Different countries and population groups within Australia have different levels of health; we use determinants of health to explain these differences.

Internationally

Australia leads the world in many measures of health; our life expectancy is very high, and our under-five and infant mortality rates are very low.  This is due to determinants such as:

• Access to healthcare, including medications and widespread immunisation
• Shelter rather than overcrowding
• Safe clean water
• High national income (GDP, gross domestic product)
• Peace and a stable government rather than conflict
• High adult literacy & numeracy rates (education)

Compared with other developed countries, we are also very healthy; if you get a question about comparing developed countries with Australia on the exam, data will be provided for you to compare, and you aren’t expected to know anything beforehand.

Different population groups within Australia

Different population groups in Australia have different levels of health.  Our question is, why do these exist?  It’s because they experience different determinants of health, which have different influences on their health.  If we can find out which determinants are negatively affecting the health of some population groups, then we can try to improve these determinants and hopefully thus improve their health and promote equity.

With each population group, you should be able to:

• list some differences in health status
• explain these differences in health status using any of the four types of determinants of health.

Males vs females

Males face lower life expectancy and higher rates of mortality from injury (due to suicides and road accidents), cardiovascular disease, melanoma, prostate and lung cancer, and type 2 diabetes.

Females face higher rates of morbidity from non-fatal conditions such as osteoporosis, arthritis, Alzheimer’s disease, and mental health issues.

Determinants – males (compared with females) have:

• (bi) higher rates of obesity
• (bi) more testosterone -> increases risk taking behaviours -> injury
• (bi) no oestrogen, and their fat is distributed more round the abdomen -> CVD
• (be) poor diet with fewer fruit and vegetables
• (be) use less preventative healthcare
• (so) ‘strong’ macho image -> less likely to seek medical treatment, especially for mental issues, as it appears weak
• (so) more blue collar/tradies jobs -> increased pollution, manual labour and injury
• (ph) hazardous work environment: pollution and chemicals, manual labour

Socioeconomic status (SES)

Socioeconomic status is a measure of one’s social and economic position, based on income, education levels, occupation, and employment status.

As socioeconomic status gets lower, rates of infant mortality, cardiovascular disease, Type 2 diabetes, lung cancer, mental health issues, suicide, injuries, emphysema, and asthma increase.

Determinants – lower SES groups, compared with higher SES groups, have:

• (bi) higher rates of obesity
• (bi) higher blood pressure and blood cholesterol levels
• (be) higher rates of smoking, excessive alcohol consumption, and illicit drug use
• (be) higher rates of physical inactivity
• (be) poorer diet
• (so) unemployment, financial stress, social exclusion -> mental health issues
• (so) low income -> less access to healthcare and healthy foods like fruit and vegetables
• (so) lower education levels -> less knowledge of health-promoting behaviours such as healthy diets and exercise
• (ph) poor housing – overcrowding -> spread of disease
• (ph) inadequate cooking facilities -> more likely to eat takeaway or processed foods, higher in unhealthy nutrients
• (ph) polluted air and passive smoking -> lung cancer, emphysema, CVD

Rural and Remote vs. Metropolitan

The further from large cities people live, the higher the rates of injury, mental health issues, diabetes, cardiovascular disease, and preventable cancers such as lung, liver, skin and cervical cancer.

Determinants – those living in rural/remote areas, compared with those in metropolitan areas, have:

• (bi) higher rates of obesity
• (be) higher rates of smoking and excessive alcohol consumption
• (be) greater UV exposure
• (be) unsafe driving -> injury
• (so) lower education levels and income
• (so) more unemployment -> financial stress and mental health issues
• (ph) isolation -> mental health
• (ph) poorer roads and road signage, and longer driving times -> injury
• (ph) less access to fresh foods and healthcare, and more consumption of processed foods high in trans fats, which increases shelf life
• (ph) greater UV exposure (due to employment as a farmer, for instance)

Indigenous

Indigenous Australians have a vastly lower life expectancy than non-Indigenous Australians, and have higher rates of injury, under-five mortality, diabetes, chronic kidney disease, cardiovascular disease, mental health issues, cancers, and infectious and parasitic diseases.  They also tend to have lower SES and live in rural/remote locations, so the determinants that apply to those groups also apply to Indigenous Australians.

Determinants – Indigenous Australians, compared with non-Indigenous Australians, have:

• (bi) higher rates of overweight/obesity
• (bi) impaired glucose tolerance
• (bi) Syndrome X, which is a genetic risk factor for diabetes
• (bi) higher blood pressure and cholesterol levels
• (be) higher rates of smoking, excessive alcohol consumption, and illicit drug use
• (be) lower rates of physical activity
• (be) poorer diet
• (so) lower SES – unemployment, low education levels, and low income
• (so) different culture – less social inclusion and less access to culturally appropriate healthcare and social support
• (ph) live in remote areas
• (ph) poorer housing: overcrowding, poor sanitation, and limited cooking facilities