Page 3305 - Week 08 - Tuesday, 16 August 2011

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agreement about the best way of doing so. Statistically, Australians are in very good health. We are consistently ranked in the top 10 OECD countries in terms of life expectancy. However, good health is not shared equally by all Australians. As stated by the Public Health Association, there are significant differences in the rates of death and disease, life expectancy, self-perceived health, health behaviours, health risk factors and health service utilisation. The determinants of the inequalities in health are often outside the health system and relate to differences in education, occupation, income, employment status, postcode, ethnicity and gender.

On average people who are in lower socioeconomic groups have shorter life spans and poorer health. They have higher rates of death and disease and are more likely to be hospitalised and less likely to use specialist and preventive health services. Up to 65 per cent of people in public housing have long-term health problems compared with only 15 per cent of homeowners.

The social determinants can be broadly defined as including healthy behaviours—eating more green vegetables, perhaps taking the stairs rather than the lift, and minimising your alcohol intake. Determinants also include socioeconomic characteristics such as education, housing and ethnicity. For example, Indigenous people with low levels of educational attainment were more likely than those who have completed year 12 to regularly smoke, to consume alcohol at high levels and engage in low levels of exercise. They were also less likely to eat fruit or vegetables on a daily basis.

Being overweight and obesity have become increasingly more prevalent among socially disadvantaged groups, particularly in urban areas. In 2008 a University of New South Wales study found that, like most other risk factors for ill health, excess body weight tends to be more prevalent among people further down the socioeconomic scale. Similarly, the use of tobacco increases as socioeconomic status decreases.

Broad features of society such as policies and decision-making authority also play a role. The impact on socioeconomic circumstances and physical environments which, in turn, influence people’s health and behaviour, their psychological and mental states and factors relating to safety can all produce further health effects. Unemployment and instability in employment can have a major impact on health. Education and employment are closely correlated. The lower wages and unemployment related to inferior formal qualifications—those people who do not attain year 12 or above—results in lower socioeconomic status. And lower socioeconomic status is universally associated with poorer health outcomes.

Employment can also have a direct impact on short-term health outcomes. A 2007 ANU study found that there is strong evidence that work is generally good for physical and mental wellbeing. Worklessness is associated with poorer physical and mental health and wellbeing. Work can be therapeutic and can reverse the adverse health effects of unemployment.

Social integration is also a key determinant of health. Social integrations can be defined as the comfortable insertion of a person within society. Social relationships

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