hoerster, Reiber, Bastian &
Nelson, 2019). High exposure to unemployment has also been associated to impaired

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metabolism of glucose in middle-aged individuals owing to the fact that lack of employment
is a common stressor that results in poor health outcomes, thus increasing risk for pre-
diabetes and type 2 diabetes (Rautio et al., 2017).
According to the 2016 Census, around 223,000 ATSI aged more than 15 years were
found to participate in labour force, with higher employment rates in urban regions,
compared to rural regions (54% versus 45%) (Australian Bureau of Statistics, 2018). Hence,
there are several ATSI who still do not have a secured employment opportunity, which in
turn makes them more prone to the disease. There is a growing body of evidence that
physical environment creates a substantial effect on risk for diabetes and proper access to
resources like green spaces, sports or physical exercise are correlated with a decreased
propensity of developing diabetes (Amuda& Berkowitz, 2019). The major environmental
factors that affect the health of the ATSI are lack of water treatment and supply poor access
to healthy and affordable food, lack of free spaces, inadequate housing, overcrowding,
personal hygiene, and sewage disposal, thus increasing diabetes risk. Additionally, the ATSI,
particularly those residing in remote and rural areas suffer from diet-related poor health
outcomes and are not able to consume nutritious foods. This can be accredited to the
greater store overheads, poor store management practices, food stock wastage and high
freight costs, thus augmenting diabetes risks (Temple & Russell, 2018).
Aboriginal Road to Good Health Program
The Aboriginal Road To Good Health Program is a recent health lifestyle program
that has been formulated with the aim of providing assistance indigenous people who are at
an increased risk of being affected with cardiovascular disease or type 2
diabetes(HealthInfoNet, 2016). This program is generally administered in the form of a

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telephone coaching service or a group course. The program is based on the premise that
though lifestyle modifications have been found effective in treating a wide range of chronic
diseases like obesity and diabetes, it is particularly challenging to people to maintain a
healthy behaviour (Raghavan et al., 2019). This program is the keystone of the Aboriginal
Life! Program and it intends to help the ATSI individuals, together with their family members
to select healthier drinks and food, and increase their level of physical activity, which in turn
will decrease their susceptibility to the identified chronic condition, and comorbidities of
high blood pressure and cardiovascular problems. The most significant principles of this
program are that it focuses on how food patterns create an impact on health, electing
healthy foods, and what kind of food items are easy, good and cheap.
There is a growing body of evidence that consumption of red meat, carbohydrates,
baked goods, poultry, whole milk and dried or pickled fruits increase the blood glucose
levels (Bordeleau, Asselin, Mazerolle&Imbeau, 2016). Since time immemorial the ATSI have
considered sugar to be a significant cultural food. Refined and processed foods have also
been introduced in their diet over time, which in turn have replaced healthy alternatives
and increased their risk of diabetes (Leonard, Aquino,Hadgraft, Thompson& Marley, 2017).
Therefore, the program will help the ATSI understand the impact of their diet on their
health.
According to Bramwell, Foley and Shaw (2017) fruits, whole grains, vegetables and
fibre are good in maintaining a check on the blood glucose levels. However, the nutrition
pattern of the ATSI individuals are under the direct influence of several factors such as,
geography, society, environment, and the low socioeconomic status of the target
population. The aforementioned factors do not allow the indigenous people to gain access

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to vegetables and fruits, thereby causing either under-nutrition or over-nutrition, and
eventually contributing to diabetes. Hence, the program will increase awareness of the ATSI
people regarding the food products, which can be purchased and will affect their health in a
beneficial manner. The program also teaches how to spend food money and searching food
label. The basic factors that directly contribute to food insecurity amid the ATSI encompass
socioeconomic factors like employment and income, overcrowding, housing, food costs,
transport, food and nutrition literacy, and cultural food values (McKay, Haines& Dunn,
2019).
For the past two decades, the food costs have been reported consistently around
30% greater in remote ATSI communities, when compared to urban areas, however, the
median household earnings are lesser in the remote regions. Furthermore, around one in
five ATSI reported reside in homes that commonly runs out offoodstuffand they were not
able tohave enough moneyfor adequate food in 2011–2013 (Lee& Lewis, 2018). Therefore,
teaching proper expenditure of food money would greatly benefit the people by increasing
purchase of healthy food products, and decreasing diabetes risk. The program also focuses
on educating ATSI on things that should be noticed on a food label. Though the traditional
diet of ATSI included several healthy animal and plant foods, vegetables, roots, nuts and
seasonal fruits, their colonisation was characterised by a gradual shift from the varied,
nutrition dense and traditional diet that was low in refined carbohydrates and fat and high
in fibre to an Westernised diet that is energy dense, and high in refined sugars and fat
(Luppens, L., & Power, E. (2018). Moreover, majority food items available in remote
community stores are poor in nutrition and energy-dense. Hence, by searching the food
labels, ATSI will become aware of the food products that they should purchase and
consume.

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The program also intends to educate ATSI on maintaining healthy weight, remaining
active and staying on track, apart from preventing diabetes. As claimed by Verma and
Hussain (2017) being obese or overweight increases the risk of developing diabetes and
insulin resistance has been found to improve with a combination of exercise and weight loss
strategies. The burden of obesity contributes to 1-3 years gap in life expectancy between
ATSI and non-indigenous population (AIHW, 2018). Not only participation in exercise help in
maintaining normal body weight, but also decreases the likelihood of getting cardiovascular
disorders. Moreover, it also decreases blood sugar level and increase the sensitivity of the
body towards the insulin hormone, thus countering insulin resistance (Jenkins& Jenks,
2017). Hence, this program will prove effective in addressing the prevalence of diabetes
amid the ATSI.
Conclusion
Thus, it can be concluded that the ATSI are several times more likely that their non-
indigenous counterparts to suffer from the metabolic disorder to diabetes mellitus. The
SDOH reflect the education, income, social support, employment and access to food, all of
which govern the health status and make the ATSI more likely to suffer from diabetes
mellitus. This calls for the need of enhancing the lives of indigenous people who are affected
by diabetes, and the Aboriginal Road To Good Health Program is one such initiative that
trains and educates the ATSI on different healthy habits, food choices, money expenditure
and active lifestyle. The ATSI people will gain benefit from education regarding he disease
and its effective management, which in turn will help them maintain the blood glucose
levels within acceptable limits. In addition, considering the associated risks of comorbidities,
the program will also act beneficial in controlling obesity and high blood pressure. Hence,

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the Aboriginal Road To Good Health Program is a good initiative implemented by the
Aboriginal Life! Program and will prove effective in decreasing prevalence of diabetes in the
target population, if followed appropriately.

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