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  1. Nursing in the Australian





    • Identify and critically discuss one of the Australian Health Care System’s national health priority areas experienced by Aboriginal and Torres Strait Islander (ATSI) communities e.g. diabetes or cardiovascular disease. In your discussion include how the social determinants of health have impacted on the health and wellbeingof indigenous individuals andcommunities. · Identify one health promotion and/or illness prevention program, and discuss how the program encourages and motivates Aboriginal and Torres Strait Islander (ATSI) communities to reduce theirrisk factors for chronic disease. Include in your discussion how this primary health care concept addresses health inequalities experienced by this population. Social determinants of health impact on health inequalities. Social determinants of health are situations, circumstances and environments in which people live. Theyinclude: Income and SocialStatus Social Support Networks Education and Literacy Employment/Working Conditions Social Environments Physical Environments Personal Health Practices and Coping Skills Healthy Child Development




Subject Nursing Pages 8 Style APA


The Social Determinants of Health with Regard to Aboriginal and Torres Strait Islander


The National Health Priority Areas (NHPA) initiative is a collective effort which involves the Commonwealth, State and Territory governments whose main aim is to focus public attention and health policies on regions which are deliberated to contribute considerably to the burden of diseases in Australia. According to the Australian Health Care System, the country is experiencing cases of several diseases whose prevalence are different from one region to the other depending on the conditions in which people are born, live, grow, work, financial status, and age- factors that are known as social determinants of health (Anikeeva et al., 2015). One of the populations which has been of interest to the Australian Health care system and also marked as a burden in the country in terms of disease prevalence is Aboriginal and Torres Strait Islander (ATSI). These groups belong to indigenous set of Australia which has been faced with several diseases and other health related issues over a long period of time. One of the Australian Health Care System’s national health priority areas experienced by Aboriginal and Torres Strait Islander (ATSI) is cardiovascular diseases (CVDs). According to the study conducted by LoGiudice (2016), these communities are faced with heart related diseases due to several factors among them being low education level, low income, and inability to access health services. This paper, therefore, critically discuses cardiovascular diseases as one of the priority areas and how social heath determinants have contributed to their high prevalence affecting the health of indigenous communities in Australia. Additionally, the paper also discusses one promotional program and how it can reduce the risk of chronic diseases among ATSI communities.

Cardiovascular Diseases and Statistics among Aboriginal and Torres Strait Islander (ATSI)

Cardiovascular diseases is one of the interest area of Australia Health Care System. Cardiovascular diseases are conditions that generally affect the function of the heart. They include heart attack, which is the common one, coronary artery disease, heart failure, congenital heart disease, heart muscles diseases, and blood vessel diseases.  According to LoGiudice (2016), heart and circulatory problems contribute most to the disease load of ATSI and are major backers of life expectancy gap between Indigenous groups and other Australians. Research studies demonstrate that as well as having higher rates of cardiac conditions, ATSI people have lesser access to health services which are aimed at treating or preventing cardiac conditions. Particularly, in the year 2017, twelve percent of the total death among the ATSI people were caused by heart diseases. According to Reading and Greenwood (2015), the same study revealed that ATSI people are more likely to die from the cardiovascular diseases than non-indigenous Australians.

CVDs remain the foremost cause of death among Aboriginal and Torres Strait Islander, with 12 percent of deaths in individuals between ages 30 and 39-years-old Indigenous caused by heart diseases. This is in comparison to only 3.8 no- indigenous groups who belong to the same age bracket. In summary, Aboriginal and Torres Strait Islander people are twice likely to have a heart attack compared to non-indigenous Australian. They are 10 times likely to die from coronary heart diseases as compare to their counterparts non – indigenous Australians. Additionally, they are 1.2 times likely to have blood pressure than non-indigenous Australians. Australian health care system argues that much of the cases of cardiovascular diseases are curable. However, the society is mandated to check on the major modifiable risk factors which include tobacco smoking, high blood cholesterol, high blood pressure, overweight and obesity, insufficient physical activity, poor nutrition, diabetes, and excessive consumption of alcohol. Other risk factors that are beyond the control of the government as well as health institutions include age, family history, gender, and ethnicity. 

Social Determinants of Health Within Indigenous Communities

According to Reading and Greenwood (2015), the social determinants of health are the social and economic conditions which influence group and individual differences in health status. Social determinants of ATSI people are wide ranging and have been appropriately documented on other indigenous populations which include Alaskan Inuit people and North American Indians. According to Sherwood (2013), social determinants are associated with traditional lifestyles and culture of these groups. Conversely, CVDs are also influenced by the social, physical, and political environments in which individuals live as well as early exposure to a variety of social determinants. While clinicians concentrate on medical developments to benefit healthcare, actual improvements in Indigenous health will essentially come when attention is given to factors such as gender, education power, employment conditions, and racism.

The first social determinant of cardiovascular diseases among ATSI people is socio-economic status.  It is important to note that indigenous people in Australia including ATSI experience socioeconomic disadvantage which expose them to chronic diseases such as cardiovascular illnesses.  Sherwood (2013) indicates that the average gross income of indigenous people in Australia is three times less than those of non-indigenous Australians. During 2001 census, it was revealed that unemployment rate of for indigenous people was 20% higher than their counterparts, indigenous individuals.  Therefore, poor socioeconomic status does not allow these people to access proper medication for these chronic diseases. Schembri et al., (2016) also argue that only one in five individuals among ATSI people go for checkup about their health condition. Australia is one of the countries that supports regular screening for chronic diseases; however, ATSIs do not attend these services citing money related issues. Additionally, due to lack of enough money, this group cannot afford expensive management and treatment services of cardiovascular diseases.

Another social determinant which has led to the spread of chronic diseases such as CVDs is lack of quality education and illiteracy. As study conducted by Riekert et al., (2013) reveals that indigenous students were half as likely to complete their education as compare to non-Indigenous students. The same study reveals that these groups have held on certain traditions which prevent children from going to school but are tasked with certain activities such as looking after the animals. Prevention and management of cardiovascular and other chronic disease depend on the knowledge people possess about them. These include strategies to prevent them, ways to avoid risk factors, and even home remedies to manage some of such illnesses. To prove this proclamation, a research conducted by Reading and Greenwood (2015) demonstrated that individuals with little education or lesser secondary education have a 46 percent higher likelihood of dying prematurely than persons who have attained advanced education level. Informed by their far-reaching analysis, Gladigau et al., (2015) argue that the contributing contrivance behind the connotation between mortality and education is that formal training that provides a significant value to the inherent ability to establish high cognitive skills, which are critical in making healthy choices.

Additionally, discrimination has also been a social factor that has exposed ATSI people to CVDs. Notably, it is evident that under some circumstances, ATSI people do not get equal health care services as non-indigenous Australians. Access to specialists, cardiology services, acute care modalities, suitable interventional diagnostics are limited in the remote and areas where a large proportion of indigenous populations reside (Lucero et al., 20140. Even in the cases where such CVDs services are available, indigenous Australians are less likely to get the services as compared to non-indigenous Australian.  Little attention is being given to ATSIs due to negative perception in relation to ability to pay for those services, and this is the reason ATSI people are 40 percent more likely to die from CHD, and faced with case fatality rates 1.5 times than non-indigenous Australians.

Lastly, lifestyle of ATSI people is another social determinant which expose them to chronic diseases such as heart attack.  A study conducted by Reading and Greenwood (2015) shows that even within non indigenous population and in other developed countries, lifestyle has contributed significantly to CVDs. Lifestyle includes issues like smoking, diet, consumption of alcohol, and physical activities. In particular, in 2012/13, 43% of Indigenous Australians aged 15 years and above smoked, and 95 percent of them did it daily. This was 2.5 times higher than non-Indigenous Australians. The same study also demonstrated that smoking rates for Indigenous Australians were expressively higher across all age groups. “The majority (97%) of Indigenous Australians aged 18 years and over did not meet the daily recommended intake for fruit and vegetables, higher than the national average of 94% (Lucero et al., 2014, p. 32)”. The statistics, therefore, proves that ATSI people have a lifestyle which could be contributing to high number of cardiovascular cases in the region

Health Promotion Preventive Program

Cardiovascular education and awareness is a health program which is able to reduce the risks of cardiovascular diseases among ATSI people. According to Raczynski and DiClemente, (2013), one of the first line of disease prevention is creation of awareness within the affected population, especially when there is little information about the disease among the affected population. Sherwood (2013) adds that, although people may know about certain diseases in a community, prevention strategies and deeper understanding of such illnesses may not be available to the ordinary individuals. It is in this context that cardiovascular education and awareness can significantly reduce the risk of heart diseases.

The program targets individuals from ten 10 years since children below that age are presumed to be still under the care of their parents who are part of the audience in the program. Basically, educational program focuses on two main issues; educating people about the diseases and informing them about preventive measures. According to the study conducted by Schembri et al., (2016), indigenous students were half likely to complete school as compared to their counterparts, non-indigenous Australians. This simply means that within the ATSI population, there is still low level of education hence comprehensive knowledge and understating of CVDs is still lacking. It is in this context that such programs would teach the community about cardiovascular disease, their causes, risk factors, prevention strategies, and treatment measures. Sherwood (2013) adds that some of these people still hold on certain cultural beliefs and may not go to the hospital when attacked by chronic diseases hence it is important to let them know the value and significance of hospital procedures. Important factors which must be part of this program is causes, prevention and treatment of cardiovascular diseases.

On the same note, cardiovascular education program also addresses inequalities that has been caused by education where people from ATSI people do not only get quality education but also lack needed infrastructures for good education. In the end, they fall behind their counterparts non indigenous Australians in terms of access to information. This program specifically concentrates on ATSI hence is likely to solve the inequalities as far as education is concerned.




Cardiovascular diseases make the largest substantial contribution of mortality rate among the Aboriginal and Torres Strait Islander, and it is the reason why they have become a matter of concern to the National Health Priority Areas (NHPA). Heart and circulatory problems contribute most to the disease load of ATSI and are major backers of life expectancy gap between Indigenous groups and other Australians. The factors contributing to the high levels of CVD among Indigenous people, and associated hospitalization and mortality are complex. However, most of them have been associated with social determinants which highly expose Aboriginal and Torres Strait Islander people to such diseases. Some of the social determinants which have highly contributed to the acquisition of these diseases include education and literacy, discrimination of Aboriginal and Torres Strait Islander people, socioeconomic status, and lifestyles of ATSI people. Therefore, clinicians who are at frontline to reduce the high prevalence cases of CVDs among ATSI people must first address the above mention social determinants. However, it is important to note that cardiovascular education and awareness ins one of the health promotion programs which is able educate ATSI people on important matters regarding CVDs which may reduce their prevalence.


Al-Yaman, F. (2017). The Australian Burden of Disease Study: impact and causes of illness and death in Aboriginal and Torres Strait Islander people, 2011. Public Health Res Pract, 27(4), e2741732.

Anikeeva, O., Bi, P., Hiller, J. E., Ryan, P., Roder, D., & Han, G. S. (2015). Trends in migrant mortality rates in Australia 1981–2007: a focus on the National Health Priority Areas other than cancer. Ethnicity & health, 20(1), 29-48.

Gladigau, E. L., Fazio, T. N., Hannam, J. P., Dawson, L. M., & Jones, S. G. (2014). Increased cardiovascular risk in patients with severe mental illness. Internal medicine journal, 44(1), 65-69.

LoGiudice, D. (2016). The health of older Aboriginal and Torres Strait Islander peoples. Australasian journal on ageing, 35(2), 82-85.

Lucero, A. A., Lambrick, D. M., Faulkner, J. A., Fryer, S., Tarrant, M. A., Poudevigne, M., … & Stoner, L. (2014). Modifiable cardiovascular disease risk factors among indigenous populations. Advances in preventive medicine, 2014.

Mitrou, F., Cooke, M., Lawrence, D., Povah, D., Mobilia, E., Guimond, E., & Zubrick, S. R. (2014). Gaps in Indigenous disadvantage not closing: a census cohort study of social determinants of health in Australia, Canada, and New Zealand from 1981–2006. BMC Public Health, 14(1), 201.



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