Discuss About The Health Inequity And Its Social Determinants.
The Australian population has dramatically progressed during the 20th century in regards to health and wellbeing. Comprehending inequity in health should be a priority for the Australian government. It is essential for these issues and their healthcare effects including the health breach between indigenous and non-indigenous Australians to be addressed. This report examines the association between the natural health effects and socioeconomic disadvantage in the Northern Territory of Australia. Even though there are several improvements, it has been characterised by severe health inequities like health conditions and health service access and the position of socioeconomic in population health.
In Australia, there is a broad scope in this populations, and it is the only country in which the breach is full and extended compared with other advanced countries with the significant indigenous population. The discrepancies and in health results between two subpopulations in Australia has been considered by the health jurisdiction as a critical social and public health challenge as outlined in Australian Human Rights Commission (2005). The Australian government has shown interest in closing the life expectancy breach within a population and have some gaps in academics and employment crisis in a decade.
The Northern Territory is located in northern and central Australia which also has the smallest population (231,331 in 2011) among all nations. It entails high population in remote areas than any other state. The indigenous people live in impoverished areas which exposes them to continuous health inequalities and the extent to which the socioeconomic determinants contribute to such issues (Braveman 2014, pp. 366-372).
A person’s economic and social status is measured by their academics, income and their professions. There is an expanding body of literature which outlines the socio economic inequity in health in Australia. Those who belong to low socioeconomic status do not have access to quality healthcare services because they are poor hence they tend to die early. There is a healthy relationship between poor health, remoteness and poverty. However, previous research in Northern Territory affirms a clear social acclivity to the diabetes prevalence of diabetes assessed in disability-adjusted life years. (Braveman 2003, pp. 254-258).
The old public health model has revealed that indigenous people have experienced negative results of colonisation that has left many of them with inadequate education, unemployment, low income, overcrowding and lack of proper health services. The old public health model has limited success in regards to health in attempting to modify peril behaviours like smoking, taking alcohol and obesity. The peril conditions are often planted within the disadvantages which reinforces the risk conditions as suggested by Culyer& Wagstaff (1993, pp. 431-457).
Health inequality has been assessed through evaluating various measures and effects between multiple groups for similar differences in mortality rate and hospitalization rate and life expectancy. The old public health model has also found another way of determining health inequality, and that is to investigate the distribution of health effects in the population through the use of concentration index and their rectifications and disintegration. This has helped in examining the contributions of the factors that have led to health inequity as commented by Daniels (2008, 79-102).
Socioeconomic is considered as one of the leading causes of diagnoses of hospitalization in Northern Territory population. The old public health model has associated indigenous health inequity with socioeconomic inequity using the data provided. This population has lacked access to quality healthcare services due to living in very remote areas. They also have easy access to unhealthy meals which can lead to obesity. The population has a high risk of suffering from infectious illnesses such as tuberculosis and respiratory diseases due to poor sanitation and hygiene. The model tries to highlight the usefulness of reducing the standards of living so that they can quickly access quality healthcare services as outlined by Department of Health, Northern Territory (2017). The northern territory population suffers a significant exposure to unhealthy lifestyle because of overcrowding and more so low socioeconomic position in the area.
Research has indicated that the men’s mortality rate depends on risk-taking behaviours that they indulge in the area. There are obvious issues that the men can handle, and there are other things that women can control which can influence their health outcomes. There is the presence of income inequality and violence because of the gender identity. The biological, physiological and reproductive sex has various definitions and effects in different communities. Men in Northern Territory are subjected to harsh conditions of living due to their remote areas. Therefore, they have to work harder to support their families ( Drewnowski 2004, pp. 154-162 ). They are exposed to cold which presents them to respiratory disease such as asthma. Thus they are unable to get quality care because they are considered as reliable and people who can manage the situation by themselves.
Gender criteria also allow social inequalities, for example, the difference between male and female. This social inequity is responsible for the health effects from gender socialization, role-related actions and gender variations in chances which give men and women various and unmatched amenities and exposure to health perils (Leeder 2003, pp. 475-478). For example, a woman who is married contracts HIV from her partner since the society condones her husband’s lousy behaviour discouraging her from insisting on the use of a condom.
Personal behavior has influenced health inequity . In a male-dominated area, the females have a difficult time some of them lack confidence in themselves since culture depicts them as inferior beings. In the Northern Territory in Australia, the usage of alcohol in women has increased. Research has indicated that the consumption of alcohol among Australian women is publicly visible. Individual behavior is actually changing the perception of women taking alcohol because they want to be at the same level as men in the modern world (Schofield 2007, pp 105-114). The community have used alcohol for a long time and its results as vital techniques to distinguish, represent and adjust their duty. Since the women in that area are considered as low income earners, they are not able to get quality medication compared to men.
2011 Australian Bureau of Statistics health survey data (Australian Bureau of Statistics 2013) showed that young women alcohol usage was meeting the young men’s. This means that the number of women who suffer from cirrhosis of the liver is much higher than men. Thus majority do not have the necessary means to get healthcare services adequately. Most of the men take alcohol with the perception of releasing stress and women make it boost their confidence when they lack confidence. Each individual’s action determines health inequity in Australia. Some of them indulge in drug abuse after being lured by men and end up dying without getting necessary treatment. The old public health explains the effects of alcohol but fails to put measures that can be used to stop this menace. It has encouraged health inequity by providing medication for the wealthy people as commented by Sloane et al. 2003, pp. 568-575)
Lack of income has a more significant effect on the type of food people consume. Individuals with high socioeconomic status can buy healthy nutritious foods compared to those with low socio-economic status as outlined in ‘Australian Dietary Guidelines Appendix A: Equity and the Determinants of Health and Nutrition Status’ (2013, pp. 31-40). They tend to purchase less dense and unhealthy foods and hence failing to meet their daily nutrient requirements. As a result, the latter is faced with numerous health challenges such as malnutrition and obesity which may lead to high mortality and increased health care costs (Drewnowski 2004 , pp. 154-162).
Several studies have indicated that education influences the health of individuals. More educated people have the advantage of receiving better care compared to the less educated. They are often well informed on the benefits of good health-seeking behaviour. As a result, they do visit the hospitals regularly for checkups and early disease detection (Berkman et al.2011, pp 97-107). They also end up getting well-paying jobs and hence acquiring proper health insurances which help them get improved medical care. They also have improved access to nutritious food preventing them from preventable nutrition-related diseases. They also live in good houses that are often free from health hazards compared to the less educated. The less educated live in overcrowded and unhealthy environments predisposing them to diseases such as tuberculosis, cholera and typhoid. They lack knowledge about sanitation and healthy meals which can prevent them from the exposure to infections.
The old public health model emphasized mainly on immunization and sanitation while the new federal health assumes that all these are well established and need only surveillance. The former public health model tried to analyze the interventions required to restore health equity in the Northern Territory. It encouraged the public hospitals to deliver adequate services since the population cannot afford expensive healthcare in private hospitals. It also highlights the importance of nutrition. The community is encouraged to practice good eating behaviours and eat nutritious food at all times. The model emphasizes disease prevalence but does not provide modern treatment systems that can be used to take care of people living in the rural areas. Ward (2009, pp. 270-284) suggested that the old public health tried to advocate a multi-causal step that saw infectious and chronic diseases as being the result of the complicated relationship between social and psychological elements.
The 6th iteration of the Andersen’s and Newman model of utilization of health care best explains the inequalities and factors influencing the uptake of the services ( Baum 20 16 ). The model contemplates access to and utilization of health care as a function of three features which include predisposing factors, need factors and enabling factors.
These are the socio-cultural elements of people that exist before acquiring illnesses. They include the social structures such as education, social networks and interactions, occupation and ethnicity. High level of education attainment contributes to maximum utilization of health care services. This is because well learned have a higher opportunity of getting high paying jobs which enables them to acquire better health than others. They also know more about the importance of going for screening services or visiting the hospitals on a regular basis.
Predisposing factors also include knowledge, values and the attitudes of people about the health care system. These characteristics have a significant influence on the utilization of health care services as they determine whether one will visit the hospitals or not. Lack of proper health education on the benefits of timely treatment of diseases makes it difficult for individuals to seek the services. Negative attitudes towards the healthcare providers and values that discourage people from visiting the hospitals also result in reduced usage of the health care services.
Demographics such as age and gender also influence the seeking of health care services. Research indicates that women consume more health services compared to men. Compared to men who tend to use the emergencies services in the hospitals, women frequently use diagnostic and preventive services. Older individuals often fail to visit the facilities as they rely on fixed incomes making it difficult for them to pay for the services. They also lack transport to visit the hospitals that are distant from their houses and hence losing on essential hospital care they need.
Enabling factors to include personal or family, community and possible addictions. Some families often lack the income to pay for the services. They also lack funds to pay for transport to the facilities. As a result, they are unable to utilize the services and hence increasing mortality rates. They also view visiting hospitals as a form of wasting of resources. Lack of insurance services makes it hard for them to receive quality and timely health care. They also miss out on the benefits that come with having an insurance such as cover for life-threatening illnesses and increased number of checkups and diagnostics as commented by Williams et al. 2015, pp. 106-108).
Lack of enough number of facilities and personnel influences the usage of healthcare services. Lack of adequate professionals makes the waiting time too long and hence discouraging the patients from visiting again. The staff also experience huge workloads, which makes them fail to attend to all the patients and as a result, they turn them away. Lack of sufficient well-equipped hospitals has an impact on the health-seeking behaviours of people. Some genetic and behaviours factors affect the uptake of the services. Individuals often regard diseases as mild or not for medical care, preventing them from acquiring the services.
Need factors include both the perceived and evaluated needs. The perceived needs are those that influence an individual’s understanding of the importance of adherence to medications and care-seeking. It also involves peoples view their health as well as how they encounter symptoms of pain, diseases and troubles concerning their health. It also includes how people judge their illnesses to be of considerable extent and importance to seek physicians or healthcare professionals help. Evaluated needs relate to the amount or type of treatment a patient receives after seeing a medical care provider. It also constitutes professional decision regarding an individual’s health status and their need for health care. The explanations of the health inequities have changed over the years.
The old public health considered health as a uniform essential requirement and solved the issues according to the population’s health. It focused on measurements and monitoring the inequalities that are present in health. It developed tools that can be used to measure the health of the population. The old public health focused on service delivery and the wellbeing of the patient. It encouraged the community to visit the nearest health facilities to get adequate treatment. It offered limited education to the consumers concerning their eating behaviours and hygiene practice. It showed the importance of early diagnosis but failed to provide necessary measures after the diagnosis, and in the case of Northern Territory of Australia, people live in very remote areas hence they are unable to get the required treatment on time (Daniels 2008, 79-102). This increases the mortality rate of the population. The old public health majored on the health effects of a particular illness and did not pay much attention other ailments. It was difficult to solve health inequalities since it focused on individual behaviour.
In conclusion, the current public health model focuses on advanced health systems to cater for various diseases. It addresses the health predicaments comprehensively and also considers human elements as it tries to fight health inequities. It focuses on the primary interventions that examine the wellbeing of the patient at all times. The model helps in evaluating the challenges that the population faces and creating awareness about healthy lifestyle to avoid these health inequalities. It helps in understanding in solving the health inequities which are present today.
References
‘Australian Dietary Guidelines Appendix A: Equity and the Determinants of Health and Nutrition Status’ 2013, Journal of the HEIA, vol. 20, no. 1, pp. 31-40
Australian Human Rights Commission 2005, Achieving Aboriginal and Torres Strait Islander Health Equality within a Generation- A Human Rights Based Approach, Sydney, viewed 3 April 2018, < https://www.humanrights.gov.au/publications/achieving-aboriginal-and-torresstrait-islander-health-equality-within-generation-human>.
Baum, F 2016, The New Public Health, 4th edn, Oxford University Press, South Melbourne, VIC.
Berkman, N.D., Sheridan, S.L., Donahue, K.E., Halpern, Business-law.J., & Crotty, K. (2011). Low Health Literacy and Health Outcomes: An Updated Systematic Review. Annals of Internal Medicine 155 (2) 97-107.
Braveman, P 2014, ‘What is health equity: And how does a life-course approach take us further toward it?’, Maternal and Child Health Journal, vol. 18, no. 2, pp. 366-372, viewed 4 April 2018, https://link.springer.com/article/10.1007/s10995-013-1226-9
Braveman, P, Gruskin, S 2003, ‘Defining equity in health’, Journal of Epidemiology and Community Health, vol. 13, no. 1, pp. 254-258, viewed 4 April 2018, https://jech.bmj.com/content/57/4/254
Culyer, A.J. & Wagstaff, A. 1993, ‘Equity and equality in health and health care’. Journal of Health Economics, vol. 12, no. 4, pp. 431-457
Daniels, N. (2008). Just health: meeting health needs fairly. Cambridge University Press, Cambridge, 79-102
Department of Health, Northern Territory. (2017). Tennant Creek Hospital. Northern Territory Government of Australia.
Drewnowski, A 2004, ‘Obesity and the Food Environment: Dietary Energy Density and Diet Costs’, American Journal of Preventive Medicine, vol. 27, no.3, pp. 154-162, viewed 5 April 2018, (online ScienceDirect/ Elsevier B.V.).
Leeder, SR 2003, ‘Achieving Equity in the Australian Healthcare System’, The Medical Journal of Australia, vol. 179, no. 9, pp. 475-478, viewed 5 April 2018, (online The Medical Journal of Australia)
Schofield, T. (2007). Health inequity and its social determinants: a sociological commentary. Health Sociology Review, 16, (2) 105-114
Sloane, DC, Diamant, AL, Lewic, LB, Yancey, AK, Flynn, G, Nascimento, LM, Carthy, WJ, Guinyard, JJ & Cousineau, MR 2003, ‘Improving the Nutritional Resource Environment for Healthy Living Through Community-based Participatory Research’, Journal of General Internal Medicine, vol. 18, no. 7, pp. 568-575, viewed 7 April 2018, (online Wiley Online Library)
Ward, P 2009, ‘Equity of access to health care services’, in Keleher, H & MacDougall, C (eds.), Understanding health: a determinants approach, 2nd edn, Oxford University Press, South Melbourne, VIC., pp. 270-284, viewed 4 April 2018, https://flex.flinders.edu.au/file/08ab9b63-d091-48e8-9cddcaf897149600/1/Equity%20of%20access%20to%20health%20care%20services.pdf
Williams, O, Mutch, A, Douglas, PS, Boyle, FM, & Hill, PS 2015, ‘Proposed changes to Medicare: undermining equity and outcomes in Australian primary health care?’, Australian and New Zealand Journal of Public Health, vol. 39, no. 2, pp. 106-108, viewed 7 April 2018, https://onlinelibrary-wileycom.ezproxy.flinders.edu.au/doi/epdf/10.1111/1753-6405.12348
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