Health Essay: Indigenous Health Determinants and Health Status

This essay examines the theory of social determinants of health (SDOH) and its profound impact on the health status of Indigenous Australians. The essay identifies key indigenous health determinants, including socioeconomic status (SES), lack of access to primary health care, and poor housing conditions, and explores their contribution to health disparities. It highlights the significant role of SES in the high prevalence of diabetes, chronic diseases, and mental disorders within the Aboriginal population, linking it to historical factors like colonization and discrimination. The essay also discusses the effects of poor housing on infectious diseases and mental health. The analysis reveals that addressing SDOH factors is crucial for improving health outcomes, reducing health inequities, and promoting well-being among Indigenous communities. The essay emphasizes the need for policy makers and health promotion programs to prioritize these factors to achieve health equity and excellence in disease control. The study reveals that SES is highly linked to high rate of diabetes, chronic disease and mental disorders in Aboriginal people. In addition, poor housing was identified as a contributing factor behind high burden of infection disease in indigenous population.

Running head: HEALTH CARE
Essay topic: Outline the theory of the social determinants of health. Choose one or more
‘Indigenous health determinants’ and explain how they contribute to poor Indigenous health
status.
Name of the student:
Name of the University:
Author’s note

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The prevalence of gaps in health outcome and health status of indigenous people in
Australia is a longstanding challenge for Australian government. It has been identified by United
Nations Committees as a human rights issue because of inequalities and impact of systematic
discrimination on the health of the indigenous group (Fisher et al., 2019). The theory of social
determinants acknowledges that many interconnected social factors affect population health and
inequity (Sallis, Owen & Fisher, 2015). Understanding of the theory of the social determinants of
health (SDOH) and its links with indigenous health determinant is necessary to understand the
influence of inequalities in health determinants on their health outcomes. The main aim of this
essay is to review one or two of the indigenous health determinants and discuss the impact of
these factors on indigenous health status.
According to the World Health Organization (WHO) definition, SDOH is defined as the
condition in which people are born and live that impact their health. These conditions include
intangible factors like political, socioeconomic and cultural constructs. It includes access to
education, availability of healthy food and safe environmental conditions (WHO, 2019).
Currently public health practitioners and policy makers are actively considering the determinants
of health factor to analyse population health and consider approaches to improve health, address
health inequalities and accelerate health outcomes. The significance of implementing actions
informed by the social determinants is that such decisions are made based on understanding of
dynamic interaction between environment, socioeconomic and environmental determinant of
health (Dean, William & Fenton, 2013). Hence, it is imperative that policy makers and program
developed put major emphasis on assessing the broader influence of SDOH on health outcome to
maintain health equity and excellence in disease control. This essay furthers looks at the key
indigenous determinants of health and how it affects their health status.
The data by WHO (2018) shows vast disparities between health of Australia’s indigenous
Aboriginals and the rest of the population. Currently, the government is focusing on the social
problems that undermine their communities to improve health outcomes of the indigenous
population. Important indigenous determinants that have resulted in health inequality for
indigenous Australians include poor socioeconomic status, lack of access to primary health care
and health infrastructure, unemployment issue and greater risk of exposure to environmental and
behavioural risk factors (Fisher et al., 2019). Factors like housing, employment condition,

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education and distribution of power and resources adversely affect physical as well as mental
health of the group. In case of Aboriginal Australian people, all the above factors are social
determinants of indigenous health. History of racism and colonization underpin disparities in
each area of SDOH for the groups too. To understand the extent to which SDOH factors affect
indigenous health, the essay will discuss in detail about the impact of poor housing and
socioeconomic status (SES) on health status of indigenous population.
The extent to which SDOH factors affects overall health and well being of indigenous
Australians is understood from the report by AIHW, which states that 64% of the total burden of
chronic disease in Aboriginal group is due to chronic disease and 39% of the gap between
indigenous and non-indigenous health outcomes can be explained by social determinants
(AIHW, 2017). Socioeconomic disadvantage is one major risk factor of poor health outcomes in
Indigenous Aboriginals. This socioeconomic disadvantage has emerged following history of
colonisation and discrimination of the group in Australia. The history of forced resettlement
resulted in loss of land and culture for aboriginal people and reduced opportunities for
employment in new regions. They have faced profound marginalization over the years that
affected their SES and contributed to poor health outcomes (Shepherd, Li & Zubrick, 2012).
SES is the reason for high prevalence of diabetes in Aboriginal and Torres Strait
Islanders. The statistics by AIHW (2019) revealed that burden of diabetes is high for Aboriginal
and Torres Strait Islanders as they experience disproportionately high level of diabetes and death
rate was two times high in remote areas. The disparities in diabetes outcome between indigenous
and non-indigenous population of Australia is evidenced from the data that in 2012-2013,
prevalence of diabetes was three times more likely in Aboriginal and Torres Strait Islander
people compared to non-indigenous group. It became the second leading cause of death in the
group in 2013. Health inequality in this area is influenced by social and historical determinants
of health. Firstly, the arrivals of Europeans led to major changes in their lifestyle as their cultural
practices and resources were lost. In addition, they developed westernized lifestyle contributing
to risk of diabetes, (Burrow & Ride, 2016). In contemporary world, social conditions and
economic opportunities significantly influence health outcome for the group. However,
indigenous Australians have experienced substantial disadvantage in all areas such as housing,
income, employment and access to services resulting in poor diabetes outcome (Hill et al., 2017).

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The inverse relationship between low SES and higher prevalence of diabetes is a factor that must
be looked at seriously because diabetes is the risk factor for other chronic disease too.
There are many reports that explain how indigenous determinant of health has negatively
affected health and well-being for indigenous group. They have poor health status in almost all
vital health related parameters. For example, Hill et al. (2017) explains Aboriginals have worst
health, lowest life expectancy and high child mortality rate due to diabetes. The main cause
behind high child mortality due to diabetes is because of the high prevalence of pre-existing and
gestational diabetes in Aboriginal women. Presence of such condition in pregnancy is associated
with high risk of perinatal death, congenital malformations and pre-term delivery. In case of
aboriginal women, healthy eating during pregnancy is affected due to poor SES. Hence, poor
access to quality food and healthy living before and during pregnancy increases risk of diabetes
for the developing baby too and chronic disease in later life (Australian Health Ministers’
Advisory Council, 2017). This data shows how SES influence pregnancy outcomes and child
mortality rate for indigenous population. Therefore, the evidence regarding the impact of SES on
diabetes and child mortality outcome of indigenous Australians gives the implication to
policymakers to address SES factors of the group to address health inequities and promote access
to diabetes related services in rural and remote indigenous communities.
The influence of indigenous determinant of health in contributing to their poor health
status is also evidenced by the impact of poor housing on their health. Quality housing is a
critical social determinant of both physical and mental health and well-being. Affordable housing
alleviates the risk of crowding and limits exposure to environmental toxins that deteriorates
health (Maqbool, Ault & Viveiros, 2015). Liotta (2018) reports that living in overcrowding is
major problem for aboriginal Australians. Many houses in the indigenous community of
Australia has been deemed as overcrowded and overcrowding is a major risk factor of health
problems like respiratory infections, eye infection and mental health issues. Families living in
overcrowded house are more susceptible to infection risk because of poor sanitation and high
possibility of close contact with others. Ali, Foster and Hall (2018) clearly explain the
relationship between infectious diseases and housing in indigenous Australian Households.
Through the literature review on housing maintenance contribution to infectious diseases, the
study revealed that skin related disease and gastrointestinal infection was high because of poor

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housing maintenance. Housing and crowding is exacerbated by socio-economic and cultural
factors. Hence, improving housing condition is the key to reducing burden of infectious disease
among Indigenous Australians.
From the discussion so far regarding the high burden of diabetes and infectious disease
in Aboriginal Australians, it can be interpreted that SES is a significant determinants of health
that not only increases the risk of physical illness, but also mental illness. Common mental
disorders presence in indigenous people living regional, remote and metropolitan Australia
include high prevalence of co-morbid mental disorders like depression, anxiety, substance use
disorder and emotional disorders (Das et al., 2018). The risk of self-harm and suicide rate is high
among Aboriginal Australians. The rate of disparities in psychological distress is also high in
indigenous population compared to non-indigenous groups. With wide range of report disparities
in mental well-being of indigenous people, WHO has made this a high priority area to achieve
equitable mental health outcome for the high risk population group.
The review regarding the causes of poor mental health and high risk of psychological
distress also link social determinant of health as a major cause behind mental health status. The
interaction between factors like experience of poverty, discrimination, effects of colonisation and
marginalisation are all responsible for variations in mental health for the Aboriginal people
(Nasir et al., 2018). Das et al. (2018) regarded mental health issues in Aboriginal and Torres
Strait Islander’s as a social causation because of life experiences of marginalization, poverty and
experiences of racism and discriminatory policies. The factor linked to decline in health for the
group includes settling in new lands and destruction of ancestral land leading to poverty and
psychological distress. In addition, destruction of aboriginal way of lifestyle and resources
became a source of poverty and poor mental health outcomes too. Being unemployed is a critical
risk factor too evidenced by the statistics that only 48% of the indigenous population were
employed in 201-2015. The situation was found to be worst for indigenous Australians living in
remote and rural areas as the employment rate in inner areas was 48% and 35 % in remotes areas
(pmc.gov.au., 2015). These statistics gives the implication to address SES factors to promote
health equity and address disparities in mental health too. Key actions that will be required
includes supporting job growth in indigenous group, provide assistance to job seekers and
increasing indigenous employment goals in government programmes. Taking strong action

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regarding stigma and discrimination is also suggested so that social, spiritual, physical, mental
and spiritual components of well-being for the group are addressed (Fisher et al., 2019).
The essay summarized key indigenous determinants of health and its impact on poor
health status of indigenous Australia. Taking cues from the theory of the social determinants of
health and identifying health determinants linked to poor indigenous health status, the essay
identified poor SES, lack of access to primary health care and health infrastructure,
unemployment issue and environmental and behavioural risk factors as some specific indigenous
determinants of health. The essay specifically discussed about poor SES and poor housing
condition on health outcome of the group. The study revealed that SES is highly linked to high
rate of diabetes, chronic disease and mental disorders in Aboriginal people. In addition, poor
housing was identified as a contributing factor behind high burden of infection disease in
indigenous population. The essay revealed that history of intergenerational trauma and
discrimination is the reason for poverty, poor SES and poor housing conditions for the group.
The review of the link between these SDOH factors and the disease related statistics further
confirms why addressing SDOH factors should be a priority for policy makers and health
promotion programme linked to aboriginal health and well-being.
References:
AIHW (2017). The health & welfare of Australia's Aboriginal & Torres Strait Islander people.
Retrieved from:
https://www.aihw.gov.au/reports-data/health-welfare-overview/indigenous-health-
welfare/overview
AIHW (2019). Diabetes. Retrieved from: https://www.aihw.gov.au/reports-data/health-
conditions-disability-deaths/diabetes/overview
Ali, S. H., Foster, T., & Hall, N. L. (2018). The Relationship between Infectious Diseases and
Housing Maintenance in Indigenous Australian Households. International journal of
environmental research and public health, 15(12), 2827.

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Australian Health Ministers’ Advisory Council (2017). Diabetes in Australia: Focus on the
future. Australian Government: Canberra. Retrieved from:
https://www1.health.gov.au/internet/main/publishing.nsf/Content/3AF935DA210DA043
CA257EFB000D0C03/$File/FINAL%20-%20Jan%202018-%20PDF%20%20-
%20Implementation%20Plan%20-%20Diabetes%20Australia%20Focus.pdf
Burrow S., & Ride K. (2016). Review of diabetes among Aboriginal and Torres Strait Islander
people. Australian Indigenous HealthInfoNet.
Das, M., Kini, R., Garg, G., & Parker, R. (2018). Australian aboriginal and torres strait islanders'
mental health issues: A litany of social causation. Indian Journal of Social
Psychiatry, 34(4), 328.
Dean, H. D., Williams, K. M., & Fenton, K. A. (2013). From theory to action: applying social
determinants of health to public health practice. Public health reports (Washington,
D.C. : 1974), 128 Suppl 3(Suppl 3), 1–4. doi:10.1177/00333549131286S301
Fisher, M., Battams, S., Mcdermott, D., Baum, F., & Macdougall, C. (2019). How the social
determinants of Indigenous health became policy reality for Australia's National
Aboriginal and Torres Strait Islander Health Plan. Journal of Social Policy, 48(1), 169-
189.
Hill, K., Ward, P., Grace, B. S., & Gleadle, J. (2017). Social disparities in the prevalence of
diabetes in Australia and in the development of end stage renal disease due to diabetes for
Aboriginal and Torres Strait Islanders in Australia and Maori and Pacific Islanders in
New Zealand. BMC public health, 17(1), 802.
Liotta, M., (2018). Overcrowding leads to poorer health outcomes for Aboriginal and Torres
Strait Islander peoples. Retrieved from:
https://www1.racgp.org.au/newsgp/racgp/overcrowding-a-key-determinant-of-poor-
health-outc
Maqbool, N., Ault, M., & Viveiros, J. (2015). The impacts of affordable housing on health: A
research summary. Center for Housing Policy.

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Markwick, A., Ansari, Z., Sullivan, M., Parsons, L., & McNeil, J. (2014). Inequalities in the
social determinants of health of Aboriginal and Torres Strait Islander People: a cross-
sectional population-based study in the Australian state of Victoria. International journal
for equity in health, 13(1), 91. doi:10.1186/s12939-014-0091-5
Nasir, B. F., Toombs, M. R., Kondalsamy-Chennakesavan, S., Kisely, S., Gill, N. S., Black,
E., ... & Nicholson, G. C. (2018). Common mental disorders among Indigenous people
living in regional, remote and metropolitan Australia: a cross-sectional study. BMJ
open, 8(6), e020196.
pmc.gov.au. (2015). ABORIGINAL AND TORRES STRAIT ISLANDER
HEALTH PERFORMANCE FRAMEWORK 2017 REPORT. Retrieved from:
https://www.pmc.gov.au/sites/default/files/publications/indigenous/hpf-2017/
tier2/207.html
Sallis, J. F., Owen, N., & Fisher, E. (2015). Ecological models of health behavior. Health
behavior: Theory, research, and practice, 5, 43-64.
Shepherd, C. C., Li, J., & Zubrick, S. R. (2012). Social gradients in the health of Indigenous
Australians. American journal of public health, 102(1), 107-117.
WHO (2018). Australia’s disturbing health disparities set Aboriginals apart. Retrievd from:
https://www.who.int/bulletin/volumes/86/4/08-020408/en/
World Health Organization (WHO) (2019). Social determinants of health. Retrieved from:
https://www.who.int/social_determinants/en/