What works? A review of actions addressing the social and economic determinants of Indigenous health

Introduction: The purpose of this paper is to review evidence relating to ‘what works’ to influence the social and economic determinants of Indigenous health, in order to reduce health inequities, and ultimately contribute to closing the life expectancy gap between Indigenous and non-Indigenous Australians. We outline a conceptual framework for understanding how social and economic determinants influence health and wellbeing, and identify a number of key determinants of health. We review evidence relating to how each determinant is associated with Indigenous health and wellbeing, and then consider specific actions designed to improve Indigenous outcomes in each of these areas in order to determine the characteristics of successful initiatives. Based on our conceptual framework, we link successful actions which result in positive outcomes for Indigenous Australians in each of the key determinants to ultimately improving health and wellbeing and contributing towards ‘closing the gap’ in health and wellbeing. We note that many actions we consider only aim to improve the situation for Indigenous Australians in regard to that specific area (for example, education, housing) and were not devised to take direct action to improve health, even though the evidence indicates that those actions may be likely to contribute to improved health over the longer term

Are the National Preventive Health initiatives likely to reduce health inequities?

This paper examines commitments to address health inequities within current (2008–11) Australian government initiatives on health promotion and chronic disease prevention. Specifically, the paper considers: the Council of Australian Governments’ ‘National partnership agreement on preventive health’; the National Preventative Health Taskforce report, ‘Australia: the healthiest country by 2020’; and the Australian Government’s response to the taskforce report, ‘Taking preventative action’. Arising from these is the recent establishment of the Australian National Preventive Health Agency. Together, these measures represent a substantial public investment in health promotion and disease prevention. The present paper finds that these initiatives clearly acknowledge significantly worse health outcomes for those subject to social or economic disadvantage, and contain measures aimed to improve health outcomes among Indigenous people and those in low socioeconomic status communities. However, we argue that, as a whole, these initiatives have (thus far) largely missed an opportunity to develop a whole of government approach to health promotion able to address upstream social determinants of health and health inequities in Australia. In particular, they are limited by a primary focus on individual health behaviours as risk factors for chronic disease, with too little attention on the wider socioeconomic and cultural factors that drive behaviours, and so disease outcomes, in populations

Health equity and sustainability: extending the work of the Commission on the Social Determinants of Health

The final report of the WHO Commission on Social Determinants of Health presents opportunities to promote synergies between health equity and action on sustainability, including reducing global warming. The report makes important recommendations for political and economic reform, but stops short of calling for major change to the conventional neo-liberal model of economic development and growth. Yet the challenge of global warming appears to make growth according to this model unfeasible. In this paper we explore opportunities in the work of the Commission for combining goals of health equity and sustainability, and discuss ideas for economic reforms which further challenge the dominant model, and seek to accommodate the imperatives of reversing climate change

Digital technology use among disadvantaged Australians: implications for equitable consumer participation in digitally-mediated communication and information exchange with health services

The considerable variation in ICT access and use within lower income and disadvantaged groups must be acknowledged and accommodated by health initiatives and services when delivering digitally-mediated consumer-provider interaction, online health information, or online self-management of health conditions. If services require consumers to participate in digitally-mediated communication exchange, then we suggest they might support skills and technology acquisition, and/or provide non-ICT alternatives, in order to avoid exacerbating health inequities

Social determinants in an Australian urban region: A 'complexity' lens

This item is under embargo for a period of 12 months from the date of publication, in accordance with the publisher's policy. This is a pre-copyedited, author-produced PDF of an article accepted for publication in Health Promotion International following peer review. The version of record [Fisher, M., Milos, D., Baum, F., & Friel, S (2014) Social determinants in an Australian urban region: a ‘complexity’ lens, Health Promotion International] is available online at: doi: 10.1093/heapro/dau071Area-based strategies have been widely employed in efforts to improve population health and take action on social determinants of health (SDH) and health inequities; including in urban areas where many of the social, economic and environmental factors converge to influence health. Increasingly, these factors are recognised as being part of a complex system, where population health outcomes are shaped by multiple, interacting factors operating at different levels of social organisation. This article reports on research to assess the extent to which an alliance of health and human service networks is able to promote action on SDH within an Australian urban region; using a complex systems frame. We found that such an alliance was able to promote some effective action which takes into account complex interactions between social factors affecting health, but also identified significant potential barriers to other forms of desired action identified by alliance members. We found that a complex systems lens was useful in assessing a collaborative intervention to address SDH within an urban region. Key words: Complex systems, urban health, social determinants of health, collaboratio

Vicious cycles: digital technologies and determinants of health in Australia

This is a pre-copyedited, author-produced PDF of an article accepted for publication in Health promotion International following peer review. The version of record [Baum F, Newman L, Biedrzycki K (2014), ‘Vicious cycles: digital technologies and determinants of health’. Health Promotion International, 29 (2), 349-360.] is available online at: http://heapro.oxfordjournals.org/The use of digital technologies continues to bring rapid changes to personal and institutional forms of communication and information. Digital technologies are becoming increasingly important as ways to gain access to most of the important social determinants of health including employment, housing, education and social networks. However, little is known about the impact of the new technologies on opportunities for health and well-being. This paper reports on a focus group study of their impact on people from low socio-economic backgrounds. It uses Bourdieu’s theories of social inequities and the ways in which social, cultural and economic capitals interact to reinforce and reproduce inequities to examine the ways in which digital technologies are contributing to these processes. Six focus group discussions with 55 people were held to examine their access to and views about using digital technologies. These data are analysed to determine what factors facilitate access to digital technologies and what the implications of exclusion from the technologies is likely to be for the social determinants of health. The paper concludes that some people are being caught in a vicious cycle whereby lack of digital access or the inability to make beneficial use reinforces and amplifies existing disadvantage. The paper concludes with a consideration of actions health promoters could take to interrupt this cycle and so contribute to reducing health inequities

Australian children's accounts of the closure of a car factory: global restructuring and local impacts

This paper presents children’s accounts from Adelaide, South Australia, about parental job losses from automotive manufacturing: an industry that is being restructured globally. The research is informed by the “new sociology of childhood” and nests within a longitudinal, mixed-method study of 372 displaced workers. We interviewed 35 boys and girls aged 4 to 19 from 16 families. Findings support calls for children’s voices to be heard. Many children did not see the job loss as a major problem, some felt they now had a better life, and many valued not moving for new work. While some reported social, health and financial impacts, others were shielded by parents. Parents consented to their children’s involvement in 23% of in-scope families and those who had moved interstate were not included. Nevertheless, the children’s accounts contribute a better understanding of adult domains, including the value of family-friendly work patterns; they also highlight the benefits of including children’s perspectives on social and economic change. Economic and policy contexts that may have limited the job loss impact include the welfare state, trade unions, a low unemployment rate and government intervention to manage job loss

Digital technology access and use among socially and economically disadvantaged groups in South Australia

This paper explores digital technology access and use (computers, Internet and mobile phones) among lower income and disadvantaged groups in Australia. It reports focus group research which identified wide differences in frequency and quality of use, and in skills, confidence and trust. It identifies pathways to digital use (or non-use) related to existing socioeconomic inequities which mean that lack of (or limited) digital access or use creates further barriers to improving the underlying determinants of that use. Technological solutions to the digital divide must therefore be accompanied by a broader digital inclusion approach.South Australian Department of Health; South Australian Department of Further Education, Employment, Science & Technology. National Health & Medical Research Institute; Australian Research Counci