Groups Experiencing Inequities

Groups Experiencing Health Inequities

The Nature and Extent of the Health Inequities

The nature and extent of the inequities in health cover a number of chronic and lifestyle diseases and include large gaps in health outcomes. Health inequities are the unjust impact on the health status of some groups due to social, economic, environmental and cultural factors^[1]. Health inequities regarding socioeconomic status (SES) are commonly measured by an individual’s income, housing, education level and employment. Socioeconomically disadvantaged people or groups are characterised by poor levels of education, low income, poor housing, and unskilled work or long periods of unemployment. Consequently, there is a steady trend in relation to an individual’s SES and their health. A risk factor for ill health is often related to socioeconomic disadvantage.

There are higher mortality rates and higher levels of illness in all age brackets for men and women who are socioeconomically disadvantaged, as opposed to those that are more upscale. Socioeconomically disadvantaged people are less informed about their own health, resulting in lesser use of preventative health strategies. For example, utilising preventative health services such as, dental check ups, immunisation, family planning and pap smears1. They often have poor levels of education, which is an underlying factor of their health unawareness. The ‘Outcomes 2 Personal Development, Health and Education HSC Course’ textbook outlines that lower education correlates with higher levels of blood pressure for both sexes, women have higher cholesterol levels, and both sexes have a greater body mass index, which increases their risk of obesity1. Subsequently, lower levels of education lead to unskilled work or unemployment. This results in people only being able to look after their basic needs and affects those living in rural and remote areas as they have higher living costs. For example, in 2005 the ‘Australian Institute of Health and Welfare’ highlighted that food cost 10-20% more, due to the insufficient access to goods thus leading to a poor diet ^[2]. Consequently, there are higher mortality rates, they die at an earlier stage in life and are exposed to higher levels of sickness1. Additionally, the socioeconomically disadvantaged have increased levels of smoking. The course textbook also identifies this and provides the following figures: 28.9% of people 15 years or over in 2007-8 smoked as to the 11.1% of people with a higher SES. Furthermore, a person's ability to find work, education and training affects their ability to access safe and affordable housing^[3]. This has a negative effect on a person’s health and wellbeing. For example, in 2011 11.1% of people in rural and remote areas suffered from housing stress^[4].

Below is a diagram of the prevalence of risk factors and disease by SES in 2007-8.        [pic 1]

(Source: R. Ruskin, K. Proctor, D. Neeves, 2013. Outcomes 2 Personal Development, Health and Education HSC Course. 5th ed. 42 McDougall Street, Milton, Qld 4064: John Wiley & Sons Australia.)

Sociocultural, Socioeconomic and Environmental Determinants

The sociocultural, socioeconomic and environmental determinants of health have an impact on health or affect people’s ability to make good decisions about their health1. This is demonstrated through the health inequities of socioeconomically disadvantaged people in Australia.

The sociocultural determinants of health include family, peers, media, religion and culture. However, family, peers and culture are the determinants that are more applicable in regards to the health inequities of socioeconomically disadvantaged people in Australia. Individuals raised in a family of low SES are more likely to form poor lifestyle habits. For example, an individual may develop a sedentary lifestyle, where they participate in no or little physical activity and statistically have a high prevalence of disability. For example, a report by the Australian Institute of Health and Welfare titled ‘the geography of disability and economic disadvantage in Australian capital cities’ in 2009, highlights that people living in the most disadvantaged area of Adelaide were 2.6 times as likely to have severe disability^[5]. Subsequently, the income of these families with disability will be significantly affected, especially when families of low SES statistically receive a lower income^[6] and lack of employment can place a burden on families. A Joint Report by the National Rural Health Alliance Inc. addresses the issue of unemployment in rural areas being higher than in major cities. For example, the unemployment rate in Tasmania’s capital city is 6.2%, whereas unemployment rate outside the city is 8.1%3. Rural and remote areas do not have the same amount of employment opportunities, job security and future employment prospects than larger urban cities. Therefore, families of low SES are significantly restricted in their ability to provide. Furthermore, peer pressure provides a climate for an individual to participate in risky behaviours, such as drinking and smoking. The Joint Report by the National Rural Health Alliance Inc. also identifies that there is less prevalence of motivation amongst students. For example, the limited opportunities for highly educated workers minimises the motivation of students to aim for a better education. Culture also impacts an individual’s outlook on life. For example, ATSI peoples are more likely to drink and are less likely to seek preventative measures1, causing lifetime harm on health.

The socioeconomic determinants of health correlate to levels of education, employment and income. People of low SES are characterised to have lower levels of education and lower rates of income1. As a result, their options for health care and healthy behaviours are significantly reduced. Ultimately, those with lower levels of education are less informed about the choices they make, the services that are available to them, and they can develop apathy1. The ACOSS’ Poverty Report Update, outlines that people with lower levels of education are likely to have a restricted ability to escape from poverty^[7]. Likewise, the NATSEM report determines that poverty rates for families with education levels below year 10 have extreme poverty rates, with around 1 in 2 households living with incomes below the poverty line5. Lack of education leads to long term unemployment, unskilled and semi skilled workers. Data published by the Public Health Information Development Unit (PHIDU), illustrates that the unskilled and semi skilled workers are more than double in ‘very remote’ areas than of those in ‘major cities’, conclusively resting at 30.4%4. Additionally, the National Rural Health Alliance Inc. identified in 2011 that jobless families with children under 15 years in very remote areas are more than double than that of major cities3. This then leads to a lack employment choice, resulting in individuals of low SES participating in hazardous work. These poor working conditions can lead to a decline in good health, as the environment can be harmful to physical and mental health. For example, in a rural and remote area working in the mines or as farmer is likely and can lead to premature hearing loss due to excessive noise exposure. Low levels of employment and working conditions result in a decline in mental health, such as low self-esteem and lacking a sense of purpose. A lower level of income has a domino effect as it restricts people’s afford housing choices, ability to cover energy costs, further education, access to goods and services, and the standard living needs declines. The Joint Report further outlines that in order for families to have a reasonable lifestyle, they need sufficient, regular and reliable income, a factor that those of low SES struggle with3.