Page 3306 - Week 08 - Tuesday, 16 August 2011

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and social support are important for mental and physical health. Social connections, including engaging with friends and peers, undertaking education, hobbies and other activities, have a direct benefit for health. Social integration is especially important for mental wellbeing. Studies show that people with mental illness are more likely to have smaller social networks and their network tends to decrease in size as the duration of illness increases.

Education is a key determinant of health as it provides individuals with skills and knowledge that can be used to improve their health and access appropriate services. Education impacts on health in two ways: firstly, through teaching that enables children to learn specifically about health; and, secondly, through the educational process as a whole which provides skills such as critical thinking and making choices that enable children to opt for healthy lifestyles.

Access to quality education and health literacy are strongly associated with health behaviours and risk avoidance, equipping individuals with the resources needed throughout the course of life to achieve a secure income, provide for family and cope with health outcomes later in life. Children from disadvantaged backgrounds are more likely to do poorly in school and drop out early. Subsequently as adults, they are more likely to feel less empowered to provide good health care, nutrition and stimulation to their own children.

Environmental factors such as provision of and access to local public facilities and spaces for recreation and play are directly correlated with health and wellbeing. Poorly planned urban road networks, overcrowding and building on unsafe land all reduce opportunities for physical activity and increase the risk for injury and violence.

All of these determinants have a significant impact on health service use. As previously mentioned, people in lower socioeconomic groups are less likely to use specialist and preventive health services. Just because health services exist does not mean that people are using them or using them well. Generally, for example, men use health services less than women. A general practice survey of Australian men found that one in four had not visited a GP in the last 12 months compared to one in 10 females. It is widely documented that your local GP plays a vital role in the monitoring and provision of health services. Often GPs are the first to acknowledge and the first to educate individuals on the impact that their lifestyle choices are having on their health and the health of their families.

In the ACT it can be difficult to access your local GP. The GP task force found that we currently have a shortage of 70 FTE doctors in the ACT equating to a shortage of 140 doctors on the ground. In recent years we have seen the closure of many small suburban GP clinics. This means that Canberrans have lost the valuable resource of a local GP who knows and understands their family’s circumstances and medical history. The low rate of bulk-billing GPs in Canberra further exacerbates the effects of health on low socioeconomic demographics. People simply cannot afford to see a GP in Canberra in a timely manner. Indeed, we have the highest cost of visiting a GP anywhere in Australia.

Why should we take action on the social determinants of health? Because health inequalities are unavoidable, but they are amenable to change. Shifts in

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