Introduction
Social determinants play an important role in all facets of an individual’s life. The article, “Indigenous and Juvenile Crime Crisis Needs Resolve”, addresses the plight of aboriginal communities in the hand of Australia’s justice system. It opines that social determinants have pushed juveniles into crime and violence and the justice system has remained indifferent towards youth from native communities. The article draws inspiration from reports by Natasha Robinson that indicted the justice system for inequality and discrimination in administration of justice. In comparison to their white counterparts, youths from aboriginal communities get stiffer penalties and harsher sentencing for crimes. Moreover, their deplorable social circumstances drive aboriginal communities into committing crime to attract jailing as a respite to harsh social realities.
This paper will address several social determinants including social economic situation, education and social norms. Social norms encompass aspects such as attitude towards members of particular ethnic and racial orientations. Moreover, it will explore exposure to social disorders as a social determinant. In the article alluded to above, going to jail qualifies one for higher social status. This exacerbates crime and violence amongst aboriginal communities. Additionally, availability and access to recreational opportunities play a big role as social determinants in shaping how individuals interact with social institutions. This paper will explore these social determinants in respect to the health and welfare of the indigenous population of Australia.
Social Determinants of Health: Indigenous Population
Despite being an affluent country, Australia has among the highest health inequalities amongst developed countries of the world. Aboriginal communities find it harder to access preventive and primary healthcare in comparison to the rest of the population in Australia (Hunter, 2006). Their socioeconomic circumstances and historical discrimination have sidelined these native communities to the periphery of all aspects of Australia’s life. A United Nations report indicates that aboriginal communities have a lower life expectancy than the rest of the population (Willise, Reynolds, & Keleher, 2012). Moreover, they remain at a higher risk of suffering disability especially those that emanates from exposure to danger and old age. Access to health care is fatally low, an aspect that lowers the quality of lives of aboriginal and Torres Strait Islanders. This has a far-reaching ramification on prevention of communicable and childhood diseases. An aboriginal community child has half the chances of the child from other population to get immunization against childhood illness. The poor access to preventive health care means that aboriginal communities are five times likely to spend a part of their lives admitted in hospital bed than the rest of the population.
The first social determinant that adversely affects aboriginal communities’ access to health care is poverty. Unemployment and poor access to educational facilities have conspired to make aboriginal communities the poorest in Australia with their household earnings barely half of what the rest of the population households earn (Social Determinants of Aboriginal Health Workshop, Anderson, Baum, & Bemtley, 2007). The high poverty levels mean that these native communities cannot afford health care despite government subsidies. Their geographical location, often in rural and remote areas far off from medical facilities, exacerbates the situation because they cannot afford travelling to nearest medical facilities. Moreover, poverty hampers access to education thus contributing to high illiteracy levels. This translates to a cycle of poverty that has a negative bearing to access to health care.
The other social determinant is exposure to social disorders. Despite being just 3% of the entire Australia’s population, they are the majority in drug abuse and alcoholism (Willise, Reynolds, & Keleher, 2012). This translates to their higher population in prison, often a result of engagement in crime and violence. Poverty drives youth from aboriginal communities into crime and other activities likely to cause social disorders. From the article discussed earlier, it is common for aboriginal youths to commit crime with the sole intention of attracting imprisonment because life in jail is better than the one outside. This social disorder plays a big role as a social determinant in provision of health care. To begin with, alcoholism and drug abuse lowers quality of life, manifest by low life expectancy in comparison to the rest of the population (Briscoe, 2003). Qualified health practitioners are hesitant to take up jobs in areas where aboriginal communities are prevalent for fear over their safety. Additionally, aboriginal communities’ youth have shown a propensity to favor a life that defies conventional wisdom by shunning treatment.
Social norms and attitudes are the other social determinants that have influenced access to health care by aboriginal communities. The social and economic inequality emanates from historical and present discrimination. In comparison the rest of the population, aboriginal communities have little access to education, further reducing any chance for social and economic emancipation (Social Determinants of Aboriginal Health Workshop, Anderson, Baum, & Bemtley, 2007). The low income per household is a direct consequence of the discrimination that has pervaded the Australia society. In health care, it is inexplicable how aboriginal communities die of trachoma, a disease that the rest of the population hardly suffers. Moreover, United Nations reports indicate that that the native communities, especially those in urban areas, are at a higher risk of mental and psychological disorders. The condition of the aboriginal communities is very much similar to that in developing countries despite the fact that Australia is a regional economic superpower. However, as (Willise, Reynolds and Keleher (2012) argue, aboriginal communities have norms and attitudes that make it difficult for them to access and benefit from improved health care services. A case in point is the low hygiene levels among rural populations. Despite incentives, such as the 2004 initiative by the government to provide petrol pump to Mulan aboriginals in exchange for better hygiene, locals were not receptive of the idea (Willise, Reynolds, & Keleher, 2012). Racial orientation has played a big role in shaping norms and attitudes with a far-reaching effect on health care.
The other social determinant is education and literacy. Research links high quality of education and literacy to health well-being of individuals (Mcmurray & Clendon, 2011). In Australia, Aboriginal communities do not enjoy the same access to education as the rest of the population. Their illiteracy levels are as high as those prevalent in developing countries are. This translates to lower awareness on health issues especially preventive measures. Moreover, it lowers self-confidence and increases poverty, factors that research has blamed for increasing mental and psychological disorders among members of aboriginal communities (Morgan, Ziglio, & Davies, 2010). A literate individual can easily read instructions on medicine’s wraps and bottles and follow them for better health outcomes. Additionally, he or she can sustain desired levels of hygiene to keep off infections. This is hardly the case for aboriginal communities especially those in rural areas whose children are dirty to the extent of necessitating government intervention. Their lack of education, combined with systemic inequality, has locked them out of the mainstream healthcare. Despite tremendous technological advancement in preventive and curative health care, illiteracy has made it impossible for aboriginal communities to benefit.
Additionally, presence of resources for daily consumption and use plays an important role as a social determinant in provision of health care among aboriginal communities in Australia (Gray, Taylor, & Hunter, 2004). Because of systematic inequality and culture, aboriginal communities find it difficult to access and afford basic resources like housing, food, and recreational facilities. In rural Kimberly region, Aboriginal communities live in traditional houses that resemble camps. This exposes them to extreme weather conditions and increases chances of occurrence and spread of infections such as pneumonia. Additionally, sanitation is poor and related diseases are prevalent. Absence of recreational facilities means that those in need of emotional relief cannot find a place to do so. This explains the prevalence of emotional and psychological disorders as highlighted earlier in this paper.
The other social determinant is culture and the history of a community. Aboriginal communities have for a long time held to their traditional lifestyle and cultural beliefs. Most of them have shied away from modern treatment in prevalent to their traditional treatments. Moreover, aboriginal communities have always distrusted the government because of real and perceived historical injustices from state agents. A good example of how this comes into play is the 2007 compulsory check by military officials on aboriginal children following increase in cases of child sexual assault (Willise, Reynolds, & Keleher, 2012). Despite the good intentions, the move did not deliver desired outcomes because of the mutual suspicion and mistrust that characterizes the relationship between government and aboriginal communities. The largest health organization for aboriginals, Aboriginal Community Controlled Health Organization, opposed the implementation of the process for fuelling fear against medical facilities (Eckermann, 2010). Despite deliberate attempts by the government to improve health care for aboriginal communities, poor consultation and involvement of local leaders and opinion makers ahs compounded mutual distrust between government and communities.
In conclusion, the social determinants highlighted above have had an adverse effect on the health and welfare of aboriginal communities. Systemic and systematic marginalization has escalated poverty levels, alcoholism, drug abuse, and crime. It has also made it difficult to afford basic needs like food and housing. Poor nutrition, lack of access to health care and education has conspired to deteriorate heath care and welfare of aboriginal communities. In comparison to the rest of the population, aboriginals have low life expectancy, high child mortality, and are at high risk of diseases. Research shows that aboriginals are at the highest danger of mental and psychological diseases because of stress. Social determinants of health care are heavily against aboriginals, with negative consequence on their wealth and welfare.
Minister for Health,
Australia
Dear Sir,
RE: IPROVEMENT IN CONTEMPORARY INDIGENOUS HEALTH AND WELFARE
I hereby draw your attention to the contemporary indigenous health and welfare in Australia. I write to you as a nursing student, deeply perturbed by the plight of indigenous communities who you vowed to improve their status. In this letter, I bring to your knowledge the fact that our health care policies are not as meaningful as we purport. Specifically, I write to make you aware that more than 3% of our population, that, according to Ansari (2012), comprises aboriginal communities, is at the periphery of every aspect of our lives, more directly to you, they do not enjoy the health care services that befit a citizen living in a country of great material prosperity as Australia.
To begin with, several social determinants have conspired to lock out indigenous communities from Australia’s robust health care. The first is poverty. Indigenous communities’ social economic status is very low. Research shows that their household earnings are unacceptably lower than the rest of the population (Willise, Reynolds, & Keleher, 2012). There is no dignity in poverty. Low access to quality education ruins any chance to break from this cycle of poverty. The consequence is that members of indigenous communities cannot afford health care. Lack of education deprives them the confidence requisite to deal with various life situations. This explains why research after research is portraying indigenous communities as the most vulnerable to mental and psychological disorders. Unless something happens to correct this situation, the country health care is tethering on the brink of collapse.
Secondly, indigenous communities have found it difficult to access basic amenities such as balanced diet, decent housing, sanitation, and recreational facilities. Just to cite a case, youths from the aboriginal communities are finding it more hospitable to spend time in jail than in the society (Indigenous and Juvenile Crime Crisis Needs Resolve, par 3). This is an indictment to the society and though not directly under your ambit, it demonstrates the levels of despondency among indigenous communities. This has led to increase in alcoholism and drug abuse, factors that strain the national health care. It also accounts for low life expectancy and infant mortality. I emphasize this because I appreciate that health care is inextricably bound to other social determinants. If we remain ignorant of what members of aboriginal communities are eating, where they are sleeping, and whether they are having the recreational facilities that they require, we are setting ourselves up for failure.
I also bring to your attention the fact that there is no trust between the government and indigenous communities. Historical injustices and cultural differences have made it difficult to enforce government directives and implement policies, those by your ministry inclusive. Just to mention one, the 2007 efforts by your predecessor to enforce a health care policy in Malan backfired (Evert, Drain, & Hall, 2014). Your ministry has done very little to endear itself to indigenous communities hence the high number of members of aboriginal communities in hospitals.
Finally, I conclude by highlighting what I hope this letter will achieve. First, it has brought to your attention that the health care and welfare of indigenous communities is linked to various social determinants. Efforts to improve one while doing nothing to the other would be futile. As a student registered nurse, I encounter members of aboriginal communities with diseases like trachoma, something we erased permanently from medical records of the rest of the population. Moreover, I am encountering a high number of indigenous communities suffering psychological diseases. I beseech you that Australia’s health care cannot stand as long as a section of the population are enjoying developing countries’ health care amidst prosperity within their boundaries. Lastly, I remind you that you cannot improve the health care and welfare of indigenous communities without involving them.
Yours faithfully,
References
Ansari, R. M., 2012, Applications of public health education and health promotion interventions, Singapore, Trafford Publishing.
Briscoe, G., 2003, Counting, health and identity a history of aboriginal health and demography in western … d queensland, 1900?1940, Aboriginal Studies Press.
Eckermann, A.-K., 2010, Binan Goonj: bridging cultures in Aboriginal health, Chatswood DC, N.S.W., Elsevier Australia.
Evert, J., Drain, P. K., & Hall, T., 2014, Developing global health programming: a guidebook for medical and professional schools.
Gray, M., Taylor, J., & Hunter, B., 2004, Health expenditure, income and health status among indigenous and other Australians, Canberra, ANU E Press.
Hunter, B., 2006, Assessing recent evidence on Indigenous socioeconomic outcomes a focus on the 2002 NATSISS, Canberra, ANU E Press.
Indigenous and Juvenile Crime Crisis Needs Resolve, The Australian, 09, January,2013.
Mcmurray, A., & Clendon, J., 2011, Community health and wellness primary health care in practice. Chatswood, N.S.W., Elsevier Australia.
Morgan, A., Ziglio, E., & Davies, M., 2010, Health assets in a global context, New York, Springer.
Social Determinants of Aboriginal Health Workshop, Anderson, I., Baum, F., & Bemtley, M., 2007, Beyond bandaids: exploring the underlying social determinants of Aboriginal health : papers from the Social Determinants of Aboriginal Health Workshop, Adelaide, July 2004. Casuarina, N.T., Cooperative Research Centre for Aboriginal Health.
Willis, E., Reynolds, L. E., & Keleher, H., 2012, Understanding the Australian health care system. Chatswood, N.S.W., Churchill Livingstone.
Willise, Reynolds, L. E., & Keleher, H., 2012, Understanding the Australian health care system, Chatswood, N.S.W., Churchill Livingstone.
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