The social determinants of health for Aboriginal and Torres Strait Islander mothers - Free Essay Example

Aboriginal and Torres Strait Islander people, referred to as Indigenous Australians, experience significantly poorer health outcomes than non-Indigenous Australians. This is particularly true for Indigenous women. The difference in life expectancy between Indigenous and non-Indigenous women is some 9.5 years, and Indigenous mothers are three times as likely as non-Indigenous mothers to die during childbirth (AIHW, 2014a; AIHW, 2014b). There are many complex, interrelated social factors which impact the health of Indigenous people. This paper provides a critical analysis of the social determinants of health for Indigenous mothers in particular. Education is one of the most fundamental social determinants of health, and this is particularly true for Indigenous Australians. Education enables Indigenous women to access and interpret health-related information to prevent ill health, and it also improves their capacity to engage effectively with the health care system when necessary (Jones et al., 2014). In Indigenous women, higher levels of education are directly linked with positive health outcomes; for example, an Indigenous woman is less likely to smoke if she completes secondary schooling (Australian Government Department of Health Ageing, 2012; Biddle Cameron, 2012). However, Indigenous women have poor rates of formal education attainment; just 29% of Indigenous people complete Year 12 compared with a nationa l average of 73% (ABS, 2012). Indigenous women with a lower standard of education are more likely to bear a child in their adolescent years, a particular problem for Indigenous women generally, and are also more likely to have a child with a low birthweight (Comino et al., 2009; Osborne et al., 2013). Additionally, Indigenous mothers with lower standards of education are more likely to children with poor educational outcomes; this highlights the significant problems associated with the intergenerational transfer of health and social risk in Indigenous communities (Benzies et al., 2011). Education is related directly to an Indigenous womans level of economic participation à ¢Ã¢â€š ¬Ã¢â‚¬Å" specifically, her ability to gain employment and earn an adequate income, both of which are key predictors of health (Osborne et al., 2013). Research suggests that an Indigenous persons chance of gaining employment increases by 40% if they complete Year 10 and by 53% if they complete Year 12 (N ew South Wales Government Department of Education Training, 2004). However, as with low education, low employment is a significant problem for Indigenous women; indeed, rates of unemployment for Indigenous women are above 16%, compared with a national average of just 4% (ABS, 2013). Economic disadvantage resulting from unemployment is a significant predictor of poor health. Booth and Carrol (2008) suggest that economic variables can explain up to 50% of the disparity in health between Indigenous and non-Indigenous Australians. Additionally, and demonstrating the cyclical nature of socioeconomic disadvantage and poor health in Indigenous communities, research also suggests that poor health may explain 60% of the disparity in employment participation between Indigenous and non-Indigenous women (Kalb et al., 2011). Unemployment and socioeconomic disadvantage may affect the health of Indigenous women in a range of ways. Primarily, limited disposable income à ¢Ã¢â€š ¬Ã¢â‚¬Å" in comb ination with a lack of food storage and cooking facilities within households and, particularly within remote communities, lack of access to fresh food itself à ¢Ã¢â€š ¬Ã¢â‚¬Å" means indigenous women have reduced access to nutritionally-appropriate foods and lower food security (Osborne et al., 2013; Browne et al., 2014). Indeed, the diets of Indigenous people in many regions are characterised by a high intake of saturated fats, refined carbohydrates and salt, and little to no intake of fresh fibre-rich foods (ABS, 2006). In Indigenous women, as in all women, nutrition is fundamental to health in the ante-, intra- and post-partum periods (Browne et al., 2014). Poor dietary intake leads to high rates of gestational diabetes mellitus among Indigenous mothers à ¢Ã¢â€š ¬Ã¢â‚¬Å" 5.1%, compared with a national average of 4.5% (2000-2009 estimate) (Chamberlain et al., 2014). Poor nutritional status also underpins the burden of chronic disease evident in Indigenous women and particularly c hronic diseases related to obesity, which are a significant problem in Indigenous communities (Liaw et al., 2011). Around 60% of Indigenous women aged 25-55 years have a body mass index which indicates they are obese (ABS, 2006). Because of the risks posed by chronic disease, Indigenous mothers are significantly more likely than non-Indigenous mothers to require antenatal hospital admission (Badgery-Parker et al., 2012). Additionally, maternal chronic disease means that around 11% of indigenous neonates have a low birthweight (ABS, 2014). This is an important marker for increased risk of chronic disease, again demonstrating the cyclical nature of socioeconomic disadvantage and poor health outcomes in Indigenous communities. Socioeconomic disadvantage has a variety of other impacts on Indigenous mothers. For example, lack of employment and poverty mean that many Indigenous women have reduced access to appropriate housing. Up to 28% of Indigenous people live in housing which is sev erely overcrowded and where basic facilities à ¢Ã¢â€š ¬Ã¢â‚¬Å" including showers, toilets and stoves à ¢Ã¢â€š ¬Ã¢â‚¬Å" are not available or do not work (Osborne et al., 2013). Compounding the issue of poor housing is the fact that Indigenous Australians, and particularly those living in regional and remote communities, have disproportionate access to essential health infrastructure such as safe drinking water, rubbish collection services, sewerage systems and a reliable supply of power (Australian Human Rights Commission, 2007; Osborne et al., 2013). Indeed, lower standards of housing health infrastructure in Australian communities contribute directly to the high rates of parasitic and bacterial infection and increased rates of physical injury à ¢Ã¢â€š ¬Ã¢â‚¬Å" for example, from house fires à ¢Ã¢â€š ¬Ã¢â‚¬Å" among Indigenous women (Bailie Wayte, 2006). Inappropriate, overcrowded housing has had other impacts on Indigenous mothers. Specifically, it has led to breakdowns in tr aditional, complex social structures, norms and spiritual practices in Indigenous communities (Osborne et al., 2013). This has resulted in increases in the rates violence, including domestic violence, perpetrated against Indigenous women; indeed, Indigenous women are 40 times more likely than non-Indigenous women to experience violence, and are 35 times more likely to experience intra-familial violence which results in hospitalisation (Osborne et al., 2013). Indigenous people are also significantly more likely than non-Indigenous people to experience sexual assault (Phillips Park, 2006; ABS, 2009). The Australian Human Rights Commission (2007) notes that a combination of unemployment, the receipt of welfare payments and a lower standard of education also predispose Indigenous women to an increased risk of poor health outcomes due to violence. In Indigenous women in particular, social capital à ¢Ã¢â€š ¬Ã¢â‚¬Å" including a connection with community, country and culture, is positi vely correlated with wellbeing (Brough et al., 2004; Biddle, 2012; Osborne et al., 2013). The relationship between social capital and mental wellbeing, particularly in Indigenous people, is well-established, however the correlation between social capital and physical wellbeing is now also acknowledged. For example, a number of Australian studies have demonstrated that Indigenous people who are connected to their community, country and culture are less likely to be diagnosed with a range of chronic health conditions including obesity, diabetes mellitus, hypertension and renal disease (Burgess et al., 2009; Campbell et al., 2011). Where there are declines in social capital, therefore, the mental and physical health of Indigenous women also decline. Shepherd et al. (2012) report on the growing body of knowledge which suggests that Indigenous peoples social environment may significantly affect their mental health. Rates of mental illness among Indigenous women are high; indeed, Indig enous women are 2.6 times as likely as non-Indigenous women to report experiencing psychological distress and are also more likely to engage in self-harm and / or suicide (Australian Human Rights Commission, 2007; Burns et al. 2015, np). Mental illness is also strongly correlated with poverty; for example, Australian research suggests that people in poverty lack a sense of control over their lives and so experience higher levels of psychological stress (Australian Human Rights Commission, 2007). In addition to poor mental health, psychological stress can also lead to poor physical health outcomes à ¢Ã¢â€š ¬Ã¢â‚¬Å" specifically, via negative effects on the immune and cardiovascular systems and metabolic function (Australian Human Rights Commission, 2007; Shepherd et al., 2012). Mental illness is not only underpinned by social health determinants, it is also problematic in terms of modifying the social factors which underpin poor health outcomes in Indigenous communities. For example , Marmot (2011) suggests that, in Indigenous communities, marginalisation results in disempowerment which in turn leads many Indigenous women to perceive little value in efforts to make health-related changes. Social dysfunction and high rates of mental illness in Indigenous communities is driven by à ¢Ã¢â€š ¬Ã¢â‚¬Å" and, indeed, drives à ¢Ã¢â€š ¬Ã¢â‚¬Å" the high rate of substance abuse in these communities (Osborne et al., 2013).   Indigenous women are twice as likely as non-Indigenous women to smoke on a daily basis, and three times as likely to smoke during pregnancy (Osborne et al., 2013; Passey et al., 2013). Approximately 50% of Indigenous people report consuming alcohol at least once per week, 28% report current regular use of illicit substances including cannabis and other drugs, and 15% engage in risky behaviours related to substance use (ABS, 2006). Substance abuse is an important social determinant of health; the correlation between substance use and poor outc omes in terms of both physical and mental health in adults is well-established. Whilst the prevalence of Indigenous mothers who use alcohol and illicit substances is unknown, rates of fetal alcohol spectrum disorder and neonatal abstinence syndrome are high among Indigenous neonates (AIHW, 2015). Additionally, Indigenous mothers who abuse substances are at greater risk of losing custody of their children; because of the relationship between social capital and health in Indigenous communities, this can itself be perceived as a poor health outcome (Australian Human Rights Commission, 2007; Osborne et al., 2013). As noted by the Australian Government Department of Health and Ageing (2013), poverty limits the access of many Indigenous people to health care services. This is particularly true in regional and remote communities à ¢Ã¢â€š ¬Ã¢â‚¬Å" and approximately 46% of Indigenous women live in an area classified as regional or remote (ABS, 2010). Though many regional and remote Indig enous communities are supported by fly-in fly-out health services, research suggests that fragmented services and discontinuity of care can contribute to poor health outcomes for Indigenous women (Bar-Zeev et al., 2012). Many communities have no health services at all, and to receive medical attention Indigenous women are often required to travel long distances to regional centres. Although the federal government subsidises the transport and accommodation expenses associated with such trips, general living costs borne by Indigenous women are often significant (Kildea et al., 2010). Additionally, the costs for those accompanying a woman are often not subsidised, so women may be required to travel without support (Kildea et al., 2010). These issues affect Indigenous mothers disproportionately; for example, in comparison to non-Indigenous women, Indigenous women tend to access antenatal care both less frequently and later in their pregnancy, and this is underpinned by lack of access to care (Osborne et al., 2013). Further complicating these issues is the fact that the risk-prevention paradigm evident in many medicalised health services is incompatible with the holistic perception of health held by many Indigenous women (Ireland et al., 2011). Additionally, historic protectionist and paternalist attitudes directed towards Indigenous people continue to pervade many medicalised health services in Australia. Durey and Thompson (2012) suggest that racism, both covert and overt, towards Indigenous women in Australian health services remains a significant problem; indeed, the Australian Human Rights Commission (2007) notes that systematic discrimination is a key factor underpinning the lack of opportunity for Indigenous Australians achieve a health status equitable to that of non-Indigenous Australians. These issues associated with culturally-safe service provision often culminate in Indigenous mothers disengaging from medicalised health services. This is a significa nt problem considering a lack of antenatal and intrapartum care in particular, and health care in general, is fundamental to the high maternal morbidity and mortality rates in Indigenous communities (AIHW, 2014a). This paper has provided a critical analysis of the many social determinants of health for Australias Aboriginal and Torres Strait Islander peoples à ¢Ã¢â€š ¬Ã¢â‚¬Å" and, particularly, Indigenous mothers. It has demonstrated that social factors underpin the health of Indigenous mothers in both the physical and mental domains. It has also provided evidence for the complex relationship between health and social determinants in Indigenous mothers. 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The Veil of Economic Inequality - Literature Essay Samples

In 1903 the controversial black rights leader W.E.B. DuBois wrote one of the most influential African-American books to date. In The Souls of Black Folk, DuBois proclaims that the problem of the twentieth Century is the problem of the color-line(xxxi). Now, the twenty-first century has begun and it seems as though the color-line issue, of distinct racial prejudice, has been resolved through the elimination of slavery and racial segregation and the application of the Civil Rights Act. In truth however, America has not conquered the race problem. Now, though less identifiable, the new problem of the color-line is even more applicable post the benchmark Civil Rights Act. Though there have been slight advancements in social equality, there is, more than ever, economic conflict and class struggle embedded in racial discrimination, leading to the new problem of the twenty-first Century, racial inequality in economics and class. DuBois very broadly describes the problem of the color-line in The Souls of Black Folk, in much length and expertise. However it can be summed up in one question from the book: How does it feel to be a problem? To which, DuBois answers being a problem is a strange experience (DuBois, 1). DuBois poses this query to himself, other blacks in America, and even whites. He asks African Americans to revaluate their current status in America. DuBois seeks out blacks that will not only understand and realize the current anti-black sentiment of the time, but also actively work to change the distinctive conception of black racial identity, in a society that viewed blacks with contempt. DuBois openly announces that he is the problem. He doesnt wish anyone to avoid the issue of racial division, saying such things as I know an excellent colored man in my town; or, I fought at Mechanicsville (DuBois, 1). He admits to contributing to the twentieth century problem in America, the continued struggle for social recognition and cultural identity of blacks. The p roblem is both as simple and complex as the statement. According to DuBois, the problem in twentieth century America is blacks. However, complexity arises when analyzing the social situation of blacks in America. The problem is rooted in ethnic divisions between blacks and whites, but develops much further into the effects, mentally, economically and socially, on African Americans. Thus we have the seemingly changed twenty-first century, where due to elimination of forced slavery and segregation, we have so proclaimed equality between blacks and whites. However, does this forgiveness of the dark side of American history, really give us evidence of equality? Though we have made advancements, racial inequality is still prominent in our post-Civil Rights age. Is equality evident in schools, where teenagers still self-segregate between races? In Gary Younges article White-Only Proms Dancing to an Old Southern Segregationist Tune, he reported in 2003, students in rural Georgia at Taylor County High School self segregated their prom. A milestone event, the school held its first integrated prom in 31 years in 2002. However, due to interracial conflicts in the 2002 school year, school officials stopped sponsoring dances, and shortly after, parents and students began organizing separate dances for whites and blacks. However, this self-segregation is not an isolated issue; Bob Jones University in South Carolina only lifted its ban on interracial dating in 2000. Also in 2000, the high school in Coldwater, Mississippi, held separate votes for its black and white homecoming queens (Younge). Though these situations were all self imposed by blacks, self-segregation instances do shed light on an important critique in American social inequality. If blacks were made to feel equal with whites they would not self segregate themselves, and perhaps be more motivated to incorporate themselves into a higher social and economic status, on par with whites.Thus we begin to uncover the p sychology of the black individual, the fragmentation of power. DuBois refers to the strange experience as being born with a veil, and gifted with second-sight in this American world, a world which yields him no true self-consciousness, but only lets him see himself through the revelation of the other world always looking at ones self through the eyes of others, of measuring ones soul by the tape of a world that looks on in amused contempt and pity (DuBois, 38). This fragmentation creates a sense of two selves, neither one recognized by whites. In a study connecting physical ailments with subtle racial prejudice, Rob Stein reported Sarah Person, a member of the study; to having said It (racial prejudice) happens all the time. Its part of day-to-day experiences, unfortunately. But you are never prepared for it, it makes you feel like youre out of rhythm with the rest of the world, and like theres no justice. Blacks want what we all want, to better ourselves. They however, must first m erge the double self into one truer self, recognized by all of America. Unfortunately, this decision to change cannot be made by blacks alone. DuBois called out to Americans all across the nation to make it possible for a man to be both a Negro and an American, without being cursed and spit upon by his fellows, without having the doors of Opportunity closed rough in his face (DuBois, 39). The doors of Opportunity, unfortunately, have not been completely opened to blacks, even since DuBoiss call for justice in 1903. Though advancements have been made in black education efforts, social welfare and sports, America has really not developed as well or as quickly as the greatest nation on earth should have. White America fails to recognize many important black attributes. For example, in the 1996 Olympics, European squads fantasies of gold were being crushed by a U.S. Dream Team of eleven West African-Americans and a lone white (Sailer). However, we ignore those aspects of American socie ty where equality is most important, such as equal employment opportunity and social equality. One may argue that blacks are slowly rising to equality in these areas, for example, publicly important figure Secretary of State, Condoleezza Rice. However, only upon investigation of her role as Secretary of State can we truly understand her function as a false ethnic icon. Rice stands on a pedestal to be viewed by all Americans, blacks and whites. Her purpose is to portray blacks as rising in social and economic standing. According to The Black Commentator, blacks, historically excluded from high titles, have applauded every African American first as collective victory. This was a logical and correct response to the solid wall of white refusal to tolerate the presence of Black faces in high places. In such circumstances, which still prevail today in vast swaths of American society, individual advancement actually does represent a kind of collective triumph. The rule applies, even in are as of endeavor having little effect on the lives of Black people. Indeed, the more exclusively white the enclave or activity, the greater the shared victory once the color line is crossed (The Black Commentator). However, as one critic states, Rice is the purest expression of the race traitor (The Black Commentator). Many would say, according to DuBois, that she has bleached her Negro soul in a flood of white Americanism, supporting such anti-black opinions as the Bush partys campaign against affirmative action. Though we are making progress, at what alarmingly slow rate is this progression continuing? Blacks are still the targets of economic and social prejudice in mainstream areas, such as the American judicial system. The Federal Bureau of Justice revealed an alarming statistic; Twenty percent of all black men born from 1965 through 1969 had served time in prison by the time they reached their early thirties. By comparison, less than 3 percent of white males born in the same time period had been in prison. Being jailed in federal or state prisons has become so common today that more young black men in the United States have done time than have served in the military or earned a college degree. (Schwarz). Spending time in jail, or persecution by the law seems to be an everyday part of black lives. Is it that blacks are really dramatically more crime prone than whites? Or could the issue at hand be unequal treatment under the law? This concept is so real and appropriate nowadays that the issue of unequal racial treatment under the law has even forced itself into contemporary music. Popular black rapper, Jay-Z, brings light on the subject in his song, 99 Problems. The song describes all of the problems a young black man faces, one being unequal race treatment. The song details the correspondence between a white police officer and the black male driver he has pulled over: White officer: Son do you know why Im stoppin you for? Black man: Cause Im young and Im b lack and my hats real low. Do I look like a mind reader, sir? I dont know. Am I under arrest or should I guess some mo?White officer: Well you was doin fifty-five in a fifty-fo. License and registration and step out of the car. Are you carryin a weapon on you, I know a lot of you are. (Jay-Z)Contrary to the common stereotype, there is no evidence to suggest blacks are simply more violent or prone to crime. They are perhaps, more motivated to commit profit crimes in order to rise in economic status. Therefore, there is a social and psychological reason behind these crimes. We, as Americans, then have a more complex dilemma to solve, establishing economic equality between blacks and whites. Thus, blacks would be less inclined to commit the two most frequent non-violent crimes in the United States, theft and drug possession with intent to sell (Federal Bureau of Justice). Then blacks can be further integrated into higher American society, enough to shed their double selves for a more c oncise, accurate and respected one.Economic inequality is further evident where black wages are still lower than white wages. PhD. Professor of Sociology, David Newman states, according to the U.S. Bureau of the Census, that the average annual income for black households is $30,43, compared to $44,232 for whites. Black unemployment is also twice as high as that of whites and only 48% of blacks own their own homes compared to 74% of whites (Newman, 389). Though America has abolished such inequalities as slavery and forced segregation, Americans have not proved the wishful idea that after years of racial inequality, blacks and whites are finally equal in all aspects of law and society. The color-line problem has not been resolved, merely changed to show the economic and psychological aspects of black fragmentation and powerlessness, the new problem of the twenty-first century. The problem of economic inequality is simply an expansion of the racial crisis. This powerlessness was horrif ically made known to the rest of America after the crisis of Hurricane Katrina on the Gulf Coast. Over a million people were displaced after the class five hurricane hit the city of New Orleans on August 29, 2005. The official death toll stands at 1,325, with 6,644 others unaccounted for, and 1,300 of them feared dead (Hurricane Katrina). The hurricane not only did irreplaceable damage to one of Americas great cities, it also devastated Americas progressing racial equality. The U.S. Census Bureau estimates the 2004 New Orleans population to be 20% white and 68% black. Within the city itself, the poorest citizens tended to live in the lowest parts that are most vulnerable to flooding, most of these citizens being black. Vivid news video and photographs accurately showed primarily poor, black citizens stranded in New Orleans, without food, water or shelter. Furthering the racial conflict, specific derogatory language was later used in regard to predominately black citizens, referred t o as looters. Looting usually means large-scale theft and pillaging, not the taking of necessities such as water, that some desperate people engaged in. On September 2, while presenting the Concert for Hurricane Relief, music producer and rapper Kanye West openly said what so many black activists and political minds were thinking. He strayed from his script and addressed the racism of both the government and of the media, stating, George Bush doesnt care about black people. He also asked the media to stop labeling African-American families as looters while white families were depicted as looking for food (Hurricane Katrina). Hurricane Katrina has opened many American minds to United States racial inequalities, including that of health. Poverty, unemployment, and neglect all contribute to the health divide for the poorest black communities across the United States. However, the result is a racial health gap, which has endured and even grown, despite years of health development and o verall economic growth. As we struggle to rebuild the damage of Katrina, the most destructive and natural disaster in the history of the United States, American, now more than ever, should analyze and speculate to create more racially equal communities. It is even more important that we and others apply these lessons to help the many other individuals and communities who continue to languish out of the public eye (Dickinson). The root of under employed and under paid black Americans is unequal racial prejudice and discrimination. If blacks are not equal in racial standing how can they receive equal treatment, legally and socially? Therefore we have the altered, the veiled economic problem, of the twenty-first century. In The Souls of Black Folk, DuBois coins one of the most simple and descriptive terms in understanding the quintessential African American experience. He reveals that all African Americans are living in the two worlds within and without the Veil, a Veil of uncertainty that implies the whites lack of clarity in seeing blacks as true Americans, deserving of every legal and social right they themselves posses (xxxi). The veil also explains blacks lack of understanding as to how they see themselves, separate from white America and their stereotypes and assumptions. Even after racial advancements such as the Civil Rights Act, we have a new crisis that is not actually so different from the old one. Racial inequality has been veiled, though evident in so many aspects of everyday American life, to reveal economic inequality, the new racial problem of twenty-first century America.Works CitedDickinson, Emma. A Virtual Katrina of Deaths Every Week in US Due to Racial Health Gap. 20 Oct. 2005. British Medical Journal. 5 Dec. 2005. DuBois, W.E.B. The Souls of Black Folks. Chicago: A.C. McClurg and Co., 1903. Hurricane Katrina. Wikipedia. 6 Dec. 2005. Jay-Z. 99 Problems. The Black Album. Rick Ruben., 2005.Newman, David M. Sociology: Exploring the Architectu re of Everyday Life. 5th ed. Thousand Oaks: Sage Publications, Inc., 2004. Sailer, Steve. Great Black Hopes. 12 Oct. 1996. National Review. 4 Dec. 2005. .Schwarz, Joel. More Young Black Men Have Done Prison Time than Military Service or Earned College Degree, Study Shows. 20 May 2004. The Real Cost of Prisons Weblog. 4 Dec. 2005. .Stein, Rob. Study Links Discrimination, Blacks Health Stress From Persistent, Subtle Slights May Increase Heart Disease Risk in Women Washington Post 1 May 2005. A17The Black Commentator. Condoleeza Rice: The Devils Handmaiden. 4 Dec. 2005. .The Federal Bureau of Justice. Key Crime and Justice Facts at A Glance. 13 Nov. 2005. 5 Dec. 2005. . Younge, Gary. White-Only Proms: Dancing to an Old Southern Segregationist Tune. Guardian Unlimited. 3 May 2003. Guardian Newspapers Limited. 10 Nov. 2005 .