ANALYZING CARDIOVASCULAR DISEASE AMONG ABORIGINALS AND TORRES STRAIT ISLANDERS USING A SOCIAL DETERMINANT OF HEALTH FRAMEWORK.
Health is an age-old topic with various dimensions and dynamics. As such, a complete grasp of this crucial part of human existence has always eluded the world. Needless to say, there has been an exponential growth in the knowledge of the various factors within the human environment that could have a significant impact on the health of mankind. This knowledge has evolved from the simple study of diseases and their respective cures (curative medicine) to the in-depth knowledge of baseline measures to prevent disease occurrence (preventive medicine). In recent times, there has been a shift in focus to the social factors embedded in human day to day living, which could affect health. These factors are broadly referred to as the social determinants of health and have unlocked yet another dimension within the topic of health. Various research findings have validated the application of these social determinants of health framework to disease states among different populations. Certain limits may, however, exist in the application of this framework. This essay is designed to give a brief overview of the indigenous people of Australia ( Aboriginals and Torres Strait Islanders), analyze the occurrence of cardiovascular disease among them with possible solutions using the social determinants of health framework and identify the relevant stakeholders required to address this health issue.
Aboriginals and Torres Strait Islanders are collectively known as the indigenous people of Australia (New South Wales Government (NSW): Australian Museum, 2018). Prior to 1788, these people populated the whole of Australia (NSW: Australian Museum, 2018). Aboriginals were the primary inhabitants of Australia while Torres Strait Islanders inhabited the islands located between Australia and Papua New Guinea (NSW: Australian Museum, 2018). The European colonization of Australia, however, changed this dynamic and brought about dramatic changes that affected these people and their way of life (NSW: Australian Museum, 2018). This led to a massive decline in the population of indigenous Australians. According to the Australian Bureau of Statistics (ABS), the estimated resident population of indigenous Australians as of June 2011 was about 669,900. This number constitutes just about 3% of the current Australian population (ABS, 2013). 90% of the above-mentioned estimate (606,200) identified as being of Aboriginal origin only while 6% (38,100) identified as Torres Strait Islanders (ABS, 2013). The remaining 4% (25,600) were of both Torres Strait Islander and Aboriginal origin (ABS, 2013).
The health status of indigenous Australians played a crucial part in the decline of the population following the European colonization. Diseases such as smallpox, influenza, tuberculosis, pneumonia, measles, typhoid, whooping cough, varicella, and diphtheria were the main culprits in the decimation of the indigenous population of Australia (Murtagh & Rosenblatt, 2015, p. 1496). Today, the average life expectancy of indigenous Australians remains significantly lower than that of non-indigenous Australians and they also have an increased risk for several diseases (both acute and chronic) compared to the non-indigenous population (Murtagh & Rosenblatt, 2015, p. 1496). The commonest cause of death among these people is cardiovascular disease (Murtagh & Rosenblatt, 2015, p. 1496) and as such, underlines the reason why it is the focus of this essay.
Cardiovascular disease is synonymous with heart disease and it is a broad term used to describe pathologic conditions of the heart and blood vessels (Heart Research Australia, 2018). There are a number of such conditions and they include; stroke (ischaemic heart disease), arrhythmias and septal defects (Heart Research Australia, 2018). Ischaemic heart disease accounts for about 57% of all cardiovascular deaths among indigenous Australians (Murtagh & Rosenblatt, 2015, p. 1496). The risk factors for cardiovascular disease are broadly divided into two groups – modifiable and non-modifiable risk factors (Arboix, 2015). Modifiable risk factors include; hypertension, smoking, alcohol abuse, and obesity while non- modifiable risk factors include; age, gender, genetic factors and race (Arboix, 2015).
The analysis of the occurrence of cardiovascular disease among indigenous Australians will be based on the social determinants of health framework contained in a 2003 World Health Organization (WHO) publication titled The Solid Facts. This publication briefly highlights a few social determinants of health which could be considered as modifiable risk factors for cardiovascular disease. The following paragraphs will explore the association between cardiovascular disease among indigenous Australians and these social determinants of health.
The social gradient
A social gradient exists in health and it runs through all levels of the socioeconomic spectrum (WHO, 2018). There are several current studies that suggest a positive link between low socioeconomic status and poor health outcomes (Rief & Isaac, 2014). In general, most diseases tend to be more common, further down the social ladder (WHO, 2003, p. 10). Life expectancy also tends to be shorter among poorer groups in any society (WHO, 2003). There are many forms of social disadvantage (WHO, 2003, p. 10). Examples include; insecure employment, living in poor housing and lack of financial assets (WHO, 2003, p. 10). Socioeconomic status can, therefore, be considered as a significant factor in social advantage or disadvantage. According to Tang, Rashid, Godley, and Ghali, (2016), low socioeconomic status significantly increases the odds of cardiovascular disease. Singh, Siahpush, Azuine, and Williams, (2015) reported similar findings, concluding that cardiovascular disease mortality was inversely associated with socioeconomic status determinants such as education, income, and occupation. The 2011 census in Australia by the ABS revealed that only 13% of indigenous Australians had a weekly household income of $1000 or more compared to 33% of non-indigenous Australians. Also, 25% of indigenous Australians reported year 12 or equivalent as their highest level of education as compared to 52% of the non-indigenous people. More recent data could not be found on the percentages given above at the time of this essay but even with the two examples given, the social disadvantage of indigenous Australians is quite apparent. Considering the wealth of evidence linking cardiovascular disease to low socioeconomic status, addressing these socioeconomic gaps would most likely decrease the occurrence of cardiovascular disease among indigenous Australians.
Stress is generally a combination of two things: a psychological perception of pressure and the body’s response to it, which is usually multisystemic (Psychology Today, 2018). It is an expected human response to challenging situations and as such, is actually part of being alive (Health direct, 2017). Stress can be helpful in small amounts leading to increased productivity and alertness (Health direct, 2017). Long-term stress, however, can have damaging effects to the body and mind (Health direct, 2017). Causes of stress include; lack of job satisfaction, chronic illness, work, discrimination, emotional problems and increase in financial obligations (WebMD, 2018). As highlighted in the previous paragraph, indigenous Australians are prone to some of these stressors specifically, discrimination and emotional trauma. This is as a result of decades of oppression following the European colonization of Australia. The traumatic events of that era can be considered as significant causes of psychological stress. According to Lagraauw, Kuiper and Bot, (2015), psychological stress is a substantial but also modifiable risk factor for cardiovascular disease. Edmondson and von Kanel , (2017) also concluded that post-traumatic stress is a risk factor for the incidence of cardiovascular disease. Although medical remedies to stress already exist, these remedies nevertheless rely on drugs to control symptoms (WHO, 2003, p. 13). There is a need for more policies that focus on addressing the major causes of stress among indigenous Australians.
Several studies have shown that the foundations of adult health are laid before birth and in early childhood (WHO, 2003, p. 14). Good health-related habits such as not smoking, exercise and eating right are associated with good education as well as parental and peer group examples (WHO, 2003, p. 14). These habits shape the growth of the body and can therefore increase or decrease the likelihood of certain illnesses in adulthood (WHO, 2003, p. 14). The ABS data cited previously suggest that indigenous Australian parents are often likely to lack the education or income to provide a support system for their children that encourages these good health-related habits. Smoking, lack of exercise and poor quality diet are lifestyle practices that tend to increase cardiovascular disease risk (Hobbs et al., 2016). These risks associated with a poor early life are predominant among those in poor socioeconomic circumstances such as indigenous Australians (WHO, 2003, p. 15). Better access to health education and sufficient economic and social resources for parents of these children could help to improve parent-child relations, therefore prompting improved growth and development before birth and during infancy (WHO, 2003, p. 15). This could potentially reduce the risk of adulthood diseases such as cardiovascular disease.
Social exclusion has a major impact on health (WHO, 2003, p. 16). It results from poverty, deprivation, racism, stigmatization, and discrimination (WHO, 2003, p. 16). Ethnic minorities such as indigenous Australians are at particular risk of being socially excluded (WHO, 2003, p. 16). The processes of stigmatization, racism, and discrimination prevent these individuals from gaining access to services which could improve their health and life as a whole (WHO, 2003, p. 16). For example, accommodation within a public hospital was segregated until the 1960's which is merely 58 years ago (Hayman, White, & Spurling, 2009). For many years, indigenous Australians lacked access to mainstream healthcare and knowledge of healthy habits and practices that could have improved their general health because of their origin. This was mainly the result of one social determinant of health – social exclusion. Social integration through education and financial empowerment, therefore, has a crucial role to play in the improvement of Aboriginal and Torres Strait Islander health. The public also needs to be further enlightened about the detrimental effects of racism, stigmatization, and discrimination.
Unemployment rates among indigenous Australians is significantly higher compared to their non-indigenous counterparts (Busy At Work, 2013). Only 56% of Aboriginal and Torres Strait Islander people of working age were actively participating in the labour force as of 2011 compared to about 76% of non-indigenous Australians (ABS, 2013). The participation rate is defined as the number of individuals of working age (15-64 years) who are actively seeking employment or in work or full-time education (Busy At Work, 2013). Of the total participating number of indigenous Australians, 17.2% were unemployed compared to 5.5% of the participating number of non-indigenous Australians (ABS, 2013). Unemployment is a risk factor for poor health (WHO, 2003, p. 20) and high rates of unemployment have been linked to increased rates of heart disease and stroke mortality (Brenner, 2016, p. 6). Furthermore, there is evidence from different countries suggesting an association between unemployment and many health outcomes, including cardiovascular mortality (Kaspersen et al., 2015). Educational qualifications improve labour market prospects (ABS, 2013) and could, therefore, be key to reducing unemployment rates among indigenous Australians. Based on the evidence available, a reduction in unemployment rates will most likely improve cardiovascular health outcomes among Aboriginals and Torres Strait Islanders.
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- Emenike Muonanu (Author), 2018, Cardiovascular Disease among Aboriginals and Torres Strait Islanders, Munich, GRIN Verlag, https://www.grin.com/document/537446