Social Determinants of Health in Australia
1. Characteristics of Individuals
Carla and her family lives in a small mining town that are generally remote and families needs to be ready for a life in small, rural town. The family seems to be from Indigenous population of Australia having lesser access to facilities, better infrastructure and development opportunities.
The reason for this view is the job of Carla’s husband in a mine, lack of proper educational facilities and high cost of living reported in the area. Furthermore, the case study says that when the mining site closed down there were several people who left the town and moved to cities in search of employment thereby uprooting the whole family.
In such remote areas there are generally indigenous people living with higher old age dependency ratios and improper child development outcomes across geographic areas (WHO, 2013a). Within these remote areas there are around 59% of families with couples and their children while 27% can be found to be couples without children and only 13% are one-parent families (ABS, 2016). On the level of education almost 47% of Aboriginal and Indigenous people reported in the year 216 that they completed Year 12 or equivalent and there are less cases of leaving school early as per 2016 Census (ABS, 2016). However there lies a considerable gap in the outcomes of the labour force among Aboriginal and Indigenous population and that the non-indigenous population of Australia (AIFS, 2015). There is evidence that only 47% of Indigenous population had employment as per 2016 Census in comparison to 75% of non-Indigenous people (ABS, 2016). The gross household income is reported to be $1,000 or more per week where the income of females is less (approximately $799 per week) in comparison to male members of the community. Finally, in terms of housing a majority of these people (more than 66%) are less likely to live in their own house (ABS, 2016).
2. Social Determinants of Health in the Case Study
Social models of health help in understanding that individual’s health is dependent upon several social, environmental, interpersonal and individual factors apart from general diseases or illness (Marmot, 2011 and Yuill et al., 2010)). Social determinants of health refer to the conditions in which an individual or people are born, grow, get education, find employment, work and develop cultural beliefs (Lawless et al., 2017). These social determinants are responsible for strengthening or undermining the health of people and overall societies or communities (Wilkinson and Marmot, 2010).
There are several social determinants of health that applies to the current case study including employment and working conditions, early childhood development, housing and transport, food security, education and literacy, income and social status and culture. Carla being from a disadvantaged background struggles during school and lack employment opportunities, stable income and proper childhood development. Her children also didn’t completed education in a proper manner. Lack of proper education for Carla and her children is a major reason of insecure employment and income, inadequate housing and several other stressful conditions.
Furthermore, the employment and working conditions of Carla’s husband resulted in severe injury due to which he lost his efficiencies and work abilities. Loss of income due to illness and depression has clearly affected the socioeconomic position of Carla and her husband in an adverse manner. Carla’s daughter also got health issues in the form of gestational diabetes due to stressful situations in life.
In the later part of Carla’s life it was housing and transport conditions that were expensive and made it difficult to support her daughter and at the same time her daughter’s boyfriend also planned to quit the school due to financial difficulties. Again it as lack of proper education for her daughter that she was unable to support her family in making ends meet. The low-income status of Carla and her daughter as well as their low social status of working to make little money are some of the social determinants that are responsible for stress, struggle and worries affecting their mental health in the case study.
Certain facts clarifies that social determinants of health are directly associated with health of individuals. As per the report from ABS (2015a) Australian people living in lowest socioeconomic areas are 1.6 times more likely to have chronic health conditions like diabetes and heart disease. Further, in such areas mothers are 30% more likely to have a low birth weight baby (AIHW, 2015a). Further social determinants are directly associated with mental health where evidence is available to explain that improper social conditions affect the mental well being of individuals directly (WHO, 2013b).
3. Strategies to address the issue
Here considering the social determinant of education and early childhood development, two important strategies are suggested: Nurse-Family partnership programs and Improving Educational Outcomes Programs. Both of these strategies are upstream as they focus on addressing the social determinant from the policy formulation and government intervention level (Williams et al., 2015).
Under the first strategy, i.e. Nurse-Family partnership program, a broader view of healthcare needs is considered including the society, the individual and the family. Under this program, home-visits from nurses will help to improve the prenatal health-related behaviours of women, educating any kind of stress, reducing any drug-abuse and making health care and treatment of pregnancy-related complication accessible for them. Further the visits will continue even after childbirth to maintain a focus on proper care of child in the early years of life. The strategy will work, as the care will be planned in consultation with parents and also include efforts to improve the self-sufficiency of parents and encouraging a vision for better future, improving educational and employment opportunities for children and parents as well (Holzer et al., 2006 and Thomton et al., 2016).
In the second strategy, i.e. Improving Educational Outcomes Programs, the focus will be on designing control groups working to reduce the risk of failure in school or any kind of struggle for children not having enough support from their family. The efforts of the control group will make education accessible, extra support and motivation to children to complete their studies. Further the interventions will comprise of cognitive and social stimulation through daily supervision, daily academic instructions structured as per the syllabus and weekly home visits by teachers from the associated school of children. The strategy will work as it ensures fewer dropouts from school and better education resulting in better neuro development, strengthening of families, improved economic outcomes and an impact on health and well being over a lifestyle and even across generations.
There are several evidence of successful interventions focused on parent education and nurse-visits like the Parent Effectiveness Training Program (Australia), the Parenting between Cultures Program (Australia, the Head Start Education program (Australia), the DePelchin Children’s centre Parent Education program (USA), etc (Thomton et al., 2016). These programs reported the evidence of reduction in child maltreatment; improved knowledge of parents, awareness of child development and education needs, and increased self-efficacy among children (AIHW, 2016).
Further there is evidence that programs or interventions to reduce school dropouts and failures have a positive impact on improving awareness about health thereby deferring rates for many health risk factors specifically in case of chronic diseases and infections. These interventions are also successful in improving employment possibilities and overall health and wellbeing of individuals in the society.
4. Role of Health Care professionals
Health care professionals have a key role in addressing the social determinants of health as they can advocate the increased representation of people from diverse ethnic and socioeconomic groups within the workforce. This will help in have a clear understanding of the issues faced by people in remote areas and developing and implementing initiatives that will be more acceptable among people in the target communities. Further health care professionals can contribute by planning visits of nurses while focusing on addressing wider social determinants of inequalities in health outcomes (Carey et al., 2014). They can allocate adequate number of resources ensuring sustainability and required intensity.
When these professionals indulge in school-based programs incorporating the community-based initiatives, they prove to be acting as a catalyst to address a range of social determinants of health. They can identify practical ways of amending standard programs increasing the outreach of such initiatives to get better support the needs of equity groups thereby creating a much wider impact of interventions (Yuill et al., 2010).
Hence, health care professionals can play a vital role in identifying acceptable interventions, planning the phase-wise implementation of such interventions and encouraging inputs from the communities through a wide range of planning, development, implementation and evaluation of health care programs. Such special efforts will help in efficient addressing of social determinants of health under the case study scenario as well as on a broader level of health care planning in other communities.