1. What works? A review of actions addressing the social and economic determinants of Indigenous health Katy Osborne Fran Baum Presentation to Closing the Gap Clearinghouse workshop, Australian Institute of Health and Welfare, Canberra Friday 8 th February 2013

2. Overview Plan for the Issues Paper Issues for consideration: –Key determinants –Balance of content: ‘setting the scene’ vs Information about relevant interventions –Relevant interventions and programs– with evaluation data

3. Research Questions What are the social and economic determinants of Indigenous Health and how are they relevant to the health of Indigenous Australians? How do different social and economic determinants of health interact and influence health behaviours and health outcomes of Indigenous women and men through the lifecourse?

4. Research Questions What is the capacity of services and programs to address social and economic determinants, in order to improve health outcomes and increase healthy equity for Indigenous people? What are the characteristics of successful examples of actions on addressing the social and economic determinants of health that have resulted in positive outcomes? What are the major gaps in evidence with regards to improving indigenous health outcomes using a social determinants approach?

5. Proposed Structure of paper Background to social determinants and how they relate to health among Indigenous Australians Key Determinants relevant to Indigenous health Review of programs, interventions, services designed to take action on key determinants to improve Indigenous health –Table summarising interventions found for each key determinant –Two detailed examples for each determinant of interventions Identification of ‘evidence gaps’

6. Balance of content Background information: Indigenous health status and holistic understandings of health Summary and explanation of social determinants Introducing key determinants ‘What works?’: Review of programs interventions which address key determinants Information on programs which have evaluation data

7. Describing Indigenous health Story that is already known and extensively documented Brief summary of overall patterns: mortality, morbidity, chronic disease, mental heath, health risk factors Enclosed Box: Key health issues across the lifecourse.

8. Determinants of Indigenous health: Framework

9. Key Determinants Educational attainment Access to economic and material resources: –Employment –Income –Adequate Housing and living conditions Connection to country Adapted from: Vic Health (2011) Life is Health is Life: Taking action to close the gap. Vic Health, Melbourne.

10. Key Determinants Networks and interactions: Contact with Government services (Health, welfare, criminal justice, education): –Access, affordability, appropriateness, treatment –Experiences of race-based discrimination Family and community connections: –Community functioning –Social support –Obligations to others –Experiences of Race-based discrimination Adapted from: Vic Health (2011) Life is Health is Life: Taking action to close the gap. Vic Health, Melbourne.

11. Health Behaviours: Key Areas for action Structural approach to addressing the following areas: Tobacco Physical activity Nutrition and Food Access Alcohol and other drugs

12. Criteria for inclusion in paper Interventions/programs that have addressed at least one the following : Access to economic and material resources Educational Attainment Connection to country Family and community connections Interaction with Government services Up-stream approach to health behaviours which address at least one of the above Evaluation data available

13. Search Strategy: Identifying relevant information Aim: to identify peer review and grey literature: –Health related interventions, programs relevant to each key determinant –Evaluation studies and Reviews Restrict searching: 2002-2012 Sources: Databases (Scopus, Web of Knowledge, MedLine) Google and Google Scholar Closing the Gap Clearinghouse, Indigenous health Infonet, Lowitja Institute, ABS, AIHW Focus on Australian evidence

14. Areas for Feedback Key determinants Balance of content Relevant literature for inclusion: –Unpublished information about programs, interventions –Evaluation data Other useful information to include