2. Groups experiencing health inequities

3. “Health inequities; that is, the unjust impact on the health status of some groups due to: social, economic, environmental and cultural factors, such as: - income, - education, - availability of transport and - access to health services”. “Major indicators such as the incidence and prevelance of disease and different rates of sickness, hospitalisation and death point to areas in which inequalities exist”. Groups experiencing health inequities Outcomes 2: HSC Fourth Edition

4. An individuals level of health is determined by a broader range of factors and not just their health- related decisions. The following factors have a significant role in the achievement of good health: Socio cultural Socioeconomic Environmental factors “Some factors have the potential for change, such as individuals choosing not to smoke, or governments making roads safer. Other factors, such as an individuals genetic makeup, are generally not modifiable”. “Governments and health authorities recognise that people cannot always choose a particular lifestyle. Health promotion and illness campaigns attempt to address the determinants that have an impact on health or affect peoples ability to make good decisions about their health. These can be classified as: Outcomes 2: HSC Fourth Edition

5. “Socio cultural determinants of health include family, peers, media, religion and culture.” “Socioeconomic determinants of health include employment, education and income”. “Environmental determinants of health include geographical location, and access to health services and technology”. “A determinant is a factor that can have an impact on a person’s or group’s health status, either positively (protective factors) or negatively (risk factors).” Outcomes 2: HSC Fourth Edition

6. Groups experiencing health inequities - Aboriginal and Torres Strait Islander Peoples “The magnitude of the health inequities experienced by Indigenous Australians is starkly demonstrated by a comparison of life expectancy data. The gap between Indigenous and non-Indigenous life expectancy is currently about 17 years.”

7. PDHPE In Focus - The nature and extent of the health inequities

9. Between 2001 and 2005, death rates for Indigenous males and females in most states were almost three times those for non-indigenous Australians. Infant mortality remains about three times higher than for the whole population at 15 for males and 12 for females”. The five leading causes of death for Indigenous people were: 1.Diseases of the circulatory system 2.Cancers 3.Endocrine, metabolic and nutritional disorders (including diabetes) 4.Respiratory diseases 5.Injuries Outcomes 2: HSC Fourth Edition

10. “The main causes of poor health among Indigenous people include: Mental disorders Circulatory diseases Diabetes Respiratory diseases Cancers Musculoskeletal conditions Eye and ear problems Kidney disease “In 2005-2006, Indigenous people were hospitalised at 5 times the rate of non-indigenous people and at 14 times the rate for care involving dialysis.” Outcomes 2: HSC Fourth Edition

11. “Indigenous Australians experience significant socioeconomic and sociocultural challenges. Cultural divisions and conflicts since European settlement, ill-advised or ineffective programs of integration, seperation, education and welfare support have all contributed to the poor state of Indigenous health. The most critical challenges for Indigenous Australians include: Lower incomes Higher rates of unemployment Lower educational attainment Lower rates of home ownership” - The sociocultural, socioeconomic and environmental determinants

13. LOWER INCOMES: “Median household income for Indigenous families in 2006 was equal to about 55% of median household income for non indigenous people”. HIGHER RATES OF UNEMPLOYMENT: “The unemployment rate of 16% for Indigenous people in 2006 was three times the rate of 5% for non-Indigenous Australians”

14. LOWER EDUCATIONAL ATTAINMENT: “The proportion of Indigenous people who had completed Year 12 in 2006 ranged from 36% of people aged 18-24 years (less than half the indigenous rate) to 9% of people aged 55 years and over (just over a quarter of the non-Indigenous rate). Overall, Indigenous males and females reported similar rates of Yr 12 completion (22% compared with 24%). Poor levels of school attendance is a major problem for Indigenous youth.

16. LOWER RATES OF HOME OWNERSHIP: “The proportion of Indigenous families who owned or were purchasing their own homes in 2006 was half the rate of other Australian households (34& compared with 69%). “In a 2004 survey, overcrowding was reported to affect 1 in 4 Indigenous Australians, and was most prevalent in rented dwellings. In 2006, over 30% of Indigenous community housing dwellings needed major repairs or replacement”.

17. “In the 2008 AIHW report on Indigenous health and welfare, it is emphasised that the underlying social determinants mentioned above, clearly increase the likelihood of exposure to a number of the health risk factors including: Tobacco use Alcohol consumption Illicit drug use Overweight and obesity Poor nutrition Physical Inactivity Exposure to violence Poor housing conditions”

18. - Environmental Determinants: “With regard to environmental determinants, housing standards are clearly a priority issue. Other environmental issues that affect health in remote communities include: Water supply Training for ATSI environmental officers Transport Communication Health and safety relating to dogs It is important to make the point, though that despite the detrimental effect of some of these risk factors, positive achievements are also being made in reducing exposure to them and their underlying determinants”.

19. “Modern approaches to healthcare and health promotion acknowledge the fact that Indigenous health status results from the interaction of multiple determinants, and requires a similarly multi-faceted response from the healthcare system. This should include and INTERSECTORAL APPROACH, based on partnerships between people and agencies at many levels and in a variety of sectors. This is approached through the following levels: Government (OATSIH, NACCHO, AH&MRC) Community (ACCHSs and AMSs) Individuals (Individual capacity to reduce risk factors, although there are Aboriginal health services that can provide extra support and guidance). - The roles of individuals, communities and governments in addressing the health inequities: