The first International Conference on Health Promotion culminated with the formulation of the Ottawa Charter for Health Promotion in 1986 in Ottawa, Canada. In this conference, national governments, global and local healthcare organizations, as well as local communities, were sensitized on the need to realize the objective of “Health for All” through health promotion by the year 2000 and beyond (Lee, 2015). The World Health Organization (WHO); the organizer of this conference envisaged the significance of health promotion as a pathway of advancing all global citizens an “economically productive level of health by the year 2000” and beyond. In the Australian context, many health promotion initiatives have been launched to improve the healthcare situations of all Australians since the declaration of the Ottawa Charter for Health Promotion. One such health promotion initiative is the “National Alcohol Strategy; 2018-2026”. This paper involves the detailed analysis of this health promotion initiative in relation to the determinants of health for the principal purposes of determining its efficacy in advancing Australians with better healthcare outcomes.
The WHO recognized alcohol abuse as a primary healthcare concern in 2008. To this end, the body has come up with formidable healthcare initiatives to reduce the harm of alcohol consumption across the globe. The WHO observed that in 2004 alone approximately 2.5 million people lost their lives worldwide as a result of alcohol-related causes. Of this number, young people of between ages 15 and 29 were approximately 320,000. Moreover, the WHO contended that harmful alcohol abuse constitutes the third leading risk factor for disability and premature deaths globally (World Health Organization, 2008). In its approach, the WHO demands world nations need to ratify its strategic health promotion initiative provisions into national and local specific strategies in combating the same.
The principal aim of the “National Alcohol Strategy; 2018-2026” is to advance a federal framework to promote the prevention and minimization of alcohol-related harm amongst individuals, families, and communities throughout Australia. In doing so, the Australian government; Department of Health is committed to the continuous identification of national priority areas of action as well as opportunities for action plans to be considered and taken. Moreover, the initiative is committed to promoting and enabling partnership, commitment and collaboration between the government and non-government sectors in the achievement of the same. The initiative is geared towards achieving a 10% reduction in health degrading alcohol consumption. Harmful alcohol consumption refers to alcohol consumption levels that posit risks and injury to individuals from any single alcohol drinking occasion in a span of just one month. These levels also relate to alcohol consumption levels that have a high potential of subjecting individuals to high risks of contracting diseases or injury in their lifetime.
Achieving the goals of health promotion initiatives are however bound to be haunted by the facets and factors informing the social determinants of health. The WHO (2008) contends that the social determinants of health are tightly linked to the socioeconomic conditions facing different individuals, communities and social settings. Their distribution across different populations posits a direct impact on the health status of these people and may act to either promote positive health outcomes or suppress the same. As such, by and large, they sharply deviate from the individual risk factors such as genetics and behavioral risk factors that may lead to the health deterioration of a person at a personal level.
The WHO asserts that the unequal distribution of the social determinants of health is not to be taken as a “natural” phenomenon but rather the result of poor management of social policies, bad politics, and unfair economic arrangements. Moreover, these determinants posit an intimate relationship with health outcomes and tend to cluster together- for example, people living under poverty are more or less expected to experience adverse social determinants (Newman, Baum, Javanparast, O’Rourke, & Carlon, 2015). To this end, the formulation, planning, and implementation of health promotion initiatives tend to be curtailed by the rampant inequalities of these social determinants across different social settings. In a report developed by the Commission on Social Determinants of Health of the WHO dubbed “Closing the gap in a generation: Health equity through action on the social determinants of health” in 2008, the WHO identified two striking areas of social determinants of health that jurisdictions across the globe need to continuously address especially when formulating health promotion initiatives (World Health Organization, 2008). One area is the daily living conditions that constitute determinants such as fair employment, social protection, healthy physical environments and fair access to healthcare.
The other one relates to the distribution of resources, power, and money with determinants such as healthy working conditions, political empowerment, resource distribution, equity in access of health programs, economic inequalities, and gender equity is the major social determinants considerations. All these social determinants of health have the potential of impacting health initiatives and outcomes in one way or another. Since health inequities by and large emanate from societal conditions in which people find themselves in at birth and continue to live, work and age in, they are entirely unacceptable and deserve to be addressed if equality and equity in health outcomes is to be achieved across different society setups. Jurisdiction across the globe including Australia ought to lay formidable strategies to enhance equality and ease of access to resources in areas such as early childhood development, education, employment, housing, economic status and effective health promotion initiatives for the prevention and treatment of various healthcare challenges.
The Centers for Disease Control in the United States perceive the social determinants of health as the life-promoting resources. These include resources such as food supply, efficient transport, comfortable housing, rewarding education, socioeconomic relationships, decent employment and easy access to healthcare. The equitable and efficient distribution of these determinants across different populations by and large dictates the life expectancy and quality of life of these different populations. Arguably, social determinants of whichever nature will have great impacts on health promotion initiatives and therefore health equity across populations are only possible through the equitable distribution of the same.
In closing some of the gaps caused by social determinants of health with regard to access to healthcare initiatives that target alcohol abuse patients, the government of Australian has been proactive in advancing formidable strategies to counteract the same. One such stricking social determinant of health that the “National Alcohol Strategy; 2018-2026” has addressed is varying socioeconomic status among different Australian individuals, households and society setups. Differences in socioeconomic status among individuals and communities imply that some members of the community have abilities to consume more alcohol than others. At the population level, per-capita alcohol purchasing power posits a very close correlation with alcohol consumption. The number of those who decide to abstain from alcohol consumption decrease as the per-capita income Increases.
This association weakens the moment the per-capita alcohol affordability threshold is achieved. Higher socioeconomic status attracts occasional drinking while lower socioeconomic status attracts larger alcohol intakes per a single occasion of drinking. This situation is however dependent on the associated socioeconomic status measure such as occupation, income, and neighborhood deprivation and education levels. Moreover, socioeconomic status when interacted with different sociodemographic factors it may advance different alcohol consumption patterns (Rubin, 2016). For instance, poor neighborhood socioeconomic status when combined with a younger population may lead to excessive consumption of binge.
The “National Alcohol Strategy; 2018-2026” contains formidable national alcohol policies and strategies whose priority areas of focus are aimed at destroying the socioeconomic orientations that enable different individuals and community setups easily access and abuse alcohol. The initiative also constitutes strategies aimed at promoting healthier communities through the improvement of communication, drinking guidelines, awareness of harms of alcohol, and the importance of having a minimum drinking age. Moreover, the initiative is aimed at supporting individuals across different community setups through advancing support systems and treatment services.
Employment inequality is another social determinant of health that greatly influences alcohol consumption patterns as well as ease of accessing healthcare. Generally, people in employment tend to drink more than their unemployed counterparts. However, employed people tend to drink alcohol products that are safer than those who are unemployed. Moreover, employed people tend to be occasional light drinkers while their unemployed counterparts tend to be heavy drinkers on a single drinking occasion. Due to their low-income levels, the unemployed are exposed to alcohol products that can easily impair on their health by posing more complex healthcare challenges (Lee et al., 2014). The “National Alcohol Strategy; 2018-2026” suggest interventions such as peer interventions, organizational culture changes at workplaces, the formation of support groups, psychosocial skills training and rehabilitation services to cater for the needs of total alcoholics.
A social determinant of health that is perhaps not addressed by the “National Alcohol Strategy; 2018-2026” is early childhood implications. Children born and raised in disadvantaged communities tend to have greater childhood risk factors that can influence later alcohol abuse behaviors. These include risk factors such as parental drug involvement; child abuse and neglect; and family breakdown (Sussman, & Arnett, 2014). Intervention to this end may include parental education, brief interventions, family home visiting, and behavior management and school preparation programs. In addition to the early childhood exposure to alcohol, maternal alcohol use during pregnancy has the potential of exacerbating a newborn’s health condition.
Alcohol abuse in the Australian context is really a complex and multifaceted healthcare problem and especially when associated with major social health determinants. It has continuously remained to be one of the most abused drugs across Australia with approximately 90% of adults thought to have consumed it at some point of their lifetime (Newman et al., 2015). The planning and development of health promotion initiatives meant to curtail the abuse of alcohol across Australian communities are greatly affected by the various social determinants of health due to their complex and multifaceted nature.
Alcohol’s multifaceted relationship with various social determinants of health impacts inequitably the planning and subsequent development of health promotion initiatives meant to combat the same. While positive social determinants of health have enabled some sections of the communities to receive adequate health interventions meant to eliminate the risks posed by alcohol, negative social determinants have bared other sections of the communities from accessing the same. This makes the planning and development of health promotion initiatives troublesome. Though alcohol consumption is not evenly distributed across Australian communities, it nonetheless harms communities disproportionately with the greatest impacts felt by disadvantaged groups.
To this end, policy makers involved in the planning and developments of health promotion initiatives are easily distracted by the inabilities of properly prioritizing between various strategies that can take care of different determinants of health. Moreover, the same challenge is extended to the moment when policy makers want to target different individuals and communities affected by specific social determinants of health. While closing the gaps caused by some determinants necessitates the application of individualized, community and national wide intervention strategies, closing others may require focusing on the affected individuals, particular communities or the nation at large (Embrett, & Randall, 2014). As such, different individuals, families, and communities cannot be simply generalized and health promotion initiatives impacted on them because of different social determinants of health affecting them and at different levels. This greatly impacts the planning, development and implementation of the same.
For instance, interventions strategies for alcohol abusers with different socioeconomic status require totally different combating strategies for the health promotion initiative to be effective. Higher income individuals from richer neighborhood may do well with health promotion initiatives such as sensitization of the harm of alcohol through channels such as social and mainstream media. For people with lower socioeconomic status, road campaigns, rehabilitation sessions, brief counseling sessions can be more effective. This difference in individuals and community setups also tend to impact on budget allocations for various health promotion initiatives. Effective planning and development of intervention strategies are severely affected in such a complex and multifaceted social determinant framework and community setups (Braveman & Gottlieb, 2014).
Arguably, health promotion has been labeled by the WHO as a formidable channel through which global citizens can access healthcare with a lot of ease. The current “National Alcohol Strategy; 2018-2026” health promotion initiative is aimed at preventing and minimizing alcohol-related harm amongst individuals, families, and communities throughout Australia by prioritizing areas of action as well as opportunities for action plans to be taken. However, the planning and development of the “National Alcohol Strategy; 2018-2026” is bound to be impacted by the differentials of the different social determinants of health causing inequalities and equity concerns in the access of healthcare by different members of the Australian community. Allen, Balfour, Bell, and Marmot (2014) insist that a health promotion initiative such as “National Alcohol Strategy; 2018-2026” need to consider formidable intervention strategies to counteract the challenges posed by different social determinants of health.
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