Fran Baum @baumfran Southgate Institute for Health, Society and Equity, NHMRC Centre for Research Excellence in Health Equity Presentation to NACCHO Members Conference Melbourne 8th December
Social Determinants of Indigenous Health: what might really make the difference to health outcomes
(Part 1 of 3)
Overview
• Social determinants of Indigenous Health • Pathways from SD to ill health • What works to improve SDH – daily living
conditions • Global context affecting all our health – power
money and resources • Importance of advocacy
IndigenousHealthOutcomes
11yearlifeexpectancygap–10forwomen,12formen
Higherratesofinfec>ousandchronicdisease
Higherratesofriskybehaviourdrivenbyhighrisksocial,economicandculturalenvironments,highratesofincarcera>on
Death
Illness
Risk
CommissionontheSocialDeterminantsofHealth
"(The)toxiccombina>onofbadpolicies,economics,andpoli>csis,inlargemeasureresponsibleforthefactthatamajorityofpeopleintheworlddonotenjoythegoodhealththatisbiologicallypossible.Socialinjus>ceiskillingpeopleonagrandscale."InAustraliaclosingthegapbetweenhealthofAboriginalandTorresStraitIslandersandotherAustraliansismostvital
Basiclogic:whatgooddoesitdototreatpeople'sillnesses/addic>ons/sendthemtogaol….........
then give them no choice but to go back to or no control over the conditions that made them sick/
addicted/commit crime in the first place?
CommissionontheSocialDeterminantsofHealth:Recommenda>ons
– Dailylivingcondi>onscreateinequi>es
– Powermoneyandresourcesshapethesecondi>ons
– ExpandtheknowledgebaseontheSDH,developtheworkforceandadvocacyforSDH
Equitablesocie>estreatpeopleaccordingtoneed
Whataddi>onalknowledgeaboutIndigenousSDH
Osborne,Baum&Brown,2013
EmergingthemesinunderstandingSocialdeterminantsofAboriginalandTorresStrait
Islanderhealth• Impactofinvasionoflands• Lossofland• Threatstocultureandiden>tyfromwhitenessandcolonialmentality
• Dominanceofwhitenessonaccesstobasicdeterminants:educa>on,employment,housing
• Racism
hYps://www.dpmc.gov.au/sites/default/files/publica>ons/indigenous/Health-Performance-Framework-2014/aboriginal-and-torres-strait-islander-health-performance-framework-2014-report/racism-and.html
SocialDeterminantsgetunderourskinandcausediseasesandhealthinequi>es….ChronicstressisoneofcrucialpathwaysforIndigenousPeoples….
Wilkinson & Pickett 2009, 86
TheBiologyofStress
BiologicalPathways1…
PERCEIVED THREAT
FIGHT OR FLIGHT
REACTION • Increased production of adrenalin • Increased Heart Rate • Increased BP • More blood directed to muscles • Dilated pupils (eyes) • Less blood to other organs (eg
kidneys, liver)
THREAT PASSES
THOSE WITH POWER
THOSE WITHOUT POWER • Increased production of Endorphins, reduced
production of adrenalin • Decreased Heart Rate • Decreased BP • Less blood directed to muscles, muscles relax • Normal pupils (eyes) • More blood to other organs (eg kidneys, liver)
BiologicalPathways2…
High BP High Cholesterol Increased risk infection Increased Heart Rate High BP Increased risk cancer Decreased Blood Clotting Time Increase heart rate Insulin resistance Anxiety Depression
Psych-social Demands (Stressors) Resistance & Vulnerability Factors
Life events, chronic stress, daily hassles Coping Responses; Personality; Social Supports
Psycho-biological Stress Response
Neuro-endocrine (brain & hormones) Autonomic metabolic Immune
Cortisol, ACTH, Catecholamines, Beta- endorphins, Testosterone, Insulin
Cardiovascular function, Renal function, Gastro-intestinal motility, Fat metabolism, Haemostasis
Immunoglobulins, WBCs, Lymphocyte sub-populations, Cytokines.
Diabetes … Heart disease … Stroke … Renal Disease … Infections … Cancer
Source:Marmot&Wilkinson,1999
Howsocialdeterminantsgetintoourbrainsandcausemental&physicalhealthproblems
Lackofcontroloverworkandhomelife
Discrimina:on(racism,sexism)
Longtermchronicstress
Poverty–managingonlowincome
Livinginareawithhighdisorder&lackofsafety
Copingbyusingsubstancesharmfultohealth–alcohol,tobacco,illegaldrugs
ChronicDiseaseDepression,Anxiety
Barrierstoseekingmentalhealthcare:cultural,financial,class,gender
Unemployment
Non-permanentwork
Genderedviolence
Earlychildhoodnots:mula:ngmaximumbraindevelopment
Socialisola:on&lackofmeaningfulcontacts
“Thesuccessofaneconomyandofasocietycannotbeseparatedfromthelivesthatthemembersofthesocietyareabletolead…wenotonlyvaluelivingwellandsa>sfactorily,butalsoappreciatehavingcontroloverourlives.”AmartyaSen(1999)DevelopmentasFreedom
• Material• Psychosocial• Poli>cal
Empowerment-basedprac:ce
Equityisnotjustaboutpovertyalsoaboutcapabili>esandenablingpeopletoliveflourishinglives
