5. Tier 2 – Determinants of health
Health is influenced by social determinants and individual health risk factors. Social determinants of health refer to the circumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with illness. These circumstances are in turn shaped by a wider set of forces such as economics, social policies, and politics (Commission on Social Determinants of Health 2008).
Using both the 2012–13 Australian Aboriginal and Torres Strait Islander Health Survey (AATSIHS) (for data for Indigenous Australians) and 2011–12 Australian Health Survey (AHS) (for data for non-Indigenous Australians), the level of good health among Indigenous and non-Indigenous Australians were measured. Aligning with the World Health Organization’s view of good health, which is a state of complete physical, mental and social well-being, several components were assessed. That included a combination of self-assessed physical health, self-reported long-term health conditions (morbidity score) and emotional wellbeing based on self-reported level of distress (emotional distress score), the key factors that contributed to a large part of the health gap between Indigenous and non-Indigenous Australians were identified (AIHW 2018):
- Socioeconomic factors (social determinants) explained 34% of the total health gap between Indigenous and non-Indigenous Australians. The leading social determinants that accounted for the health gap include household income (explained 14% of the total health gap) and employment and hours worked (12%) (Figure 5.1).
- Individual health risk factors explained 19% of the total health gap between Indigenous and non-Indigenous Australians. The leading health risk factors that accounted for the health gap were smoking (10% of the total health gap) and overweight or obesity (7.2%).
It is likely that differences in access to affordable and nearby health services explain a significant proportion of the health gap between the Indigenous and non-Indigenous populations. Health service accessibility could not be quantified in the analysis because comparable measures of access to services were not available in the two surveys used.
Figure 5.1: Health gap between Indigenous and non-Indigenous Australians explained by social determinants and health risk factors, 2011–13 (%)