Features

The Indigenous health gap: social factors hit hard

by Bianca Nogrady

The link between overcrowded housing, ear infections and incarceration provides an insight into the complex relationship between health and social issues in Indigenous communities.



[Image source: Ezra Shaw: Getty Images ]

Australia has long been called the lucky country. We have a life expectancy of 82 years, which places us in the top 10 countries in the world when it comes to lifespan.

But this isn't the case for all of us. Indigenous Australians have a ten-year lower life expectancy than non-Indigenous Australians. For Indigenous men, that figure is even worse. In theory, we all have access to all the same amenities, so why the difference?

While the issue is complex, experts say much of the answer can be found in examining what are known as social determinants of health  factors like income, access to affordable housing, stress, age and race.

Social determinants of health The World Health Organization defines social determinants of health as the conditions in which we are born, grow up, live, work and age, and these "are shaped by the distribution of money, power and resources at global, national and local levels". These determinants are factors such as income, employment status, access to education, access to healthcare, access to affordable housing, transport, stress, age, and disability, and they have a greater impact on our risk of non-communicable chronic diseases  cancer, heart disease, diabetes, lung disease  than anything else. Indigenous Australians are impacted by these social determinants in different ways to non-Indigenous Australians, and they are also affected by other social determinants that play little or no role in the health of non-Indigenous Australia, such as racism.

Crowded houses, ear infections and incarceration

Professor Dennis McDermott uses the example of housing to illustrate how social determinants can have a profound impact on Indigenous Australians' health.

"It's not hard to see how housing impacts on everyone in terms of health. But if you look at Indigenous Australia and look at the overcrowding that's there  and I'm thinking particularly of remote communities but you can get it also in urban settings  you might get 15 people living in a three bedroom house," says McDermott, from the Poche Centre for Indigenous Health and Wellbeing at Flinders University.

At this level of overcrowding, middle ear infections become a problem. Otitis media or middle ear infections  infections behind the ear drum  are very common in childhood and are usually caused by a viral or bacterial infection. Children often get them after they have a cold and usually they don't pose a serious problem, but in some cases ear infections can cause hearing problems that persist long after the original illness has passed.

"What happens is that non-Indigenous kids get it maybe once, they have a brush with it, and then it's gone. But with Indigenous kids in an overcrowded situation, it goes around and comes back, goes around and comes back, such that it's a huge impact on hearing loss."

This hearing loss can have ongoing, life-long effects. Children can't hear in school, adults can't hear on the job, it can impact on mental health, anger management, and wellbeing, McDermott says.

"Some recent research done in the Northern Territory looked at Aboriginal prisoners in Alice Springs and Darwin jail, … [and] they found that 90 per cent had significant hearing loss," he says.

"So what starts out as overcrowding ends up as incarceration issues."

Treating glue ear is essential to help 'close the gap'

Racism doubles the detriment

But it's not just about overcrowding, there are a range of social determinants that have a long-lasting detrimental impact on the health of Indigenous Australians.

Professor McDermott calls racism a 'sleeper issue' that is systemic in Australia, citing figures suggesting 97 per cent of Aboriginal Victorians have reported being on the receiving end of racism in the previous 12 months.

"It can be when you walk into a hospital and don't get the right treatment, or it can be overt; abuse or whatever," he says.

Whatever form it takes, racism has a clear and proven negative physiological impact through its impact on stress hormones. The "most staggering indication" McDermott has seen was in the United States when stress experienced by certain racial groups increased after the September 11 Twin Towers attack and impacted on the birth weights of newborn babies.

"If you were a Californian woman, with an Arabic name, you were twice as likely to give birth to a low birth weight baby in the six months after that period," he says

Similarly, connection to country  or removal from it  has a proven impact on the health of Indigenous Australians.

There is hard evidence now that if you are "back on country and you're doing some of the elements of traditional lifestyle", your health will be better, McDermott says. For example, a 2009 study showed Indigenous participation in caring for country was significantly associated with more physical activity, better diet, lower body-mass index, lower blood pressure, lower blood glucose, less diabetes, and a lower risk of cardiovascular disease.

"You don't have to throw away your clothes or your mobile phone or whatever but if you're actually connected to country, you'll be better off.

"That psycho-spiritual connection to country, and doing these ceremonies, observing, burning the country when necessary…, is actually a positive contributor to health."

Taking action

Interestingly, Indigenous Australia is one of very few areas where social determinants of health are being addressed directly, through the Federal Government's Closing The Gap program, which flowed from the original non-government led 'Close The Gap' campaign.

Martin Laverty, chair of the Social Determinants of Health Alliance, says this campaign has established a policy framework that has social determinants of health at its core.

"It's a social determinants action plan," says Laverty. "In Indigenous affairs, we see a social determinants action plan that is informing how we are acting to improve Indigenous life expectancy and improve chronic illness."

While it's relatively early days, Laverty says the strategy is kicking some goals.

"We've got targets and indicators for Indigenous school participation, housing, employment etc, and where you have clearly defined targets and indicators, you see resources shifted to improve those portfolio areas where targets are not being met," he says, pointing to improvements in child mortality and early childhood wellbeing from interventions around maternal and child health.

"Where we now need to see the next investment is on educational attainment and smoking cessation; those two on their own will likely have the most immediate positive impacts."

It may seem like an insurmountable task; changing the negative impact that social determinants have on the health of Indigenous Australians, but McDermott is positive about the prospects given the amount of evidence that is accumulating about what can be done to address social determinants of health.

"It's like climate change: the evidence is there but there's this huge denial, vested interests in actually not listening to the evidence," he says.

"I think if we can only get that message through and build a critical mass of discourse in the community, then the politicians will fall in line."

This article is one in a series looking at social determinants of health. Previous stories include Time or money? Why you need both to be healthy and Understanding what really makes us sick.