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.

Alison Markwick,John Mcneil,Zahid Ansari,Lorraine Parsons,Mary Sullivan

doi:10.1186/s12939-014-0091-5

Abstract

IntroductionAboriginal Australians are a culturally, linguistically and experientially diverse population, for whom national statistics may mask important geographic differences in their health and the determinants of their health. We sought to identify the determinants of health of Aboriginal adults who lived in the state of Victoria, compared with their non-Aboriginal counterparts.MethodsWe obtained data from the 2008 Victorian Population Health Survey: a cross-sectional computer-assisted telephone interview survey of 34,168 randomly selected adults. The data included measures of the social determinants of health (socioeconomic status (SES), psychosocial risk factors, and social capital), lifestyle risk factors, health care service use, and health outcomes. We calculated prevalence ratios (PR) using a generalised linear model with a log link function and binomial distribution; adjusted for age and sex.ResultsAboriginal Victorians had a higher prevalence of self-rated fair or poor health, cancer, depression and anxiety, and asthma; most notably depression and anxiety (PR = 1.7, 95% CI; 1.4–2.2). Determinants that were statistically significantly different between Aboriginal and non-Aboriginal Victorians included: a higher prevalence of psychosocial risk factors (psychological distress, food insecurity and financial stress); lower SES (not being employed and low income); lower social capital (neighbourhood tenure of less than one year, inability to get help from family, didn’t feel valued by society, didn’t agree most people could be trusted, not a member of a community group); and a higher prevalence of lifestyle risk factors (smoking, obesity and inadequate fruit intake). A higher proportion of Aboriginal Victorians sought help for a mental health related problem and had had a blood pressure check in the previous two years.ConclusionsWe identified inequalities in health between Aboriginal and non-Aboriginal Victorians, most notably in the prevalence of depression and anxiety, and the social determinants of health (psychosocial risk factors, SES, and social capital). This has implications for evidence-based policy development and may inform the development of public health interventions.

Highlights

Aboriginal Australians are a culturally, linguistically and experientially diverse population, for whom national statistics may mask important geographic differences in their health and the determinants of their health
The greatest effect size was for two of the 4 psychosocial risk factors; very high levels of psychological distress (PR = 4.4; p < 0.001) and food insecurity (PR = 3.4; p < 0.001). This was followed in decreasing order: unable to work, unemployed, unable to get help from family when needed, high/very high psychological distress, and lived in the neighbourhood less than one year, all social determinants with prevalence ratios ≥2.0 and
To summarise our key findings, we believe our work, despite the shortcomings previously discussed, goes beyond the dominant biomedical model, and demonstrates the importance of the social determinants in understanding the gap in the health of the Aboriginal compared with non-Aboriginal population

Summary

Introduction

Aboriginal Australians are a culturally, linguistically and experientially diverse population, for whom national statistics may mask important geographic differences in their health and the determinants of their health. We sought to identify the determinants of health of Aboriginal adults who lived in the state of Victoria, compared with their non-Aboriginal counterparts. Inequalities in health between Aboriginal and Torres Strait Islander people and their non-Aboriginal and Torres Strait Islander counterparts are noted by the World Health Organization (WHO) to be the largest in the world [1]. Understanding the historical reasons for the ongoing health inequalities of Aboriginal and Torres Strait Islander health is critical in gaining the awareness to successfully engage with Aboriginal and Torres Strait Islander people and together envisaging a way forward. With the colonisation of Australia, the annihilation of the Aboriginal and Torres Strait Islander people began, through widespread massacres and the introduction of previously unknown infectious diseases. By 1850 only 10% of the Aboriginal and Torres Strait Islander population remained alive [4]. The inequality in health status that they continue to experience can be linked to systemic discrimination” [6]

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