Heart Disease and Social Determinants: Aboriginal Australians Report

This report examines the prevalence and mortality rates of heart disease among Aboriginal and Torres Strait Islander peoples in Australia, highlighting the significant health disparities compared to non-Indigenous Australians. The study delves into the social determinants of health, including socioeconomic disadvantage, unemployment, chronic stress, and health risk behaviors like smoking and alcohol abuse, as key factors contributing to this disparity. The report also explores the social gradient in health, where inequalities in health and illness are observable across the population. The study proposes a community-based approach, emphasizing education and empowerment, and the involvement of other sectors, such as the transport sector, to improve accessibility and address the underlying social determinants. The report concludes that addressing these social determinants through comprehensive interventions is crucial for reducing the burden of heart disease and improving health outcomes in Indigenous communities.

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Introduction
Heart disease is a public health concern and is one of the leading causes of disability and death
especially in developed countries. Approximately, 15.6 million people globally are currently
living with multiple forms of heart disease, with 230,000 people estimated to have succumbed.
Heart disease is still common among the Aboriginal and Torres Islander peoples of
Australia. This paper aims at examining the health of the Aboriginal and Torres Islander peoples
from the perspective of the prevalence and mortality of heart disease and the social determinants
of the health problem. The report will propose an intervention to address the major social
determinant of health for the Aboriginal and Torres Islander Peoples of Australia.
Section 1: Social Determinants of Heart Disease for the Aboriginal and Torres Strait
Islander Peoples
Burden of Heart Disease within the Aboriginal and Torres Strait Islander Peoples
The Aboriginal and Torres Islander people have been found to have higher prevalence and death
rates of different forms of heart diseases compared to the other Australians. A study was
conducted by the Australian Institute of Health and Welfare (AIHW) on the prevalence of
coronary heart disease among the Australian Indigenous people. The study used the hospital
mortality records from 2002 to 2004 and the findings indicated that the Australian Indigenous
people were at a higher risk of suffering from a heart attack and succumb without being
hospitalized, and even die after being hospitalized than non-Indigenous. The rate of heart disease
such as heart attack in 2011-2013 was three times much higher and 1.4 times death rates from
coronary heart disease (AIHW, 2015).

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Cardiovascular diseases have also been reported to be much higher among the Australian
Indigenous community. According to the survey carried out by the AIHW (2015), the Aboriginal
Torres Islander adults had a higher rate of cardiovascular disease in comparison to the non-
Aboriginal people (27% and 21% respectively). Over 52% of the Indigenous Australian adults
were hospitalized for cardiovascular diseases in comparison to 17% for the non-Aboriginal
people in 2013-2014. The mortality rate among the Aboriginal Torres Islander people due to
cardiovascular disease was 1.5 times higher than their counterparts. The most recent statistics
indicated that 12% of the overall deaths amongst the Indigenous Australians were caused by
heart disease (Australian Bureau of Statistics, 2018) with 70% chance of succumbing (Australian
Health Minister’s Advisory Council, 2012).
Social Determinants of the Burden of Heart Disease among the Aboriginal and Torres
Strait Islander Peoples.
The high burden of heart disease among Indigenous Australians can be attributed to the social
determinants of health. Indigenous Australians undergo socio-economic disadvantage, an aspect
of that is critical in accessing quality healthcare. For instance, the National Census in 2001
showed that the Australian Indigenous community had an average gross household income was
$364/week compared to $584/week for non-Indigenous. Moreover, the rate of unemployment for
the Aboriginals was three times much higher than that for the non-Indigenous (Australian Bureau
of Statistics, 2001). Existing research shows that there is a direct association between the social
and economic status of an individual and his/her health. poverty is also linked to poor health
(Braveman & Gottlieb,2014). The high incidence of smoking and high-risk behaviours among
the Aboriginals have been associated with lower socioeconomic status and the prevalence of
heart disease (Jarvis & Wardle, 2009). Chronic stress is another social determinant of health

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among the Aboriginal community. The high risk-behaviour among the aboriginal community has
been identified as an indication of chronic stress (Hayman, 2010). This can be attributable to
historical and social injustices and the perennial inequalities in resource distribution. According
to the study by AIHW (2019), over 50% of the Aboriginal community aged 15 years and above
smoked daily with 1 out of 6 being heavy consumers of alcohol. Such behaviours increase the
risk of developing heart disease.
The social gradient in health in Australia has been observed in several studies. Arcaya, Arcaya,
and Subramanian (2015) observe that there is an unequal distribution of health and illness in the
Australian population. The difference in the female mortality rate in 2014 between the highest
and lowest socioeconomic areas was 23% with that of the males being much higher (33%)
(AIHW 2016). furthermore, the social gradient in mortality affects life expectancy, hence the
reason why the Indigenous people of Australia with lowest socioeconomic status have the lowest
life expectancy of 79 years compared to 83 years for the non-Indigenous community.
Section 2: An intervention to address social determinants of Heart disease for the
Aboriginal and Torres Strait Islander Peoples
Community-based approaches can be important in the management of heart disease among the
Aboriginals. This approach involves partnerships with several stakeholders within a community
who are critical in identifying the challenges being experienced by the members of the
community. The Australian Indigenous community is disadvantaged by minimal access to drugs,
delayed access to the health centres and minimal intervention rates once they are admitted to the
hospitals (Couzos & Murray, 2008). Therefore, there is a need to create community awareness in

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addition to the systematic barriers that are facilitating premature mortality due to heart disease.
The community-based approach with a particular emphasis on education and empowerment as a
way of enhancing access to integrated health services have been found to improve health (Zeitz,
2009).
A community-based approach that focuses on education is important because it will create
awareness on the health-risk behaviours that contribute to heart diseases such as smoking and
alcohol abuse. Moreover, the approach will empower the Aboriginals on overcoming the health
risk behaviours in addition to offering basic treatment approaches. This approach is important in
reducing health disparities because it also helps in building trust among the patients and
healthcare providers (Mensah et al., 2018).
Other sectors that can be involved aside from the health sector
Another significant sector that can be of importance in contributing to the community-based
approach is the transport sector. The transport sector would be involved in the intervention by
ensuring that the rural communities are accessible. Furthermore, the existence of good transport
network will facilitate the implementation of the community-based approach which will require
the involvement of the community stakeholders by improving accessibility to the rural areas
(AIHW, 2016). Communities and neighbourhoods that have accessibility to basic goods and
services due to effective transportation are socially interconnected; an aspect that fosters
psychological wellbeing and avoids chronic stress which further increases the risk of engaging in
health-risk behaviours such smoking (AIHW, 2016).
Conclusion

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The Aboriginal and Torres Islander people have been found to have higher prevalence and death
rates of different forms of heart diseases such as cardiovascular and coronary heart diseases
compared to the other Australians. Additionally, the mortality rate among the Aboriginal Torres
Islander people due to heart disease is also higher than the non-Indigenous Australians. The high
burden of heart disease among Indigenous Australians can be attributed to the social
determinants of health. Indigenous Australians undergo socio-economic disadvantage, an aspect
of that is critical in accessing quality healthcare. Moreover, the rate of unemployment for the
Aboriginals was three times much higher than that for the non-Indigenous. Chronic stress and
associated health-risk behaviours such as smoking and alcoholism are other social determinants
of health among the Aboriginal community. The social gradient in Australian indigenous
community is observable in the unequal distribution of health and illness. For instance, female
and male mortality is higher which further affects the life expectancy. However, a community-
based approach which focuses on education and empowerment is critical in addressing the
prevalence of heart disease among the Indigenous community. The transport sector would also
play a significant role in facilitating the implementation of the intervention and addressing the
problem of heart disease among the Australian Indigenous community in Australia.

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References
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