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HSC Option 5: Equity and HealthWhy do inequities exist in the health status of Australians?Principles of Social JusticeDiversityThe valuing of diversity is important as it eliminates prejudice and discrimination based on ethnicity. Australians are very diverse in terms of gender, age, socio-economic status, location and ethnicity. This diversity between different groups needs to be recognised otherwise there is a risk of catering only for the dominant culture, thus creating barriers relating to the health of minority groups. Therefore health services, preventative or curative must meet the needs of a diverse society in order to effectively reach every corner of the population.EquityEquity is all about individuals having equal opportunity to achieve good health. While providing equal opportunities does not mean that people will take these opportunities it is the most that decision-making groups in society can provide.Supportive EnvironmentsInitially identified as a fundamental factor in the Ottawa Charter. Supportive Environments involve creating environments to support optimal health for example the provision of health and safety regulation.Factors that Create Health InequitiesLiving ConditionsSecure and adequate living conditions are paramount in maintaining the health of Australians. Living condition such as water supply, garbage disposal and adequate housing play a major role in the development of disease and life expectancy of a person. For example contaminated water supply can result in deadly disease such as Cholera.Socio-economic StatusA number of studies has linked socio=economic status with poor health. Socio-economically disadvantage people are less likely to engage in preventative measures, eat nutritious foods due to financial constraints, have higher rates of illness and are more likely to participate in risky behaviours. This group has higher rates of cardiovascular disease and diabetes. Their higher rate of injury is linked to domestic violence, crime and the high danger of work in blue collar industries where allot of socio-economically disadvantaged people work.OccupationA link has been established between mental health and job satisfaction. Occupation can also determine the amount of economic resources available to an individual and the nature of work can also effect a person’s health status e.g. hazardous or safe working environments.Access to and Level of EducationEducation can affect health status in a number of different ways:Poor literacy skills can limit access to health services e.g. unable to read instruction on medicine bottlesEducation regularly determines employment thus affecting socio-economic statusLow education can lead to a feeling of powerlessness and low self-esteem which can lead to mental illness such as depressionOverseas born Australians is a population group experiencing inequities partly due to many lack basic reading, writing and speaking skills which limits their interaction within mainstream societyAccess to Health CareInequalities exist due to lack of access resulting from location, transport, discrimination, level of facilities, education level and socio-economic ernment Economic and Social PoliciesEconomic policies such as provision of health care facilities can create health inequities. Social policies can also play a role in creating health inequities. For example a recent increase in child health care costs has resulted less children going to child care before beginning primary school. Thus resulting in an increase in children social isolation due to a decrease in children’s social interaction. Geographical LocationPeople living near industrial areas can experience problems associated with pollution. People living near traffic congested areas can experience health problems due to high amount of lead in the air. Additionally numerous inequities are experience by people living in rural and remote areas due to geographical location.RacismRacism refers to the unequal treatment of people on the basis of racial background. Racism can contribute to health inequities. Ways racism can affect health include:Racist attitudes can limit an individual’s access to employment and educationRacism among health care professionals such as being insensitive to peoples beliefs regarding health care will deter them from seeking treatment againRacism can lead to feeling of being different, non-acceptance and social isolation leading to an increase in mental illnessDiscriminationPeople can be discriminated against on the basis of age, gender, marital status, education level, where they live and disability. People experiencing discrimination might not be able to access employment, education, health or other services. For example older people might not be able to access work due to the conception they are ‘past it’.GenderThere are large differences in the health status of men and woman. The differences can be explained by the lives they lead such as:Men more commonly participate in risky behavioursMen participate in more dangerous jobsWomen are more likely to do something about their health such as consult a doctorMen hold back reporting disease especially mental disease due to society having expectation of men being strong, not displaying emotions and being able to cope with painHow may the gap in health status be bridged?Funding to Improve HealthGeneral Funding for HealthThe 1996-1997 health expenditure was $43 billion or $2345 per a personFunding for Specific PopulationsInvolves funding determined to improve the health status of specific population groups. In the 1999-2000 budget there were a number of funding initiatives:$78 million to improve access to health services for Indigenous people$20 million to extend the ATSIC/ Army Community Assistance Program$97 million to improve specialist medical services in rural areas$171 to strengthen the rural health workforce and to improve access to health servicesAccountability and OutcomeThe Federal and State Government are being held accountable for delivering health services that are:Cost effectiveMaximises the use of resourcesAble to meet the health needs of all groups within the populationInternationally the Australian Government is held accountable of the human rights of its indigenous people and migrants. Consistent international pressure has led the government to work towards providing additional funding to improve the health status of these groups.Limited ResourcesRecently the public health system has been pushed to the limits. However limited resources and the need for the government to direct funds at other areas of society have resulted in longer waiting lists and times, a decrease in medical professionals, less beds in hospitals and lack of medical equipment in many areas. Therefore initiatives that promote people to take out private health insurance such and lifetime health cover and increased Medicare levy have been implemented in order to decrease the strain on the public health care system. Actions That Improve HealthFunding alone will not solve health inequities. To improve the health of disadvantaged groups of the population, we also need to encourage actions being enabling, mediating and advocating.EnablingRefers to increasing the control individuals have over cultural, social and economic factors that affect a person’s health. A supportive environment, access to information and life skills all promote enabling. The self empowerment of individuals encourages them to use their knowledge and skills to promote lifestyle changes.MediatingDue to the many different perspectives and opinions that there are regarding health, conflict will no doubt occur. Mediation involves the reconciliation of such conflict to ensure that all interests of all groups are considered and that the best possible outcomes are met.AdvocatingAdvocating involves speaking up for groups to gain political commitment, policy support, funding or other types of support. Depending on the skill level and stature in society some groups are able to advocate on their own behalf. However some groups require advocates to promote their concerns as these disadvantaged groups don’t have the access to an appropriate political forum.A Social Justice Framework for Addressing Health InequitiesStrengthening Individuals in Disadvantaged CircumstancesInvolves working with disadvantaged individuals to improve their health. This involves providing culturally relevant information, providing support and developing their personal skills. For example developing personal skills of a low income earner to allow him/her to develop healthy low budget meals.Strengthening Disadvantaged CommunitiesRelates directly to strengthening community action. Disadvantaged communities are strengthened if they play an active role in identifying and addressing issues that are important and affect them. For example small towns promoting and enforcing ‘dry’ com munities in relation to alcohol problems.Improving Access to Essential Facilities and ServicesAll communities should have basic prerequisites for health being clean water, sanitation, adequate housing, food, health care and safe employment. Lack to any of these facilities or services can create inequities in the health status of people. Disadvantaged groups must be consulted to determine the facilities or services they lack. Encouraging Economic and Cultural ChangeEconomic change involves financial modification in terms of money management, funding etc. Cultural change involves a change in norms, values, beliefs and activities. The removal of health inequities requires modification of both economic and cultural factors.Characteristics of Effective StrategiesMove towards EquityAn effective strategy must move the target group into a position being equitable in relation to the rest of the population. This involves reducing the gaps in the health status experienced by disadvantaged groups. This is mainly done by addressing the underlying cause of health inequities and providing support.Working with the Target Group in Program Design and ImplementationInvolves community participation in effective strategies in terms of design and implementation of a program. This develops a sense of ownership and increases the chance of such strategies being successful. This also gets people working with the community to develop a true picture of the problems facing this community.Ensuring Cultural Relevance and AppropriatenessEffective strategies take into account the culture of the target group that is their beliefs, norms, values, activates and attitudes. Programs that are culturally relevant will address the real needs of the group. This in turn will increase the willingness of these people to be involved.Ensuring the Credibility of those Delivering the StrategyThose delivering the strategy must be credible, that is trustworthy, have a particular knowledge or skill, have a good attitude and have respect for the target group. This is because without credibility the strategy will not be effective.Providing Practical Assistance to Allow People to ParticipateInvolves providing assistance such as basic infrastructure to allow them to participate in services that support health. For example increasing public transport to hospitals in order to allow for easier access to health services.Focusing of Skills, Education and PreventionSkills are a vital aspect in improving the health of an individual. An increase in skills allows an individual to have more control over their own health. Education can thus improve health by increasing the skills of an individual. Prevention is important as it not only ensures someone will not contract a disease but also save direct and indirect costs to the community and the individual.An Impact on Social Factors and InfrastructureEffective strategies address social factors and infrastructure problems limit the opportunity for optimal health. Social factors include unemployment, social isolation, socio-economic status etc. Infrastructure includes transport, roads, housing, hospitals, school etc.Targeting Settings of Relevance to the Population ConcernedStrategies must reach their target group to be effective. Therefore using settings of importance to the target group such as using healthy canteens in school to promote healthy eating in young people increases the chance strategies will reach their group.Support for the Whole Population While Directing Extra Resources at the Target GroupEvery group in the population has health issues however some groups are worse off. Therefore it is important that an adequate level of funding is maintained for the whole population while directing extra resources at the population concerned in order to move towards equity.Intersectoral CollaborationThis involves everyone working together with health as a focus. This is a fundamental aspect as there is little point addressing factors creating health inequities if everyone is not on the same page. For instance a group that cleans mercury out of contaminated rivers work will be undermined if companies continue to dump mercury into the river.What Inequities are Experienced by Aboriginal and Torres Strait Islander People and Rural and Remote Communities?Epidemiology and Areas of Inequity Experienced by Aboriginal and Torres Strait IslandersLife Expectancy- around 20 years below the rest of the population being 57 for males and 61 for femalesMortality Rates- ATSI on average die younger than other Australians for almost every type of disease or condition. Injury, cardiovascular disease, cancer, hypertension and diabetes account for 75% of ATSI deathsInfant Mortality- ATSI infant mortality rate is 4 times that of the Australian population with 24 deaths per 1000 live birthsHospitalization- 2-5 times higher rates of hospitalizationMorbidity- have higher rates of many disease including asthma, diabetes, hypertension, dental health, mental health and cancerSignificant Factors Influencing the Health of Aboriginal and Torres Strait IslandersPoor Living ConditionsATSI are commonly living in conditions on par with that in third world countries. They lack basic facilities being adequate and clean water supply, proper sanitation and electricity. They are also more likely to live in crowded conditions increasing the strain on such facilities.PovertyATSI are some of the poorest people in our country. This can be attributed to the poverty cycle that is education determining employment which determines income. Income then determines factors such as living conditions, education of children, access to healthy practices, access to health care etc. Material possessions have little cultural relevance in many ATSI people’s lives and thus there is little care regarding finances. ATSI are less likely to own their own home and are more likely to be unemployed.UnemploymentEmployment can determine income thus determining poverty. ATSI are more likely to be unemployed. They are on average unemployed for longer periods of time. ATSI rarely go onto post-secondary education and therefore have little skills and are often found occupying the low-skill jobs in Australia.Education StandardsATSI are less likely to have educational qualification. Further education is a problem with ATSI leaving school much earlier than other Australians resulting in low numbers taking part in post-secondary education.DispossessionDispossession involves ATSI being forcibly removed from their land. This created great distress due to their large spiritual and cultural connection with their land. The land also provided them with adequate diet through hunting, gathering etc. Therefore losing much more than just land.ColonisationWhen Europeans arrived their spiritual and cultural where forced upon the ATSI. A number of changes including being restricted in movement (they where previously nomadic), laws, cultural beliefs and the stolen generation which caused great cultural, physiological and social damage forced them to be dependent on European society.DiscriminationATSI were excluded from many rights that Europeans had. ATSI were not able to vote until 1967 and where excluded from economic benefits and mainstream society until the 1970’s.Maintaining CultureDispossession and Colonisation have made it relatively difficult for ATSI to maintain their culture.Funding not Commensurate with NeedATSI people experience large health inequities. ATSI have $2320 health expenditure spent per a person on them which is more than $2163 spent per a person on the total Australian population. While this is larger it is not significant enough to reverse these inequities.Hospitalization Rate Indicating Failure of Other Health ServicesATSI have a large amount of hospital admissions. This indicates the failure of preventative and screening programs to reach their target population.Traditional Understanding about HealthATSI have a traditional belief regarding health. Many refuse to try or use western medicine as some see it as another example of colonisation. Also they regard health as the well-being of all aspects of their life. Therefore western medicine which focuses on treating the problem would not address their definition of health. ATSI people would prefer to be treated by their own people and by their own medicine.Importance of LandLand is very important to ATSI. Before colonisation they lived off the land. The land also meant a great deal to them as they had great spiritual and cultural connections to it. Dispossession resulted in a sense of a loss of control in their live.Epidemiology and Areas of Inequity Experienced by Rural and Remote CommunitiesLife Expectancy- around five years below that of the total population as rural females can expect to live 78 years and rural males can expect to live 73 yearsMortality- death rates are 14% lower in capital cities than in rural areasInfant Mortality- The highest infant mortality rates are in rural areasHospitalization- higher in rural and remote areas partly due to the nature of workFactors Influencing the Health of Rural and Remote CommunitiesGeographical and Social IsolationMost people living in remote areas experience geographical isolation due to the distances they would have to travel to access services and interact with others. Socially it is challenging to make friends and sustain relationships. The large travel distance can act as a deterrent for people attempting to access services. It also leads to them not seeking preventative measures such as immunisation or sunscreen use. Socially they are at a disadvantage when looking at mental health due to the lack of available social supports.Exposure to Drought, Fires and FloodsThe socioeconomic status of many people living in rural and remote areas is determined by weather. Drought can ruin their profit margin due to inability to grow crops, feed livestock etc. However floods can result in the same thing. Floods also result in poor road conditions leading to geographical and social isolation. It can also play a role in car accident which can partly explain the higher injury toll. Burns from fire affect 8 times the people living in remote communities than urban dweller. Fires are more serious and difficult to put out due to isolation and the lack of basic infrastructure experienced.Access to ServicesPeople living in remote areas have less access to G.P.’s preventative measures and health promotion initiatives. This is due to geographical location, harsh conditions and less services being devoted due to decrease in population as a result of less employment and drought. Lack of InfrastructureA lack of basic infrastructure is generally experienced by those in remote areas. Basic pre-requisites for health such as adequate water and food supply, proper sanitation methods as well as access to transport, telecommunications, hospitals and other services influence the health of these people greatly.Structural FactorsThe economic wealth of those living in these areas are tied up in assets such as crops, livestock, machinery etc. This affects their ability to satisfy basic needs as they have less expendable assets. Income and socio-economic status is highly influence by the weather. Rain results in a good crop season. This leads to more money being spent within the community by farmers thus the whole community farmer or not benefits.Occupational HazardsAround 80% of people living in rural or remote areas are blue collar workers. Most of which are more vulnerable to injury due to the nature of work in such industries. The fact that many have to travel long distances to find work increases the chance of injury due to the road-related accidents. The lower socio-economic status experience can also make it difficult to buy safety equipment. Agricultural worker using pesticides or herbicides are also exposing themselves to respiratory diseases and cancer-related illness if suitable safety practices are not followed.UnemploymentRemote communities have low levels of available employment. This is due to the little to no primary industries in these areas. Also the declining population also plays a role as this means fewer services are needed in these areas. Unemployment effects more than just income and standard of living. Long-term unemployment leads to unhealthy behaviours such as smoking, alcohol abuse and physical inactivity. It can also lead to depression thus contributing to their higher suicide rate.EducationEducation is beneficial as it empowers the individuals, improving their health in the process. However rural students are at a large disadvantage in terms of education. Many towns have many grades being taught by the same teacher in the same room, thus decreasing the standard of education being taught. The search for secondary and post-secondary education means children will commonly have to attend boarding school. This can result in problems as children will be required to work on farms and income might not be high enough to support them into boarding school. Boarding schools can also result in fragmentation from family in many situations.Attitudes towards IllnessWork related injuries are commonly seen as a way of life. On a farm money is lost if tasks are not done. Therefore injuries and sickness are commonly worked through. On average rural people see doctor’s less than urban dwellers. Barriers to Using Health ServicesConfidentiality is an issue. In less densely populated areas, people are more easily identified and known in the area. This leads to concerns that other people in the community will have knowledge of one’s private medical history. Others might discover that a person is accessing a particular health service for more sensitive matters such a drug dependency. This can deter people from seeking the support necessary to address a health concern.Settings for Health PromotionCommunity setting for health promotion initiatives include schools, workplaces, health care settings and through local communities such as local newspapersInitiatives that show PromiseTeeth for KeepsTeeth for Keeps is an oral health program introduced in 1994 aimed at children in the Moree Plains Shire. Children in this area on average have very poor dental health. A solution of introducing water fluoridation was turned down by a community vote. This is when Teeth for Keeps were introduced. Teeth for Keeps aims to increase dental hygiene and prevent oral disease in children. This has been done by dental health education classes, daily fluoride brushing, and regulation of sugar-chewing gum, healthy school canteens and the ‘molar patroller’ mobile dental health clinic. It was funded through intersectoral collaboration due to private sponsorship, community members and government branches contributing money towards the programs. ATSI dental worker are being used for the dental health clinic and dental health classes. This is to address the large ATSI contingent in the area and their traditional understanding regarding health. ................
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