Social, Behavioural and Cultural Factors in Public Health 

Introduction to Social Determinants of Cardiovascular Health

In Australia, the Indigenous communities, including the communities of Aboriginals and Torres Strait Islanders, are the disadvantaged communities having lower socio-economic status and higher prevalence of numerous diseases than the other Australian communities. Waterworth et al. (2015) elucidated that on an average, the non-Indigenous males and females respectively live 10.6 and 9.5 years more than the Indigenous males and females. Cardiovascular diseases (CVD) account for the maximum number of deaths in Australia and have the maximum amount of associated healthcare expenditure (Australian Institute of Health and Welfare [AIHW], 2017b). The burden of poor cardiovascular health outcomes is also more prevalent among the Indigenous Australian people than their counterpart other populations (AIHW, 2017b). This report aims at analysing the burden of diseases associated with heart among Aboriginals and Torres Strait Islanders, and the social determinants associated with the same. Furthermore, public health interventions to ameliorate the cardiovascular diseases-related patient outcomes will also be discussed, along with the interventions that can be incorporated in sectors other than healthcare.

Section 1: Prevalence of Cardiovascular Diseases in Indigenous Australians

The Burden of Cardiovascular Diseases in Indigenous Australians

Cardiovascular diseases include the aberrant conditions related to the circulatory system components such as the heart and the blood vessels, including the arteries and the veins (Health Info Net, n.d.). Ischaemia/coronary heart disease (CHD) is the most common cause of deaths in Aboriginal and Torres Strait Islander peoples with the prevalence rate of 1.8 times that of their complementary non-Indigenous people (Reath & O’Mara, 2018). As per AIHW (2019), almost three per cent (580,300 individuals) of the Australian adults (having age of 18 years or more) reported having CHD(s) at some point of their lives in a national survey conducted by Australian Bureau of Statistics (ABS) in the year 2017-2018. They further illuminated that the rates of acute coronary incidences in the year 2016 were 2.8 times higher in Indigenous people of Australia than the non-Indigenous ones i.e. 939 and 336 events respectively per 100,000 events (AIHW, 2019).

Furthermore, the cardiovascular diseases account for twelve per cent of deaths in Indigenous people in the age group of thirty to thirty-nine years, while accounting only for 3.8% in the counterpart non-Indigenous population. According to AIHW (2019), and evaluated six per cent (1.2 million) of adults in Australia in the year 2017 to 2018 had at least one condition related to heart and/or vascular system, including stroke, and this reported prevalence was relatively greater for individuals living in the disadvantaged localities (6.4%) than those who lived in the minimum disadvantaged localities (4.8%) at that time. Additionally, an approximated four per cent of Indigenous Australians (24,500 individuals) reported to have vascular and/or heart diseases, including stroke, and Indigenous people were more likely to have cardiovascular disease incidences (7%) than the non-Indigenous people (4%) (AIHW, 2019).

Analysis of Social Determinants Associated with Cardiovascular Diseases

As opined by Hinton and Artiga (2018), social determinants associated with health include the conditions an individual is born in, grows and lives, and works and ages, and are responsible for shaping the health of an individual. These consist of the socio-economic status, physical surroundings, neighbourhood, education and employment, and networks available for social support that the person has and addressing these health determinants is important to ameliorate the health outcomes and decrease the disparities in healthcare (Hinton &Artiga, 2018). Moreover, the key factors increasing the risk of the occurrence of cardiovascular diseases include high blood cholesterol and glucose levels (diabetes), and hypertension, along with other lifestyle-related conditions such as being physically inactive and obese, smoking tobacco and intake of improper nutrition (Health Info Net, n.d.). CVD(s) are more prevalent amongst Indigenous Australians because of their greater association with the above-mentioned factors. Another presumable cause of this prevalence is the inadequate availability of health and healthcare services, and affordable and quality food services for the people of Indigenous communities in Australia (Reath & O’Mara, 2018).

Reath and O’Mara (2018) further elucidated that only fifty-three per cent of Indigenous people with pertinent cardiovascular conditions in the age group of 35 to75 years and forty-two per cent of those at high risk received the therapy useful for CVD patients, this illuminates the importance of ensuring the provision of required treatments to Aboriginals and Torres Strait Islanders to reduce the risk of CVD occurrence in them. Furthermore, socio-economic and psychological factors can also contribute to aberrant heart conditions, such as low levels of income and psychological distress, which according to Issacs, Enticott, Meadows and Inder (2018) are interdependent as they reported an association between these two factors. Moreover, thirty per cent higher recurrence of hospitalisations due to cardiovascular diseases in remote and highly remote localities was reported in AIHW (2019). As a greater proportion of Indigenous people (one in every five individuals) live in remote and highly remote areas than non-Indigenous ones (one in every fifty individuals) (AIHW, 2017a), the remoteness of living areas can also be associated with the poor cardiovascular health outcomes of Indigenous Australians.

Section 2: Interventions to Address the Social Determinants of CVD(s) in Indigenous Australians

Several strategies aimed at mitigating the cardiovascular diseases related incidences have been introduced in Australia by the Government (Department of Health, 2020). Some of these strategies include the strategy “closing the gap” executed, aiming to eliminate the disparity between the life expectancies of Indigenous and other people of Australia by the year 2031 and the “2014 to 2017 strategy” introduced, aiming to prevent, recognise and treat the CVD conditions in the Aboriginals and Torres Strait Islanders, specifically of those residing in Queensland (Queensland Health, 2015). However, no such promising ameliorations have been noted in the cardiovascular health outcomes of Indigenous people of Australia (Reath & O’Mara, 2018). Furthermore, Mbuzi, Fulbrook and Jessup (2018) elicited that the interventions taken to promote better outcomes of cardiovascular health and related risk factors in Aboriginal and Torres Strait Islander people can be influential and that chances of such improvements exist at all the stages of the cardiovascular disease continuum. This calls out for the need for effective interventions and strategies to address the poor heart health determinants of Indigenous Australians, including the social determinants.

Certain measures such as increasing the involvement of Indigenous leaders as workers in the healthcare sector can be beneficial in achieving the goal of ameliorating cardiovascular health outcomes. In addition to this, the improvement of communication between healthcare professionals via implementing strategic advocacy can also help alleviate the CVD incidences in Indigenous people. Furthermore, provision of sensitive, culturally integrated approaches in remote localities, along with regional areas where Indigenous people reside to reduce the barriers for them to reach special cardiac care facilities will be helpful and can significantly reduce the rate of occurrence of CVD in Indigenous Australian people, who currently do not have access to cardiac care facilities (Health Info Net, n.d.).

Interprofessional collaborations can also impart multiple benefits as these can be useful for promoting the cardiovascular health status in Indigenous people by assisting in sectors other than healthcare also, such as education and lifestyle-related health determinants of Indigenous Australians. The term "interprofessional collaboration" can be defined as the settings where professionals from varying backgrounds work in collaborations and partnerships with the same achievement goal of providing better care, for example, multiple healthcare professionals (Vega & Bernard, 2017). Similarly, nurses can work in collaborations with inter-disciplinary health organisations and other communities in Indigenous areas to provide services to Indigenous people, as nurses are taught to act as a crucial link between the healthcare providers and their patients.

Moreover, nurses can provide the Indigenous people with the training of skills and education that can help them deeply understand the importance of adopting a healthy lifestyle to attain longevity as health and education are strongly associated (Hart, Moore & Laverty, 2017). This can be done by educating people from Aboriginal and Torres Strait communities regarding the potential factors associated with the increasing risk of cardiovascular disease prevalence in them and thus helping them adopt healthy lifestyle habits, such as quitting smoking tobacco and being physically active. The presence of mutual respect during these interactions is mandatory to prevent anyone from becoming defensive and fostering their lack of engagement during the interaction. This can be achieved via providing culturally competent, safe and reliable interactive environments to the Indigenous people (Reath & O’Mara, 2018).

Conclusion on Social Determinants of Cardiovascular Health

The disadvantaged Indigenous Australian communities of Aboriginals and Torres Strait Islanders have lower socioeconomic status than their complementary non-Indigenous communities and thus numerous diseases, including cardiovascular diseases, are more prevalent amongst them. The incidences and risk of different CVD occurrences are 1.8-2.8 folds higher in Indigenous Australians than the other Australians and their mortality rates due to CVD are also higher when compared with their non-Indigenous counterpart populations. Several social determinants are also associated with these poor cardiovascular health outcomes in Indigenous populations such as their lifestyle habits, including physical inactivity and tobacco smoking, and the pertinence of other diseases such as diabetes and hypertension. Therefore, there is a need for appropriate interventions aimed at improving the health outcomes of Indigenous people to aggravate their longevity. These strategies include the implementation of patient-centred care approaches such as inter-professional collaborations and educational and skills training for Indigenous people to make them better acquainted with the risk factors associated with CVD and provide them better access to cardiac medical facilities.

References for Social Determinants of Cardiovascular Health

Australian Institute of Health and Welfare. (2017a). Australia’s welfare 2017: in brief. Retrieved from https://www.aihw.gov.au/getmedia/5c7b48ba-f5a2-46a6-96bd-2bbae02a5139/AIHW-AUS215-AW17_inbrief.pdf.aspx?inline=true

Australian Institute of Health and Welfare. (2017b). Cardiovascular disease: Australian Facts 2011. Retrieved from https://www.aihw.gov.au/getmedia/9621f6a8-f076-4e3e-a9c7-dece59ff0d74/12116.pdf.aspx?inline=true

Australian Institute of Health and Welfare. (2019). Cardiovascular disease. Retrieved from https://www.aihw.gov.au/getmedia/d78e3238-f992-445f-ac98-a65e7ecf5781/Cardiovascular%20disease.pdf.aspx?inline=true

Department of Health. (2020). What we’re doing about cardiovascular conditions. Retrieved from https://www.health.gov.au/health-topics/chronic-conditions/what-were-doing-about-chronic-conditions/what-were-doing-about-cardiovascular-conditions

Hart, M. B., Moore, M. J., & Laverty, M. (2017). Improving Indigenous health through education. The Medical Journal of Australia, 207(1), 11-12. http://dx.doi.org/10.5694/mja17.00319

Health Info Net. (n.d.). Cardiovascular Health. Retrieved from https://healthinfonet.ecu.edu.au/learn/health-topics/cardiovascular-health/

Hinton, E., & Artiga, S. (2018). Beyond health care: the role of social determinants in promoting health and health equity. Retrieved from http://files.kff.org/attachment/issue-brief-beyond-health-care

Issacs, A. N., Enticott, J., Meadows, G., & Inder, B. (2018). Lower income levels in Australia are strongly associated with elevated psychological distress: implications for healthcare and other policy areas. Frontiers in Psychiatry, 9(536). https://doi.org/10.3389/fpsyt.2018.00536

Mbuzi, V., Fulbrook, P., & Jessup, M. Effectiveness of programs to promote cardiovascular health of Indigenous Australians: a systematic review. International Journal of Equity in Health, 17(153). https://doi.org/10.1186/s12939-018-0867-0

Queensland Health. (2015). Queensland Aboriginal and Torres Strait Islander cardiac health strategy 2014–2017. Retrieved from https://www.health.qld.gov.au/__data/assets/pdf_file/0022/441049/cardiac-health-strategy.pdf

Reath, J. S., & O’Mara, P. (2018). Closing the gap in cardiovascular risk for Aboriginal and Torres Strait Islander Australians. The Medical Journal of Australia, 209(1), 17-18. Doi 10.5694/mja18.00345

Vega, C. P., & Bernard, A. (2017). Interprofessional collaboration to improve health care: an introduction. Retrieved from https://www.medscape.org/viewarticle/857823

Waterworth, P., Pescud, M., Braham, R., Dimmoc, J. & Rosenberg, M. (2015). Factors influencing the health behaviour of Indigenous Australians: Perspectives from support people. PLoS ONE, 10(11), e0142323. https://doi.org/.10.1371/journal.pone.0142323

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