Social determinants of health and Indigenous Australians

The World Health Organization (WHO) describes social determinants of health as ‘the structural determinants and conditions of daily life’—that is, the conditions of work or leisure; people’s homes, communities and environments; and their access to education and health care (WHO CSDH 2008). People’s opportunities and circumstances are shaped by the distribution of power, income, goods and services, which are in turn affected by policy choices, and are a major component of health inequities between and within countries.

Commonly recognised social determinants of health include housing, education, employment, income, and social networks and connections. For Indigenous Australians and other Indigenous peoples across the world, cultural factors—including connection with land and waters, identity, and language, as well as the ongoing effects of dispossession, marginalisation, racism, and discrimination—also play a key role in influencing health outcomes (Figure 4.1).

Other important social determinants affecting health outcomes include:

  • health literacy (the ability to obtain, read, understand and use health-related information to make appropriate health decisions), and
  • availability of health resources (the funds, equipment, facilities, personnel and other items such as medicines and medical supplies) needed to provide health services.

The social determinants of health act through complex and multidirectional pathways, and underlie a broad range of poor health and welfare outcomes. A combination of factors may act at the community and the individual level to influence health. For example, an individual’s level of education and household income may influence their food choices, while the area in which they live may affect the availability and cost of various foods.

Other articles in this report and the Australia’s health 2020 snapshots (for example, ‘Social determinants of health’ and ‘Social determinants and Indigenous health’) detail the range of social determinants and how they relate to health; their impact throughout life; and their contribution to the gap in health outcomes between Indigenous and non-Indigenous Australians. This article examines key health conditions disproportionately impacting Indigenous Australians, which are affected by housing conditions and access to services.

Two of the critical factors connecting housing conditions to health are the impact of overcrowding and the state of domestic health hardware. ‘Health hardware’ refers to the physical equipment needed to support good health. This includes safe electrical systems; access to water; working taps, showers, and sinks with plugs; toilets; waste and wastewater removal systems; and facilities needed for the safe storage and preparation of food. If any of these facilities are unavailable, not working, or inadequate to support the number of residents, illness or injury can occur. Also implicit in this is that local infrastructure should minimise environmental health risks, by providing access to safe drinking water, and by supporting sanitation and waste management services.

Figure 4.1: Conceptual model for social determinants of Indigenous health and health inequities

This figure shows a model of how social determinants are related to health outcomes for Indigenous Australians. It connects upstream factors, such as areas affected by public policy, to midstream factors, such as socioeconomic factors and personal behaviours, and on to downstream factors, such as effects on body mass and immune function, which then result in health outcomes and inequities. The model notes that the midstream factors are also affected by an individual’s capacity to act independently and make choices, and what these choices and actions are. It also shows that colonisation, separation from land, family, community and culture are overarching issues for Indigenous Australians that affect all of the factors in the model in some way, and thus also have an impact on health outcomes.

Source: Adapted from Osborne, Baum & Brown 2013.