Inequalities exist due to social determinants:
Within the Australian Health Care System inequalities exist due to the consequences of social determinants. In an attempt to reduce such inequalities, especially amongst indigenous populations, the importance of addressing these social determinants is emphasized. When specifically focusing on diabetes as an issue in both Indigenous Australian and American Indian communities, the determinants of geography, employment and education highly influence health levels. Within Indigenous Australian communities there are various initiatives, dependent on nurses that attempt to bridge inequalities existent between these communities and the general population. Similarly, when comparing the health issues of Indigenous Australians to the Native Indians of America, great insight can be obtained to highlight the successes and failures of the Australian Health Care System.
Indigenous Australians have a larger disparity to non-indigenous Australia:
The social determinants into which Indigenous Australians are born are directly linked to their health status. For Indigenous communities the isolation caused by their geography forms the first significant social determinant influencing their health levels. Because of their remote isolation, there is a substantial disparity in access to health services, compared to the non-indigenous population. Due to the unequal spread of funding across the entire population at Federal and State government levels, these remote communities are excluded from receiving basic access to nurses and general practitioners. In 2002, the Australian Government acknowledged the shortage of medical practitioners with 281 per 100,000 people in rural and remote communities compared to 312 per 100,000 people in more populated areas. Furthermore, as of 2001 78% of Indigenous communities were more than 50km from the nearest hospital and 50% of communities were also more than 25km from the nearest community health center. This clearly shows the inequality that exists due to the social determinant of geography and the disparity in access to basic health services.
Social determinants are the greatest deciding factor in health quality:
The societal conditions, or social determinants of health in which people live directly affect the levels of healthcare they receive. The many factors which essentially decide such social conditions include the environment into which people are born, events of early life, stresses of work and unemployment, social exclusion and support, race and ethnicity, sexual orientation and substance addiction, food, transport and the healthcare system (World Health Organisation, 2013). While these factors directly determine social conditions, the dispersal of wealth, power and resources at global, national and local levels are indirectly critical in establishing the aforementioned social conditions (World Health Organisation, 2013). For Indigenous Australians the seventeen year gap in life expectancy compared to non-Indigenous Australians dramatically emphasizes the social inequalities that lead to disparity in healthcare levels. In his August 2011 article, Michael Marmot emphasized the idea of the social gradient of health, that is, “the lower the social position [of someone] the worse their health [is].” Marmot also provided several key areas which directly apply to Indigenous Australians which determine their position on the social gradient: early childhood development; education and skills development; employment and working conditions; minimum income for healthy living and sustainability of communities (Marmot, 2011). At the 2001 National Census the average household income for Indigenous Australians was just 62% that of the average non-Indigenous household. Furthermore, the unemployment rate of Indigenous Australians at 20% in 2001 was three times higher than non-Indigenous Australians (Australian Bureau of Statistics, 2002). As Marmot outlined such factors determine one’s position on the social gradient and consequently their level of healthcare. Therefore, it is because of the social conditions, or social determinants in which people live that directly affect their level of healthcare.
Rural and remote Australians experience greater disparity in healthcare:
Within the Australian Indigenous population, and especially amongst rural and remote communities, education forms an integral way forward when addressing the health inequalities. Education is fundamental in terms of social determinants and is highly responsible in determining one’s position on the social gradient. Statistics show great disparity in levels of secondary education between Indigenous and non-Indigenous Australians. In 2008, 59% of Indigenous Australians who had year 12 education reported excellent health, compared to just 49% of those without this level of education. A greater disparity emerged within this group of indigenous Australians aged 35 and older; 43% reported excellent health compared to just 25% of those who never completed year 12. This shows that the social determinants of education is directly linked to health outcomes. Education is also critical within the health care system and amongst health care professionals. An increase in nursing education to respond to Indigenous history and culture is fundamental in reducing health inequalities between Indigenous and non-Indigenous Australians. This idea addresses cultural determinants and attempts to lessen racial barriers. It is thought that indigenous Australians consider Western health care culturally inapt and as a result are reluctant to access this form of healthcare. In the year 2000 only 30% of nursing schools had implemented studies of indigenous history, health and culture. This consequently affected indigenous Australians in a way that the majority of nurses have limited insight into the unique needs of indigenous Australians. Obviously, by providing this extra education to health care professionals, such cultural and historical appreciation can be afforded in the practice of health which consequently makes progress in reducing inequalities. According to 2007 report only 0.5% of the total number of nurses were indigenous. By promoting education of indigenous nurses to have a holistic understanding of indigenous health needs, the barriers between indigenous culture and western health care can be bridged. Education is therefore critical within both the indigenous population and amongst health care professionals in reducing health inequalities.
Many projects have been put in place to try and bridge disparities:
In an attempt lessen the health disparity between Indigenous and non-Indigenous Australians in terms of cultural differences, the Yapunyah Project educates nurses in Indigenous history and culture. The Yapunyah Project, designed by the Queensland University of Technology attempts to educate nursing students with emphasis on cultural beliefs and highlights traditional life ways of Indigenous Australians and integrates this knowledge with the practice of health care. A pre-project questionnaire found that just 51% of nursing students understood the concept of culture and its inextricable link to indigenous identity. The project found significant changes in nursing students’ attitudes and understanding of indigenous history and culture. As a result this led to a significant degradation in health inequalities between Indigenous and non-Indigenous Australians when in the care of these nursing students. The Yapunyah project provides a clear example of the benefits of addressing the social determinants of race and education on cultural awareness which consequently reduces the inequalities of health.
Similarly to Indigenous Australians, the Native American Indian population suffers similar health inequalities when compared to the non-indigenous American population. Education within this ethnic group highlights the inequality compared to the non-indigenous populace. In 1992 just 6% of American Indians had a university degree compared to 23% of the white population. According to Marmot (YEAR!) who argues that one’s position on the social gradient, is directly linked to their level of health, American Indians have substantially poorer health than the white population.
The inequalities that exist within the Australian Health Care System are the consequences of the social determinants of health which are incredibly important when attempting to reduce these inequalities. Education is an integral determinant in healthcare in both the Indigenous Australian and American Indian communities. In an attempt to reduce inequalities, the Yapunyah Project provides education to both nurses and indigenous peoples, improving their position on the social gradient and consequently their level of healthcare.