Like Unit 3, where we look at how determinants of health lead to variations in health status between populations, in Unit 4 we look at seven specific determinants, or ‘factors’, that lead to the difference in health status between Australia and developing countries.  Remember, Australia’s health status is excellent while developing countries often have very poor health status.  So, we’ve got to learn the major reasons WHY this difference exists, so then we can work to fix them up!

Income

Australia has a high GDP; developing countries do not.

Thus, individuals and families in developing countries have limited money to spend on healthcare, education, food, housing and sanitation.  Also, their nation has less money to spend on providing infrastructure for healthcare, schooling, and safe water.

Gender Equality

In Australia, men and women have the same opportunities, but in developing countries, women are seen as less important.  Compared to men, women in developing countries may have to face:

• less access to education and thus illiteracy
• fewer employment opportunities and a lower income
• early marriage and childbirth, which can lead to less education and obstetric fistula during childbirth due to a young girl having an undeveloped body
• prostitution, violence, exploitation and genital mutation
• being served food last (malnutrition) and less access to medical treatment

Peace & Political Stability

Australia has political stability and peace, leading to choice and opportunity, economic growth, and stable education and healthcare systems.

However, some developing countries have political instability and conflict which can lead to:

• national poverty as the government spends money on military expenses rather than on infrastructure, education and healthcare systems
• crops and infrastructure (such as hospitals, roads, schools, housing, wells, toilets) being destroyed
• decreased trade, import of essential goods such as food and medicine, and economic growth
• high burden of disease from injury (from military action, landmines, rape, violence, and mutilation)
• families being torn apart so they can’t support themselves
• poor social and mental health due to stress and trauma

Education

Australia has high levels of education with mandatory schooling up to year 10 and high levels of tertiary education, while in developing countries people have limited access to education.

Education provides people skills so they can avoid labour-intensive jobs and earn a good income.  They can use the income to: educate their children; pay for healthcare, food, wells and toilets; and pay taxes to promote the country’s economic growth.  Educated people are also more likely to understand healthy behaviours, like using condoms to prevent spread of HIV/AIDS, healthy eating, and hygiene practices.

Australia also has higher levels of girls’ education, which decreases the maternal and infant mortality rate, as educated girls are more likely to have children later (decreasing risk of obstructed births and obstetric fistula) and understand and use health-promoting behaviours (seeking prenatal care and skilled birth attendants, infant feeding and care, hygiene, nutrition and immunisation).

Access to Healthcare

Australia has Medicare, affordable access to all necessary healthcare, while those in developing countries may not have access to:

• skilled birth attendants and pre/post-natal care –> higher infant and maternal mortality
• immunisation –> increased mortality from measles, tetanus, TB, diphtheria, rubella, whooping cough
• medicines
• treatment of common diseases and injuries
• preventative healthcare (condoms, bednets, birth control)

thus increasing their rates of communicable disease.

Global Marketing

Australia has low levels of communicable diseases (can be transmitted between people) and high levels of non-communicable diseases which are lifestyle related (e.g. CVD, diabetes, chronic respiratory diseases).  Developing countries have high levels of CDs and low levels of NCDs.

However, with global marketing of tobacco, alcohol and fast/processed foods (i.e. advertising and selling of these products in developing countries), developing countries now have a double burden of disease, because they now get both CDs and NCDs.

Developing countries also have less health promotion, so they may not understand the risks of consuming these products.  Also, if people with a low income buy these products, they may be unable to afford essentials, like education, healthcare and healthy foods.  As they have less healthcare access, they also can’t afford treatment for NCDs or CDs.  Hence, this increases the burden of disease from these conditions in developing countries:

• lung cancer, emphysema, asthma, stroke, cardiovascular disease (tobacco)
• liver cancer and liver cirrhosis, cardiovascular disease, mental conditions, injury (alcohol)
• obesity, cardiovascular disease, type 2 diabetes (fast foods)

Physical Environments

Most Australians have adequate housing with proper sanitation and shelter, whereas those in developing countries may have overcrowding, contaminated water and no toilets.

• contaminated water and poor sanitation facilities leads to spread of water-borne diseases such as cholera, diarrhoea and hookworm
• overcrowding leads to spread of communicable diseases such as measles, influenza, and ebola
• having to travel a long way to get water decreases women’s access to education and their ability to lead productive and creative lives
• poor soil and limited water decreases crop production, leading to food insecurity, malnutrition and low income
• natural disasters such as floods destroy crops (and thus income), can cause injury, and can increase spread of malaria due to increased breeding of mosquitoes in stagnant water