Social Determinants of Indigenous Health: what might ... · Overview • Social determinants of Indigenous Health • Pathways from SD to ill health • What works to improve SDH

Fran Baum @baumfran Southgate Institute for Health, Society and Equity, NHMRC Centre for Research Excellence in Health Equity Presentation to NACCHO Members Conference Melbourne 8th December

Social Determinants of Indigenous Health: what might really make the difference to health outcomes

(Part 1 of 3)

Overview

•  Social determinants of Indigenous Health •  Pathways from SD to ill health •  What works to improve SDH – daily living

conditions •  Global context affecting all our health – power

money and resources •  Importance of advocacy

IndigenousHealthOutcomes

11yearlifeexpectancygap–10forwomen,12formen

Higherratesofinfec>ousandchronicdisease

Higherratesofriskybehaviourdrivenbyhighrisksocial,economicandculturalenvironments,highratesofincarcera>on

Death

Illness

Risk

CommissionontheSocialDeterminantsofHealth

"(The)toxiccombina>onofbadpolicies,economics,andpoli>csis,inlargemeasureresponsibleforthefactthatamajorityofpeopleintheworlddonotenjoythegoodhealththatisbiologicallypossible.Socialinjus>ceiskillingpeopleonagrandscale."InAustraliaclosingthegapbetweenhealthofAboriginalandTorresStraitIslandersandotherAustraliansismostvital

Basiclogic:whatgooddoesitdototreatpeople'sillnesses/addic>ons/sendthemtogaol….........

then give them no choice but to go back to or no control over the conditions that made them sick/

addicted/commit crime in the first place?

CommissionontheSocialDeterminantsofHealth:Recommenda>ons

–  Dailylivingcondi>onscreateinequi>es

–  Powermoneyandresourcesshapethesecondi>ons

–  ExpandtheknowledgebaseontheSDH,developtheworkforceandadvocacyforSDH

Equitablesocie>estreatpeopleaccordingtoneed

Whataddi>onalknowledgeaboutIndigenousSDH

Osborne,Baum&Brown,2013

EmergingthemesinunderstandingSocialdeterminantsofAboriginalandTorresStrait

Islanderhealth•  Impactofinvasionoflands•  Lossofland•  Threatstocultureandiden>tyfromwhitenessandcolonialmentality

•  Dominanceofwhitenessonaccesstobasicdeterminants:educa>on,employment,housing

•  Racism

hYps://www.dpmc.gov.au/sites/default/files/publica>ons/indigenous/Health-Performance-Framework-2014/aboriginal-and-torres-strait-islander-health-performance-framework-2014-report/racism-and.html

SocialDeterminantsgetunderourskinandcausediseasesandhealthinequi>es….ChronicstressisoneofcrucialpathwaysforIndigenousPeoples….

Wilkinson & Pickett 2009, 86

TheBiologyofStress

BiologicalPathways1…

PERCEIVED THREAT

FIGHT OR FLIGHT

REACTION • Increased production of adrenalin • Increased Heart Rate • Increased BP • More blood directed to muscles • Dilated pupils (eyes) • Less blood to other organs (eg

kidneys, liver)

THREAT PASSES

THOSE WITH POWER

THOSE WITHOUT POWER • Increased production of Endorphins, reduced

production of adrenalin • Decreased Heart Rate • Decreased BP • Less blood directed to muscles, muscles relax • Normal pupils (eyes) • More blood to other organs (eg kidneys, liver)

BiologicalPathways2…

High BP High Cholesterol Increased risk infection Increased Heart Rate High BP Increased risk cancer Decreased Blood Clotting Time Increase heart rate Insulin resistance Anxiety Depression

Psych-social Demands (Stressors) Resistance & Vulnerability Factors

Life events, chronic stress, daily hassles Coping Responses; Personality; Social Supports

Psycho-biological Stress Response

Neuro-endocrine (brain & hormones) Autonomic metabolic Immune

Cortisol, ACTH, Catecholamines, Beta- endorphins, Testosterone, Insulin

Cardiovascular function, Renal function, Gastro-intestinal motility, Fat metabolism, Haemostasis

Immunoglobulins, WBCs, Lymphocyte sub-populations, Cytokines.

Diabetes … Heart disease … Stroke … Renal Disease … Infections … Cancer

Source:Marmot&Wilkinson,1999

Howsocialdeterminantsgetintoourbrainsandcausemental&physicalhealthproblems

Lackofcontroloverworkandhomelife

Discrimina:on(racism,sexism)

Longtermchronicstress

Poverty–managingonlowincome

Livinginareawithhighdisorder&lackofsafety

Copingbyusingsubstancesharmfultohealth–alcohol,tobacco,illegaldrugs

ChronicDiseaseDepression,Anxiety

Barrierstoseekingmentalhealthcare:cultural,financial,class,gender

Unemployment

Non-permanentwork

Genderedviolence

Earlychildhoodnots:mula:ngmaximumbraindevelopment

Socialisola:on&lackofmeaningfulcontacts

“Thesuccessofaneconomyandofasocietycannotbeseparatedfromthelivesthatthemembersofthesocietyareabletolead…wenotonlyvaluelivingwellandsa>sfactorily,butalsoappreciatehavingcontroloverourlives.”AmartyaSen(1999)DevelopmentasFreedom

• Material• Psychosocial• Poli>cal

Empowerment-basedprac:ce

Equityisnotjustaboutpovertyalsoaboutcapabili>esandenablingpeopletoliveflourishinglives