La Trobe University PHE101: Indigenous Life Expectancy Gap Analysis

This report examines the impact of social determinants, specifically education, healthcare systems, and culture, on the life expectancy gap between Indigenous and non-Indigenous Australians. The gap is estimated to be 10.6 years lower for Indigenous Australians. Education directly impacts health literacy, with lower education levels correlating to a higher probability of premature death. Healthcare system inadequacies, rooted in structural and policy issues, contribute to poor health outcomes for Indigenous populations, who face higher health risk factors and barriers to quality healthcare. Culture plays a vital role, with historical loss of cultural identity and differing understandings of health between Indigenous and non-Indigenous cultures impacting health management. The report concludes by recommending improvements in education, cultural awareness, and healthcare engagement to address the identified social determinants and reduce the life expectancy gap, emphasizing the need for Indigenous community involvement in policy and planning.

SOCIAL DETERMINANTS OF HEALTH 1
La Trobe University
Social Determinants of Heath (PHE101)
Student names: Ronaz Azazil
Joshua Loveday
Bridget Pahor
Assessment name: Enquiry 1 – Life Expectancy Gap between Indigenous and non-
Indigenous Australians
Subject: Social Determinants of Health
Subject code: PHE101 2018
___________________________________________________________________________

SOCIAL DETERMINANTS OF HEALTH 2
Introduction
Social determinants contribute significantly to the health outcomes of individuals and
communities and, in fact, “social, economic and educational disadvantages result in whole of
life poor nutrition, systemic infections and ...poor access to primary health care awareness”
(Zhao & Dempsey, 2006, p. 30). This report discusses the impact of the social factors of
education, healthcare system and culture of Indigenous Australians which can be identified as
a contributor to the current life expectancy gap that is experienced between indigenous and
non-indigenous Australians. This gap is “estimated to be 10.6 years lower than that of the
non-indigenous population” (Australian Institution of Health and Welfare, 2018, p.6).
Social Determinant: Education
Education is a contributing factor to the current life expectancy gap that’s experience
between indigenous and non-indigenous Australians. Education has a direct link to health
literacy, “People with no education or lower secondary schooling have a 46% higher
probability of dying prematurely than people who have achieved a high school or higher
education level” (Hart, Moore & Laverty, 2017, p. 3). It can be concluded that higher levels of
education generate the ability of higher cognitive skills which create a more balance lifestyle
of healthy awareness choices, education is a detrimental factor to indigenous Australians with
only 27 % of indigenous Australians to have completed year 12 compared to 54 % in non-
indigenous people (Department of the Prime Minster and Cabinet, 2014, p.1).
The importance of education is interconnected with lower life expectancy. It is
therefore important that educators target health information to the indigenous communities
through health promotion programs in schools that are constructed with both input from
medical experts and indigenous Australians to identify and rectify any cultural learning
barriers that potentially exist.

SOCIAL DETERMINANTS OF HEALTH 3
School promotion programs inform students and their families on health care issues
and raise awareness of improvements such as 99.5% Aboriginal primary health care services
now offer health promotion/education programmes (Department of the Prime Minster and
Cabinet, 2014, p.1).
Higher education being a major factor in increasing life expectancy it is imperative
that the education barriers of identified and resolutions to be made to increase overall
indigenous people's level of education.
Social Determinant: Health Care System
The health care system in Australia can be classified as one of the social determinants
of health that contributes to the difference in life expectancy between Indigenous and non-
Indigenous Australians. The indigenous Australians are reported to have twice as more health
risk factors than the general population statistics (Australian Institute of Health and Welfare,
2015).
The notion that the healthcare system determines the health of Australian indigenous
groups is deeply rooted in the structure and policy of the existing healthcare system (Human
Rights and Equal Opportunity commission, 2005, p. 65). In developed nations, the
governments are working hard for enhancing the health care system’s performance. It is major
priority of the government and is defining the agenda of the policies related to health
(Gottwald & Lansdown, 2014, p. 67). Most of the systems for healthcare have found clinical
governance as a major aspect of achieving their health agenda. It is done with the help of
developments in patient safety and quality of healthcare (Gottwald & Lansdown, 2014, p.23).
However, if a certain population, in this case, the indigenous community has low health
outcomes, it can be stated that the system is not doing enough.
The indigenous population experiences poor self-management of their health
conditions, stress among the indigenous health workers, and discrimination towards the

SOCIAL DETERMINANTS OF HEALTH 4
population are some of the primary barriers that impede the process of delivery of health
quality services to the target population (Department of Health, 2009, p.18).
Social Determinant: Culture
Culture is a key social determinant of indigenous health. Culture is the “basis for ...[a]
…healthy identity” (King, Smith & Gracey, 2009, p78), which underpins good “mental and
physical health” (Dept. of Health, 2017, p.7), and is central to indigenous “wellbeing and
needs” (Dept. of Health, 2017, p. 5). As such, the loss of cultural language and traditions
(King, Smith Gracey, p. 78) and spiritual, emotional and mental disconnection (King, Smith
Gracey, p. 77) due to European colonization (King, Smith Gracey, p. 78) has had great impact
on indigenous health. In addition, non-indigenous culture has had an impact on indigenous
health, particularly in the health services sector. Non-indigenous health culture is based on the
understanding of health as “the absence of illness or disease” (King, Smith & Gracey, 2009,
p77) whereas the indigenous equivalent is “the absence of wellbeing or balance”. This can
lead to non-indigenous health professionals not understanding the “complexities of
indigenous health” King & Gracey (2009, p.70), such as families being present during clinic
visits (King & Gracey, 2009, p73) and indigenous healing involving a public consultation
process (King, Smith & Gracey, 2009, p77). As a consequence there can be a “perceived
hostility or indifference” (McBain-Rigg & Veitch, 2011, p.73) by indigenous Australians,
further impacting indigenous health management (McBain-Rigg & Veitch, 2011, p.73).
However, by recognising these impacts, culture can also improve indigenous health
gap by way of reinforcement of indigenous cultural identity (King, Smith & Gracey, 2009,
p77), increasing the cultural education of non-indigenous health professionals, and with
greater integration of indigenous medical professionals in health services (Dept. of Health,
2017, p. 5).

SOCIAL DETERMINANTS OF HEALTH 5
Conclusion
With social determinants playing a significant role in the health gap and life
expectancy of indigenous Australians (Dept. Of Health, 2017, p. 6) it is important to
understand where and how social determinants play this role, but also identify what influence
they have on closing the health gap. This paper has discussed three social determinants:
education, health services and culture and concluded that each determinant impacts
indigenous Australians’ health separately and collectively. As a result, the discussion has
identified the following recommendations for where changes in three social determinates may
increase the life expectancy of indigenous Australians.
 Education: The increase and development of rural Aboriginal facilities and
infrastructure and to address the teacher number crisis in central Australia aboriginal
communities.
 Culture: strengthening indigenous cultural identity, educating non-indigenous medical
professional in indigenous health culture and customs, and increasing the number of
Indigenous medical professionals working in the health services area.
 Health Services -Stakeholders in the health system should work towards engaging the
indigenous community to develop essential qualities such as trust and open
communication in understanding and resolving the problems that face this community.
 Creating awareness of the collective impact of social determinants on the health of
indigenous Australians.
 Ensuring indigenous Australians are engaged in policy and planning process by
developing decision-making structures that include the leaders of indigenous
communities, as the voice of the indigenous community, in the areas of education,
health services and cultural awareness.

SOCIAL DETERMINANTS OF HEALTH 6
References
Australian Institute of Health and Welfare. (2015). The health and welfare of Australia’s
Aboriginal and Torres Strait Islander peoples 2015. Retrieved from
https://www.aihw.gov.au/reports/indigenous-health-welfare/health-welfare-australias-
indigenous-peoples-1999/formats/the-health-and-welfare-of-australias-aboriginal-and-
torres-strait-islander-peoples.
Australian Institute of Health and Welfare. (2018). Deaths in Australia. Retrieved from
https://www.aihw.gov.au/reports/life-expectancy-death/deaths/contents/life-
expectancy
Department of Health. (2009). Development of a new national women’s health policy
consultation discussion paper 2009. Retrieved from
http://www.health.gov.au/internet/main/publishing.nsf/Content/38FF434F5AE683E3C
A257BF0001E72E7/$File/cons-dis-paper2009-no-graphics.pdf
Department of Health. (2017). My Life My Lead - Opportunities for strengthening
approaches to the social determinants and cultural determinants of Indigenous health:
Report on the national consultations December 2017. Retrieved from
https://www.health.gov.au/internet/main/publishing.nsf/Content/D2F6B905F3F667DA
CA2580D400014BF1/$File/My%20Life%20My%20Lead%20Consultation
%20Report.pdf
Department of the Prime Minster and Cabinet. (2014). Aboriginal and Torres Strait Islander
Health Performance Framework 2014 Report. Retrieved from
https://www.pmc.gov.au/sites/default/files/publications/indigenous/Health-
Performance-Framework-2014/tier-2-determinants-health/206-educational-
participation-and-attainment-adults.html

SOCIAL DETERMINANTS OF HEALTH 7
Gracey, M. & King, M. (2009). Indigenous health part 1: Determinants and disease patterns.
The Lancet, 374(9683), 65-75. doi: 10.1016/S0140-6736(09)60914-4
Gottwald, M., & Lansdown, G. (2014). Clinical governance: improving the quality of
healthcare for patients and service users. McGraw-Hill Education (UK).
Hart, M., Moore, M., & Laverty, M. (2017). Improving Indigenous health through education.
The Medical Journal of Australia,207(1), 11-12.
Human Rights and Equal Opportunity commission. (2005). Social justice report 2005.
Retrieved from
https://www.humanrights.gov.au/sites/default/files/content/social_justice/sj_report/
sjreport05/pdf/SocialJustice2005.pdf
King, M., Smith, A., & Gracey, M. (2009). Indigenous health part 2: The underlying causes of
the health gap. The Lancet, 374(9683), 76-85. doi: 10.1016/S0140-6736(09)60827-8
Mcbain-Rigg, K., & Veitch, C. (2011). Cultural barriers to health care for Aboriginal and
Torres Strait Islanders in Mount Isa. The Australian Journal of Rural Health, 19(2),
70-4. doi: 10.1111/j.1440-1584.2011.01186.x
Zhao, Y., & Dempsey, k. (2006). Causes of inequality in life expectancy between Indigenous
and non-Indigenous people in the Northern Territory, 1981–2000: a decomposition
analysis. The Australian Medical Journal, 184(10) 490-494. Retrieved from
https://www.mja.com.au/journal/2006/184/10/causes-inequality-life-expectancy-
between-indigenous-and-non-indigenous-people#

SOCIAL DETERMINANTS OF HEALTH 8
PARTICIPATION RECORD
Joshua Loveday wrote the paragraph on the social determinant of education as well as
the introduction to the report.
Bridget Pahor wrote the paragraph on the social determinant of culture as well as the
conclusion and the references list.
Ronaz Azazil wrote the paragraph on the social determinant of health services as well
as formatted the document and managed the word count.
All team members agreed the recommendations, reviewed the document and
contributed to the general content and layout.