• Category:
  • Document type:
  • Level:
  • Page:
  • Words:

Social Determinant of Health

Social Determinant of Health


WHO defined social determinants of health (SDH) in terms of the circumstances, real life scenarios, environmental situations, living conditions, systems and policies that greatly influence the quality of life, growth, work, living standard, health and wellness of individuals across the community environment (WHO, 2016). The societal norms, jurisdictions, conventions and political agenda also attribute to the SDH that affect the daily lives of the common masses. The socioeconomic configuration of societies attributes to the significant aspect of SDH that govern the morbidity pattern and life expectancies of individuals of various age groups across various geographical confinements (Kronenfeld, 2013, p. 29). Social determinants of health extend direct implications in terms of improving or deteriorating the health and wellness of populations across the globe. The positive or negative behavioural attributes reciprocally develop under the influence of SDH and lead to the configuration of a healthy society or a society overburdened with various somatic as well as psychosocial conditions that make the affected individuals prone to the development of moderate to life threatening clinical morbidities. Social exclusion is one of the significant SDH that predominantly affects the lives of aboriginal natives residing across the Australian territory.

Influence of Social Exclusion on the Health of Aboriginal Australians

Social exclusion of any particular community might operate between generations under the influence of patterns of unemployment, poverty, racial discrimination, atrocities and stigmatization by the dominant societies (Dewall, 2013, p. 180). The affected individuals remain deprived of life’s necessities and experience the state of homelessness and inaccessibility of basic medical facilities across the community environment. These negative impacts of social exclusion lead to the events of premature deaths and poor hygienic conditions of the underprivileged individuals. Geographical confinements occupied by these impoverished individuals remain prone to the development of epidemic outbreaks that further deteriorate their socioeconomic as well as psychosomatic condition and elevate the mortality rate leading to the reciprocal increase in their disadvantaged conditions.

Evidence based research literature reveals the low socio-economic status of aboriginal natives as the most significant contributing factor for their social exclusion and resultant health disparities across the Australian subcontinent. The aboriginal community is evaluated by the dominant societies from the historical perspective in terms of their colonization, language, culture and geographical segregation. Aboriginal individuals remain confined to their ancestral locations affected with lack of healthcare resources leading to their predisposition toward the development of epidemic outbreaks and elevated patterns of morbidities and mortalities. The health inequalities experienced by aboriginal individuals attribute to their socioeconomic determinants like poverty and social exclusion across the community environment (Shepherd, Li, & Zubrick, 2012).

Research findings by (Markwick, Ansari, Sullivan, Parsons, & McNeil, 2014) indicate the underprivileged status of aboriginal population resulting in the development of patterns of anxiety and depression under the influence of their social exclusion and socio-economic constraints. Inaccessibility of aboriginal individuals to healthcare services offered by the mainstream society proves to be one the important determinant of their health and wellness deterioration across the community environment. The social exclusion of aboriginal natives gives rise to their psychosocial predisposition towards the development of mental and behavioural disorders under the influence of atrocities by mainstream society and patterns of food insecurity.

Evidence-based research literature reveals the consistent impact of colonization on the life expectancies and emotional, somatic and behavioural health of Australian aboriginal individuals (Gubhaju, et al., 2015). Colonization appears as the significant cause of social exclusion of Aboriginal natives from the mainstream society and therefore, in the absence of appropriate healthcare strategies the majority of aboriginal natives experiences the patterns of physical disability resulting from the chronic manifestations attributing to chronic kidney disease, diabetes and cardiovascular conditions. The careless attitude of the mainstream communities with the aboriginal natives results in incomplete determination of their health statistics and resultantly, the rationale behind the deteriorating condition of these underprivileged natives not emphasized systematically in healthcare records. The lack of appropriate identification of aboriginal natives during the process of census retrieval and documentation deficit in terms of their death registrations prove to be the biggest barriers to their psychosocial enhancement across the community environment (Phillips, Morrell, Taylor, & Daniels, 2014).

The research findings by (Clifford, Doran, & Tsey, 2013) evidently indicate the elevated frequency of suicide attempts among the Australian aboriginal natives. Their impoverished state, lack of education, inaccessibility to healthcare facilities and cultural constraints leading to their consistent state of social isolation attribute to the development of suicidal tendencies among them across the community environment. Underprivileged state of aboriginal individuals keeps them disconnected with the global community and they remain devoid of utilizing resources, technology and support systems to facilitate their progression and development reciprocally with the mainstream society. This leads to the development of mental disorders among the aboriginal population and resultantly, they lose the desire, interest and hope of their reconnection with the developed communities across the globe. The aboriginal natives in their state of social exclusion by the mainstream society remain devoid of utilizing primary healthcare and early disease management approaches across the local healthcare facilities in the context of preventively challenging the onset of various debilitating chronic conditions. The lack of provision of vaccine administration programs and trauma management facilities predisposes the aboriginal natives toward developing life-threatening conditions across the community environment (Mohanty, Edvardsson, Abello, & Eldridge, 2016). The social exclusion of aboriginal individuals is primarily responsible for the occurrence of hospitalizations requiring prevention with the timely administration of ambulatory care services.

The state of economic inequality and poverty under the influence of communal disparity and social disadvantage results in the consistent stigmatization of the aboriginal community (Zhao, You, Guthridge, & Lee, 2011). This inequality restrains the aboriginal natives in terms of surviving under adverse living environment leading to the development of contagious respiratory manifestations. Ineffective health interventions further facilitate the development of chronic conditions attributing to diabetes and carcinomas that reciprocally decrease the psycho-socio-somatic profile of aboriginal natives and adversely affect their life expectancies as compared to the mainstream society. Evidence-based research literature describes the behavioural degradation (under the influence of social exclusion) of aboriginal natives as significantly responsible for their incapacity to cope against the development of communicable as well as non-communicable diseases across the community environment (Einsiedel, Fernandes, Joseph, Brown, & Woodman, 2013). Aboriginal individuals reportedly exhibit elevated frequency attributing to the blood stream infection and chronic conditions in the context of their unawareness regarding the preventive measures warranted to reduce the onset of these life threatening and debilitating conditions. Their social exclusion indeed proves as the biggest barrier to the enhancement of their awareness and education level for controlling the progression of epidemiological outbreaks across the community environment.

Evidence-based research literature describes the pattern of smoking as the significant cause of the development of chronic disease conditions across the Aboriginal Australians (AIHW, 2011). This smoking behavior affects more than 50% aboriginal natives across the community environment. Furthermore, the pattern of alcohol abuse by the majority of aboriginal individuals results in the episodes of trauma, violence and crimes that continue to deteriorate the indigenous Australian community with the course of time. Increased alcohol intake by the aboriginal individuals significantly increases their risk for the development of hepatic cirrhosis, cardiovascular accidents and metastatic carcinomatous conditions. These behavioural attributes among the aboriginal individuals develop in the state of their social exclusion when they remain affected with patterns of mental deterioration, anxiety, depression, cognitive decline and psychosocial degradation across the community environment.

Mitigating Strategies for Minimizing Adverse Influence of Social Exclusion of Aboriginal Population and Enhancement of their Health and Wellness Outcomes

The governmental as well as non-governmental agencies require undertaking coordinated efforts in the context of facilitating behavioural modifications among Australian aboriginal natives for effectively enhancing their health and wellness outcomes. The federal government must stipulate systematic conventions in terms of assisting the aboriginal prisoners in understanding and evaluating their healthcare promotion strategies and requirements during the state of their incarceration while reducing their social isolation for enhancing the healthcare outcomes (Awofeso, 2010). The Council of Australian Governments (COAG) owns the responsibility of funding the new healthcare services for effectively bridging the gap between the local healthcare agencies and mainstream clinical facilities in the context of providing easy healthcare accessibility to the aboriginal natives across the community environment. Furthermore, the federal government should improvise norms and conventions through COAG to facilitate the empowerment of aboriginal children and women in terms of their involvement in their healthcare strategies for effectively enhancing the wellness outcomes. Research study funded by the Australian Government Department of Health and Ageing (AGDHA) advocates the engagement of CRG (community reference group) to facilitate the cultural engagement of mainstream society with the aboriginal women (Passey & Sanson-Fisher, 2015). This cultural connectivity is expected to provide insight to the aboriginal women in relation to the adverse influence of smoking on their developing fetuses during the antenatal tenure. Prospective clinical trials with the assistance of AGDHA and concomitant collaboration with CRG might prove effective in terms of exploring the best possible strategies for engaging the aboriginal women in surpassing their state of social isolation and resultant behavioural disintegration across the community environment.

Evidence-based research literature advocates the requirement of configuration of societal norms, healthcare protocols and welfare approaches to mitigate the manifestations of social exclusion among the aboriginal natives (Wang, 2015). These welfare provisions require effective formulation by the federal government for reducing the frequency of chronic disease conditions across the aboriginal population. The federal government further owns the responsibility of formulating self-management conventions while engaging the aboriginal natives in their care approaches across the community environment. This effort offers promising results in terms of mitigating the manifestations of chronic disease states among the Australian aboriginal individuals (Harvey, Petkov, Kowanko, Helps, & Battersb, 2013). Research findings by (Durey, McAullay, Gibson, & Slack-Smith, 2016) advocate the requirement of concomitant execution by aboriginal as well as non-aboriginal governmental and non-governmental agencies in terms of elevating oral health of the Australian indigenous individuals. Indeed, enhancement of oral health patterns of aboriginal natives safeguards them toward the development of various dental conditions attributing to dental abscess and dental cavities. The awareness campaigns in this regard highly warranted while surpassing the state of social exclusion of aboriginal individuals to facilitate the reduction of dental manifestations emanating from the progression of various chronic disease conditions.

The medical community of the mainstream society requires engagement as a stakeholder in organizing various health development programs for the aboriginal individuals in the context of their psychosocial enhancement across the community environment. Non-governmental organizations, hospitals, healthcare research centers, polyclinics and social care agencies require effective collaboration in the context of establishing therapeutic relationship with the aboriginal natives for evaluating their individualized challenges, healthcare requirements, depressive states, mental deprivation and behavioural patterns with the objective of connecting them to the mainstream community. The connectivity of the aboriginal people with the mainstream society enables their behavioural modification that reciprocally reduces their risk of developing chronic disease conditions as well as contagious states. The prophylactic measures by the federal government for reducing the patterns of alcohol abuse and smoking habits among aboriginal natives safeguards them from the debilitating and life threatening disease conditions attributing to diabetes, tuberculosis, liver abscess and hepatocellular as well as pulmonary carcinomas.

Australian Institute of Health & Welfare (AIHW) owes the responsibility of evaluating the health related data of aboriginal individuals in the context of formulating evidence-based measures and national guidelines for elevating their state of wellness across the community environment (AIHW, Indigenous Identification, 2016). Therefore, this governmental organization, as a stakeholder, offers promising results in terms of reducing the state of social isolation of aboriginal natives and resultantly decreasing their predisposition toward developing various metabolic as well as contagious conditions across the community environment. Furthermore, Australian indigenous community requires the privilege of configuring representative organizations as the prominent stakeholders for elevating their developmental patterns while collaborating with the stakeholders of the mainstream society. The health workers and members of task-force of the indigenous community as well as academic bodies also possess the capacity to elevate the level of education and awareness among aboriginal natives in the context of mitigating their social confinement for reciprocal enhancement of the wellness outcomes. These bodies require ascertaining the consistent delivery of education sessions and training programs to the aboriginal community as well as healthcare providers for managing equitable delivery of easily accessible healthcare services to the indigenous society.


Aboriginal individuals remain as the most underprivileged sections of Australian society with minimum welfare resources and limited access to healthcare facilities across the community environment. The practice of racism by the mainstream society with the aboriginal natives resulted in the rendering of non-equitable healthcare services leading to the state of psychosocial as well as mental deterioration of the indigenous groups. The state of social isolation experienced by the aboriginal individuals proves to be the biggest barrier to their social inclusion, elevation in life style and health enhancement. Therefore, the execution of proactive measures by various governmental as well as non-governmental organizations highly required for effectively bridging the social gap between the aboriginal natives as well as the mainstream society for overcoming the impoverished and underprivileged state of the indigenous community. Social inclusion of aboriginal natives will lead to their behavioural enhancement and the level of awareness for safeguarding their health and wellness and availing the easily accessible healthcare services extended with the collaboration of mainstream healthcare organizations with the local clinical settings. The coordinated efforts by the mainstream as well as indigenous communities undoubtedly offer the promise of elevating the quality of life of the aboriginal population and mitigating their disease manifestations across the community environment.


AIHW. (2011). Substance use among Aboriginal and Torres Strait Islander people. Australia: Australian Institute of Health and Welfare. Retrieved from

AIHW. (2016). Indigenous Identification. Retrieved from AIHW:

Awofeso, N. (2010). Prisons as Social Determinants of Hepatitis C Virus and Tuberculosis Infections. Public Health Reports. Retrieved from

Clifford, A. C., Doran, C. M., & Tsey, K. (2013). A systematic review of suicide prevention interventions targeting indigenous peoples in Australia, United States, Canada and New Zealand. BMC Public Health, 13(463). doi:10.1186/1471-2458-13-463

Dewall, C. N. (2013). The Oxford Handbook of Social Exclusion. New York: Oxford.

Durey, A., McAullay, D., Gibson, B., & Slack-Smith, L. (2016). Aboriginal Health Worker perceptions of oral health: a qualitative study in Perth, Western Australia. International Journal for Equity in Health, 15(4). doi:10.1186/s12939-016-0299-7

Einsiedel, L., Fernandes, L., Joseph, S., Brown, A., & Woodman, R. J. (2013). Non-communicable diseases, infection and survival in a retrospective cohort of Indigenous and non-Indigenous adults in central Australia. BMJ Open, 3(7). doi:10.1136/bmjopen-2013-003070

Gubhaju, L., Banks, E., MacNiven, R., McNamara, B. J., Joshy, G., Bauman, A., & Eades, S. J. (2015). Physical Functional Limitations among Aboriginal and Non-Aboriginal Older Adults: Associations with Socio-Demographic Factors and Health. PLOS.

Harvey, P. W., Petkov, J., Kowanko, I., Helps, Y., & Battersb, M. (2013). Chronic condition management and self-management in Aboriginal communities in South Australia: outcomes of a longitudinal study. Australian Health Review, 37(2), 246-250. doi:10.1071/AH12165

Kronenfeld, J. J. (2013). Social Determinants, Health Disparities and Linkages to Health and Health Care. UK: Emerald.

Markwick, A., Ansari, Z., Sullivan, M., Parsons, L., & McNeil, J. (2014). Inequalities in the social determinants of health of Aboriginal and Torres Strait Islander People: a cross-sectional population-based study in the Australian state of Victoria. International Journal for Equity in Health, 13(91).

Mohanty, I., Edvardsson, M., Abello, A., & Eldridge, D. (2016). Child Social Exclusion Risk and Child Health Outcomes in Australia. PLOS, 11(5). doi:10.1371/journal.pone.0154536

Passey, M. E., & Sanson-Fisher, R. W. (2015). Provision of Antenatal Smoking Cessation Support: A Survey With Pregnant Aboriginal and Torres Strait Islander Women. Nicotine & Tobacco Research, 746-749. doi:10.1093/ntr/ntv019

Phillips, B., Morrell, S., Taylor, R., & Daniels, J. (2014). A review of life expectancy and infant mortality estimations for Australian Aboriginal people. BMC Public Health.

Shepherd, C. C., Li, J., & Zubrick, S. R. (2012). Social Gradients in the Health of Indigenous Australians. American Journal of Public Health, 102(1), 107-117.

Wang, J. H. (2015). Happiness and Social Exclusion of Indigenous Peoples in Taiwan — A Social Sustainability Perspective. PLOS, 10(2). doi:10.1371/journal.pone.0118305

WHO. (2016). Social determinants of health. Retrieved from World Health Organization:

Zhao, Y., You, J., Guthridge, S. L., & Lee, A. H. (2011). A multilevel analysis on the relationship between neighbourhood poverty and public hospital utilization: is the high Indigenous morbidity avoidable? BMC Public Health, 11(737). doi:10.1186/1471-2458-11-737