The health of people or a group of people is dependent and associated to a host of inter-related factors such as economic, cultural, political, historical, environmental, psychosocial and social, that make an effective contribution to the engagement or lack of in health programs and opportunities for seeking improved health outcomes (Institute of Medicine, 2002). Inequalities in health arise from the prevailing and existing inequalities in the society in terms of the major social determinants of health. They can be described as influences the people have in terms of the circumstances that they are born and brought up in and in which they grow, live and work. Culture tends to play an important role and its influence on health is vast as it affects the perceptions of people around healthcare, illness, diseases, death, beliefs about the causes of diseases , how and what treatment is preferred and accepted , where the patients go for seeking treatment and over-all approach to health care and health promotion as well. Understanding and recognizing all the aspects of social determinants of health pertaining to the different cultural identities of the diversity existing within different communities is crucial to ensure effective health practices.
In this article, two separate cultural groups, namely Aboriginal and Torres Strait Islanders and Indian migrants will be discussed.
The identified cultural group for the particular case study talks about a racial and ethnically diverse group of people belonging to the group of Aboriginal and Torres Strait islanders living in Australia. They are the original inhabitants of the mainland Australia and they consider land to be the main aspect of their existence including their religion, culture, idea of spirituality, language, family, identity and law as well. Also, they feel offended by the usage of the term “aboriginals” for them as they feel it depicts as if they had no identity or history of their own before the European invasion, only because it could not be recorded. Their specific culture as other social determinants of health tends to show a significant effect on their health as well. There exists a growing inequality and gap when it comes to the status of health and healthcare between the Aboriginal, indigenous population and the other Australians. This gap in care can be attributed to the social factors, which are found to be at the root of much of these inequalities in health (Shepherd et al., 2012). Social determinants are relevant to both- communicable and non-communicable disease alike.
The specific social determinants of health determining these health inequalities and inconsistencies include socioeconomic factors, psychosocial risk factors, culture, lifestyle, social capital, food insecurity, financial stress and accessibility to healthcare as well. Under the socioeconomic factors, the aboriginals seem to have a lower household income, or be unemployed or unable to work as well when compared to the non-indigenous people of the country (Markwick et al., 2014). The aboriginals seem to have a higher rate of negatively affecting -psychosocial factors such as psychological distress and mental stress as well. This arises from the growing socio-economic disparities and inequalities which shows a direst effect in health and a greater number of mental health issues (Kingsley et al., 2018). In terms of culture, their beliefs about health and health care directly affect their health behavior and accessibility to health services. For example, an aboriginal was less likely to seek help from a mental health professional as compared to a non-indigenous Australian. This happens because of their traditional health beliefs based on a culture of spirituality and social dysfunction, instead of modern medicine. This acts as a deterrent in terms of accessing healthcare, thus affecting negatively on the health status of the population (Vallesi et al., 2018). In terms of lifestyle determinants- the aboriginals were more likely to engage in risky behavior such as alcohol consumption, cigarette smoking and inadequate intake of fruits as well (Markwick et al., 2014). Poor social capital in terms of high financial stress, lower incomes, no permanent houses or neighborhoods to live in along with a comparatively weaker support system in terms of friends, social circle and people available for any kind of help are also some other, specific social determinants of health- negatively impacting the over-all health outcome for them
All these factors determine the presence or absence of risk factors in the people, which increase the chance or likelihood of the presence of a disease or illness. Specific health related risk factors present in the aboriginal group of people include, shortage of food or food insecurity, being underweight, increased alcohol and cigarette consumption, poor living conditions including unsafe drinking water and living in unsanitary and poor neighborhoods as well (Spurling et al., 2018). Other specific risk factors include health beliefs that prevent them from approaching or accessing health care facilities and doctors. Decreasing trust of the aboriginals in the government and the government health system as well is a major risk factor that negatively influences their health and health status (Aspin et al., 2012). Certain specific programmes and activities based on the policy context of “closing the gap” by the Australian government includes Anti-smoking policies, income management , petrol substitution, Caring for country, housing construction and maintenance, increased workforce capacity, dedicated facilities for provision of healthcare to aboriginals; are some examples amongst others (Fisher et al., 2019). However, the strategies do not focus on the social determinants of heath pertaining to their culture which is determining and driving their health behavior, irrespective of the availability or non-availability of the health facilities.
Looking at how cultural, religious and lifestyle associated factors affect the social determinants of health, it can be safely concluded that the person’s access to healthcare can be linked with his/her cultural and ethnic diversity and beliefs. The health status of an individual is both, a direct and indirect consequence of his/her culture and beliefs about health and healthcare. Thus, health promotion and education strategies, steeped in cultural and ethnic understanding of the diverse groups can help in improving the accessibility and uptake of health services and help in improving health outcomes as well.
More emphasis on reduction of discrimination that the aboriginals and the indigenous population faces when accessing health services could be one very effective strategy to improve health status. Provision of fare and equitable healthcare for everyone will also help in increasing the trust of the people in the government and the system as well (Vallesi et al., 2018). Drawing upon the cultural and traditional knowledge that they have can also help in developing health promotion strategies that will be based on their cultural and religious beliefs and be able to better dispel their doubts and myths around modern medicine and increase accessibility (Aspin et al., 2012).
The cultural group identified for the study includes the migrant population, coming from India, in the country. Indian migrants are the fastest growing population in Australia both in case of percentages and absolute numbers as well. This migration of Indians has been occurring since the times of the British colonization and European colonization as well and even before that as well. Around half of the Indian population residing in Australia has improved higher levels of education in terms of having a degree above Bachelor’s. Also, in terms of culture, the Indian migrants have maintained their culture through religion, ethnicity, languages, customs, traditions, lifestyle and philosophies- all of which seem to be affecting the health status of the population. Out of these, culture, customs and traditional beliefs seem to be the most highly affecting the health status and acting as a crucial social determinant of health for them in terms of shaping their health behavior and health beliefs as well (Indian immigration to Australia, 2017 ).
The specific social determinants of health addressing the status of health of the Indian migrant population in Australia includes their socio-economic status, levels of education and literacy, psychosocial factors such as mental stress, high academic and economic expectations, culture, food habits, social capital and financial security as well. Under the aegis of socio-economic status, the Indian migrant population had better and improved average salaries, when compared with other migrant groups and Australians as well (Thornton et al., 2016). However, they faced increasing discrimination while giving job interviews and getting their resumes short-listed. They had a considerable representation in the health workforce as well. They showed increasing mental and psychological stress with a reduced chance of seeking help from a mental health professional (Brijnath et al., 2020). Cultural beliefs and religious customs and attitudes also significantly affected their treatment seeking behavior in terms of increasing reliance on traditional medicine and conventional methods of treatment such as Ayurveda, Unani, yoga etc. This increasing reliance on traditional medicine translated into lesser rates of seeking health care from the existing healthcare professionals and less number of visits to the health-care facilities. Another cultural influence seriously affecting mental health is the refusal to seek help from a mental health professional due to the stigma associated with the same as a part of the Indian culture. The ideation of the evil eye casting spells and causing diseases also directly affects the health seeking behavior and thus, over-all health as well (Brijnath et al., 2020). As a part of the cultural ethos, any major illness or disease is to be disclosed and discussed with the family and important members and friends, so the concept of patient privacy and confidentiality around sensitive issues is also compromised as well. Food and dietary habits as a part of the Indian culture, and the refusal to follow dietary advice and dietary changes makes them more prone to diseases like Coronary heart disease diabetes etc. Also, noted was the development of resistance to following the doctor’s advice because of lack of recognition and inclusion of their cultural and spiritual beliefs in the treatment plan (Fernandez et al., 2015).
Thus, these social determinants lead to the presence of increased or decreased risk or protective factors affecting health in the population. Health risk factors such as alcohol consumption and cigarette smoking were markedly decreased in the Indian migrants, whereas lack of physical activity was a major risk factor present (Gilbert et al., 2019). Also, bad dietary habits including increased intake of carbohydrates, cholesterol and sugars as well (Fernandez et al., 2015). This led to an increased incidence of CAD and Diabetes in Indians. Immunization and vaccination rates were lower as compared to the rest of the Australian population, whereas the chances of breastfeeding were higher which acted as a protective factor (Rao et al., 2019). No specific programs or policies have been specifically made or adopted by the government for improving upon the health status of Indian migrants. However, certain refugee health programs do exist to help immigrants and refugees and asylum seekers to access health services. Also, there is no focus on dealing with the specific cultural social determinants of health which are directly affecting the health status along with the health seeking behavior as well.
After observing, how cultural, religious and lifestyle associated factors affect the social determinants of health, it can be safely concluded that the person’s access to healthcare can be linked with his/her cultural and ethnic diversity and beliefs. The health status of an individual is both, a direct and indirect consequence of his/her culture and beliefs about health and healthcare. Thus, health promotion and education strategies, steeped in cultural and ethnic understanding of the diverse groups can help in improving the accessibility and uptake of health services and help in improving health outcomes as well.
As evidenced in the discussion, lack of treatment adherence and accessing healthcare exists due to the inability of the health care providers and the government to make the services culturally and spiritually inclusive and sensitive (Gilbert et al., 2019). Thus, there exists a need to develop a more holistic, inclusive, culturally sensitive workforce in healthcare along with the development of a culturally sensitive and inclusive health promotion strategy as well to help in improving the health status and increase the uptake of services to promote positive health outcomes in the migrant population (Thornton et al., 2016).
It can be effectively summarized that there exist a number of differences and similarities in the social determinants of both the diverse cultural groups. Similarities in terms of cultural influences and barriers on seeking treatment and treatment adherence behavior exists which requires in both the cases, a culturally sensitive approach to health education, promotion and practice as well (Indian immigration to Australia, 2017 ). Also, noted similarity was in terms of the way in both the cases, even though a huge difference exists in terms of socio-economic conditions, financial background and social capital as well, both the groups were directly and equally affected by their culture and customs. In terms of differences, major variation exists in terms of economic, social and financial determinants of health , where the Aboriginals are struggling to achieve equity and overcome the inequalities and discrimination meted out to them and the Indian migrant diasporas is well-off and has improved access to food, housing, education and jobs as well (Kingsley et al., 2018).
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