Charity begins at home – An insight into inequality and health in Australia

Much of this blog has been looking at issues of inequality around the world and their impacts on health outcomes. Here in Australia, we have some of the highest living standards in the world. As a nation, we enjoy significant political and economic stability, and are not plagued by war, famine and infectious disease. Furthermore, many have applauded our universal access to health care through systems such as Medicare. In light of such relative comforts its easy to forget that inequality does exist in Australia also, and that with it comes consequences those disadvantaged.

Despite its accolades , the largest health gap in the world is that between Indigenous and Non-Indigenous Australians. Sadly , this group lags far behind urban Australia in terms of education, wealth, income and of course health.This gap is even more prominent in remote Aboriginal communities where access to sound primary health care is far more limited.

When it comes to health outcomes, its quite clear that Aboriginal Australians have it far worse than non-Aboriginals. For example life expectancy for an Aboriginal child born in 2012 was on average 10 years less than for a non-Aboriginal, and their infant mortality rate is three times the national average (15.2 v 5 per 1000).

To make matters worse , Aboriginal Australians have a significantly greater incidence of several chronic illnesses  as well as infectious diseases relative to the wider population.

  • Diabetes is almost 4 times more common in Aboriginal people than among non-Aboriginal persons.
  • CVD was responsible for 25% of the deaths of Indigenous people living in NSW, Qld, WA, SA and the NT. After adjusting for age, this rate is almost twice that for non-Aboriginals.
  • Aboriginal people suffer from higher incidence of infectious and communicable diseases compared to non aboriginals
    •  TB notifications were 11 times higher for Aboriginal people than non- Aboriginal people between 2005-2009.
    •  Hepatitis C rates were 3 times higher in Aboriginal people than for non- Aboriginal people.
    •  Notification rates for Gonorrhea, Syphilis and Chlamydia were higher for Aboriginal people than for non-Aboriginal people in 2010-12

Factors contributing to these adverse health outcomes

  • Discrimination and racism
    • Discrimination and racism can impact ones chances of employment, diminish self worth and can even reduce likelihood to seek medical care.
    • In 2007, 27% of Aboriginal and Torres Strait Islanders over the age of 15 reported experiencing some form of discrimination in the past 12 months.
  •  Access to health
    • Access to health facilities for Aboriginal Australians is more limited than that for non-Aboriginals. Remoteness and isolation is a major contributor to this, however, issues such as discrimination and ability to provide care with cultural sensitivity may help explain the subpar access to health facilities in this group.
  • Education
    • Though this is improving, levels of education in Aboriginal populations far from ideal. In 2008, the proportion of Aboriginal and Torres Strait Islander children completing year 12 was only 22%. In remote communities, this rate was only 16% , while slightly better in non-remote communities at 29%.
    • Lack of education increases the likelihood of making poor health choices such as smoking, alcohol abuse and drugs. Furthermore, children not at school are more likely to be involved in delinquent activities.
  • Income
    • 49% of Aboriginal people earn incomes in the bottom quartile of the national average. Lower incomes mean that people are less likely to seek medical care for non-urgent ailments. These issues are more likely to progress into more serious health problems later.

A major challenge facing the medical system is the declining willingness of medical graduates to enter general practice. This is worsened by the fact that an even smaller proportion of those who do are actually inclined to provide services in rural and remote communities.This is a problem that must be addressed , as without increased primary care in remote Australia, these health discrepancies will persist.

This problem of inequality, however, will not be fixed simply by sending more doctors and healthcare professionals. The challenge must also be addressed from a sociocultural perspective. Possible interventions include:

 

  • Developing positive relationships with Aboriginal communities, promoting good health practices in a culturally sensitive way.
  • Training healthcare workers in cultural competence. This helps to foster better relationships with those in Aboriginal communities ,resulting in better more trusting relationships with healthcare providers.
  • Increased involvement of Aboriginal persons in policy making and advisory committees for these regions. This allows decisions to be made with  a direct insight into the needs and requirements of the Aboriginal communities we are trying to help.
  • Local councils must work to improve employment and education opportunities for people in these communities. Such measures help reduce income inequality and thus make people more likely to seek medical attention when they actually should ! A stable income also ensures access to good quality food, which can be somewhat expensive in remote areas.
  • Foster supportive environments for young Aboriginals to enance community participation. Such settings could include council  funded sports, childcare services and health facilities. This helps prevent youth from going astray down paths of delinquency or drug and alcohol abuse.

While it is important that we continue to advocate and do our part for alleviating inequality around the world , we must not forget that similar issues are present in our own backyard. We must act individual , governmental and societal levels to do whatever can be done to close this gap!

Here’s a video from Oxfam Australia about their initiative ‘Closing the Gap’

Leave a comment if you agree or disagree with what has been said, as feedback and debate on the matter are encouraged and appreciated!

 

From the Mind the Gap team.

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