School of Medicine

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For attention of: DR Leesa Wisby .................................... OFFICE USE ONLY

Assignment received:
Student ID: 450675 ....................................................

Student Name: Jeffrey Xie ...............................................

Unit Code: MBBS (M3N)

Unit Name: CAM101 (Foundations of Medicine 1) .........................................................

Assignment
Number, Title:
Essay 2 On Health and Society ..............................................................

I declare that all material in this assignment is my own work except where there is clear
acknowledgement or reference to the work of others and I have complied and agreed to the
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Signed JEFFREY XIE Date

20/03/2017
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Good health is developed, maintained and compromised by many factors outside of our

biology and our healthcare system. Famously, the World Health Organisation (1948) defined

health as a state of complete physical, mental and social well-being and not merely the

absence of disease or infirmity, to reflect this new holistic understanding. This essay will

explore the influence of non-medical factors such as the social, cultural, economic and

environmental determinants on the health outcomes of the Australian population. Special

emphasis will be placed on the status of vulnerable and disadvantaged groups, Aboriginal and

Torres Strait Islander peoples and residents of rural and remote areas in the scope of this

examination. Overall, this essay shall investigate how these determinants may benefit health

or perpetuate health inequities in the population, and how the values of social justice and

fairness can inform a socially just distribution of health.

Health distribution across Australia (social justice, inequity and fairness)

Social justice is an important concept in modern Australian healthcare since there is an

increasing socioeconomic gap and steepening health gradient between the wealthy and the

poor. In the scope of this essay, social justice will be defined as the rights of all people in

our community are considered in a fair and equitable manner (Australian Health and

Communities Services 2014). Our current, socially responsible healthcare system emphasises

the need for marginalised and disadvantaged populations in society including Aboriginal and

Torres Strait Islander (ATSI) Australians, those in rural areas and the socioeconomically

disadvantaged to have equal opportunities to lead a fully healthy and functional life. In the

same vein, the idea of health equity defined as the need to minimise unfair and avoidable

differences in health status is also important in informing health distribution in Australia.

The central concepts of social justice and equity also raise concerns of unfairness over the

way that certain population groups may have their health undermined by social, economic,

environmental and cultural conditions. Residents of isolated and remote areas, for instance,

do not have the same access to clean water and sanitation as a person living in an urban or

metropolitan area. However, these core values also inform the way the government addresses

these underlying disparities in health. When the government designs information to educate

the public about healthy lifestyles in foreign languages so that everybody can understand the

implications of certain health practices, they are acting in an inclusive way to maximise

health promotion. Overall, health outcomes in Australia as experienced by particular target

groups are greatly shaped by the need for social justice and equity when viewed in a broad

population-based framework.

Aboriginal Population: Background

There is a significant health gap between the health outcomes of Indigenous Australians

compared to that of the broader Australian population. Indigenous Australians are found to

experience lower levels of health and have a lower life expectancy than other Australians

(AIHW, 2014). The alarming health gap that exists is encapsulated by the fact that

Indigenous boys born between 2010 and 2012 can expect to live to 69.1 years and

Indigenous girls to 73.7 years compared with 79.7 for non-Indigenous boys and 83.1 for non-

Indigenous girls (AIHW 2014). This disparity is furthered highlighted by the fact that

Indigenous Australians were at least twice as likely as non-Indigenous Australians to rate

their health as fair or poor, and almost half as likely to rate their health as excellent or very

good (Indigenous Health Info 2011).

Aboriginal Population Health

A major contributing factor to the large health disparities between Indigenous Australians and

the wider population relies within the lack of resources dedicated towards culturally sensitive

care. According to the AIHW 2016, 1% of the health workforce is composed of Indigenous

Australians, leading to a great undersupply of culturally sensitive and appropriate health care

for them. As well as that, Aboriginal and Torres Strait Islanders have a preference for

services that are specifically catered for their spiritual beliefs and take into consideration their

preference for bush medicine or tribal healing. This is particularly alarming as research has

found that Indigenous Australians who more strongly identify with their culture and its

practices have significantly better self-appraised health outcomes (Indigenous Allied Health

2013). Furthermore, it has been found that Indigenous Australians who speak their native

language and participate in cultural activities also have significantly better physical and

mental health (IAH 2013). Because Indigenous Australians may hold a strong connection to

their heritage and culture, they may withhold from medical healthcare if they feel their

cultural and spiritual beliefs are not respected or catered for. Overall, there needs to be a

greater proportion of Indigenous health care workers to increase participation in health so that

chronic diseases can be prevented. In line with the values of equal participation and

engagement represented by social justice, specialised entry schemes for Indigenous

Australians further more accessible for them to gain a medical background they can bring

back to their communities. Significantly, this could mitigate the impact of language barriers

between Indigenous patients and non-indigenous health care workers in rural and remote

areas.
Aboriginal Australians are disadvantaged by social conditions which prevent them from

attaining a good education and earning a high income, often lending itself to a cycle of

poverty. Despite education rates for Indigenous students rising steadily over the past decade,

huge gaps still exist. About 40.1% of Indigenous students finished a Year 12 education,

compared with 75.9% of non-Indigenous students (Vic Health 2008). Furthermore, it has

been found that compared to the broader Australian population, Aboriginal youths are

roughly15 times less likely to have a bachelor degree or above and around 23% less likely to

have a certificate or diploma (Australian Institute of Health and Welfare 2007). This lack of

education leads them to pursue careers that are low paying. For example, Australian data has

shown that those with the lowest rates of participation in higher level learning are those

working as labourers, in manufacturing and in retail (Australian Bureau of Statistics 2007a).

This lead them to have issues with housing, whereby the socio-economically disadvantaged

are made to live in crowded houses, in neighbourhoods with high levels of crime and passive

smoking. Overall, these conditions accumulate to account for the lower standards of health

that Indigenous Australians often experience.

However, the Australian government has implemented various cultural and social measures

to improve health of these Indigenous Australians, taking account the social justice value of

equity and diversity. Their The closing the Gap program is a pledge to improve the lives of

Indigenous Australians, by celebrating cultural differences and providing a better future for

Aboriginal children by engaging with their communities. As defined by the Commonwealth,

the Closing the Gap program aims to improve the health and wellbeing of Indigenous

Australians by using culturally appropriate strategies targeting education, housing, health care

and economic participation (Commonwealth of Australia, 2016). By working with the

Indigenous to preserve their culture and support their values and way of life, the Australian

governments program will underpin a strong connection to their roots. Given the strong
correlation between good health and freedom of cultural practice, the program will empower

targeted communities to take control of their own health. Overall, by supporting these

communities to participate and become involved in their own health care, they are better able

to identify their health needs and thereby overcome difficulties.

Rural population Determinants

Across the nation, rural and remote communities have poorer health outcomes compared to

their regional and urban counterparts. A number of socioeconomic factors contribute to this

disparity in health, placing the rural populations at an inherent disadvantage. Among these,

people living in isolated communities in particular lack infrastructure and resources of larger

cities. In particular, these areas lack the same access to clean water and sanitation, variety of

clean, healthy foods in the market as well as social and medical capital.

Across Australia, incomes are 20% lower in regional areas compared to the major cities,

substantially decreasing the quality of life that these people can enjoy (National Rural Health

Alliance 2013). With most income derived from the production in the agricultural industry,

rural people, with Indigenous peoples in these smaller and isolated areas in particular

suffering from a lack of access to different (skilled) occupations. These jobs are much more

demanding; labour intensive and therefore many people in agricultural areas who are unable

to work must rely on social security. The inherent danger presented by these rural

occupations due to the frequent use of heavy duty machinery and specialised vehicles places

greater health risks to these people.

Income from the production of agricultural goods and services is not as secure as that from

skilled labour. With rural livelihoods being so dependent on the natural environment, poor

seasons can dramatically affect the incomes of farmers and those in region centres who rely

on servicing and helping out these farming communities. As well as that, extended droughts
and unfavourable seasonal changes can degrade the mental health and livelihoods of farmers

and their communities by extension. In relation to this, the ground-breaking Whitehall

Studies of individuals working in British civil service has established a direct correlation

between lower levels of control over ones life and substantially poorer health and higher

death rates due to stress (National Rural Health Alliance 2011). Therefore, the studies

predicting that climate change will greatly increase the variability of agricultural incomes and

in many areas will likely lower them indicate greater threat to the health of regional

communities.

Behaviour in regional areas is heavily influenced by social capital. Indeed, regional areas

have lower food security and costlier access to fresh food and water than urban centres. A

recent study conducted by the Rural Health Department of Australia has shown that the cost

of food is 20% higher in these areas, whilst variety decreases and quality tends to be poorer.

Therefore, people from rural areas often do not obtain the same vitamins and minerals from

their foods and suffer from worse health.

An unfair distribution of health intervention is further bolstering the divide between health

outcomes in rural compared to urban areas. In particular, there is a steepening gradient

between rural and urban areas in the incidence of lung disease and cancers due to a lack of

awareness about risking causing behaviours such as smoking in rural areas. In relation to this,

smoking rates in major cities has fallen roughly 15% between 1996 and 2005, but have not

done so in regional and remote areas (National Rural Health Alliance 2011). Clearly, a failure

of measures to reduce these risk factors in rural and remote areas has greatened inequality.

Overall, with investment in public health campaigning and prevention intervention

decreasing greatly for remote Australian communities, vulnerable groups in these areas are

not receiving the remediation that need the most. In Tasmania, this lack of health awareness

has manifested as a very strong trend towards heavier smoking and riskier alcohol
consumption. The 2011 Australian Health Survey showed that Tasmania persists to have the

highest smoking rates of all Australian states, with a current smoking rate was 21.7%

compared to a national current smoking rate of 18% (Australian Bureau of Statistics 2012).

However, recent action from local government initiatives has improved health in regional

areas, thereby reducing inequity and promoting fairness. Tasmania, with its small and widely

regionally dispersed population (compared to other states), has benefited greatly from

targeted government assistance. Smaller areas such as Tasmania which traditionally would

have received much less budgetary attention and assistance in health education have been

gaining greater traction under new measures to boost equality and national health standards.

The 2012 Tasmanian Health Assistance Package funded by the Australian Department of

Health as well as the Tasmania Medicare Local funded for the Social Determinants of Health

projects have both seen significant government budgetary assistance.

The Social Determinants of Health strategy was developed by the Tasmania Medicare Local.

It includes support in health and human services sectors for selected communities. Training

was given to these communities, aimed at addressing the population health concerns through

social determinants using a variety of measures. In the eight social determinants of health

community projects, held in the North West Region and the Southern Regions of Tasmania,

projects were held to better connect communities and reduce poverty in both the short and

long term. These projects were able to address food security in local communities with an

emphasis on formal vocational training and skills development.

Individual projects such as Tree2Sea community project held in the Derwent valley region

have been particularly beneficial to the locals. In this project, alternative environmental

sustainability training was provided for a range of jobseekers with a median age of 42 years.

This aimed at improving education and employment outcomes by educating the locals. In the

Waterbridge project, community members were trained to budget for healthy food and to

prepare these meals at home. Through weekly meetings and events aimed at fostering these

skills, the efforts were able to improve community participation and access to healthy food;

hereby reducing susceptibility to chronic diseases associated with poor nutrition. Overall both

these initiatives encapsulate the power of local government initiatives in addressing various

social determinants to better health regional Australia.

In conclusion, there is an inequitable distribution of health in Australia, caused by varying

social, cultural, economic and environmental conditions. Indigenous Australians and

Australians living in rural and remote areas are the primary groups suffering the burden of

this inequity. However, positive action guided by the values of social justice, equity and

fairness will likely improve health conditions across Australia in the future.
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