Socioeconomic Position-A Social Determinant of Health for Aboriginal and Torres Strait Islander Peoples

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Socioeconomic Position-A Social Determinant of Health for Aboriginal and Torres Strait Islander Peoples

Social determinants are defined as “the circumstances in which people grow, live, work, and age” (Australian Institute of Health and Welfare, 2018: p.1). This essay discusses socioeconomic position (as a social determinant) and explains the role Shirley Colleen Smith played in addressing it as to improve the health outcomes for Aboriginal and Torres Strait Islander people. It also presents ways of providing culturally safe care in this regard, in one’s capacity as a Registered Nurse. 

Socioeconomic position and other factors related to it significantly account for the health gaps noted between Aboriginal and non-Aboriginal people (Waterworth et al., 2015). Indeed, socioeconomic position influences health outcomes through factors like occupation, education, and income, which are important material affluence indicators. The average health status gets better moving up the socioeconomic ladder, such that people who have higher incomes enjoy better health and live longer than those with lower incomes. People in lower socioeconomic positions are highly liked to have lower levels of educational attainment and as such are more likely to engage in risky behaviors like smoking and general drug/substance abuse. Here socioeconomic position dictates the circumstances in which people find themselves in such as social marginalization and limited education attainment, hence societal inequalities that lead to health inequalities (Fredericks et al., 2017; Vallesi et al., 2018). The indigenous health gap can be linked to socioeconomic disadvantage whereby people of low socioeconomic status are more likely to engage in risky health behaviors pointed out by Markwick et al. (2019) such as alcohol consumption, physical inactivity, and smoking. Clearly, it goes without saying that socioeconomic position is a barrier (to good health) for Aboriginal and Torres Strait Islander people.

Many prominent people have been able to make a significant difference in the health outcomes of Aboriginal and Torres Strait Islanders. These people are referred to as change leaders and their impact on the health of First Nations people has been profound. One such change leader is Shirley Collen Smith who “worked tirelessly in her community work, including renting houses in Redfern and Surry Hills and caring for many people arriving in Sydney with no friends or family” (Crispin & Sahni, 2018: par. 8).  She used whatever little income she had to address the needs of the less fortunate. Recognizing the great socioeconomic disadvantage that indigenous people faced, she joined other Aboriginal activists in championing for the rights of indigenous people and coming up with other initiatives that sought to advance their welfare. Worth mentioning in this regard was the establishment of the Aboriginal Legal Service, the Aboriginal Medical Service, and the Aboriginal Tent Embassy among other entities that championed for the rights and welfare of indigenous people (Crispin & Sahni, 2018). Accordingly, Shirley was able to use her considerable influence as a public identity to bring about change that resulted in positive health outcomes for Aboriginal and Torres Strait Islander people.

When providing care for Aboriginal and Torres Strait Islander people, nurses and midwives need to be culturally competent. Three ways that this can be implemented include acknowledging and respecting Aboriginal and Torres Strait Islander culture and beliefs, challenging beliefs and bias based on assumptions, and remaining culturally sensitive. Culturally unsafe care has been identified as one of the factors contributing to the health disparities noted between Aboriginal and non-Aboriginal people (Doran et al., 2019). Aware of this fact, I am keen to make sure that in my practice I provide culturally safe care to not only indigenous people but all patients in general. According to the Nursing and Midwifery Board of Australia (NMBA, 2019),  the implied cultural safety is “recognizing the ways you can provide care that meets Aboriginal and/or Torres Strait Islander peoples’ needs and reflect on the ways that your own culture and assumptions might impact on the care you give” (p. 2).Cultural competency promotes safe care for Aboriginal and Torres Strait Islander peoples and some of the ways that this can be achieved include acknowledging and respecting Aboriginal and Torres Strait Islander culture and beliefs, challenging beliefs and bias based on assumptions, and remaining culturally sensitive.

In a word, socioeconomic position is a significant social determinant for Aboriginal and Torres Strait Islander people. It has been addressed variously by different change leaders, a good example being Shirley Collen Smith. Lastly, as concerns culturally safe care for indigenous people, much would be achieved through acknowledging and respecting Aboriginal and Torres Strait Islander culture and beliefs, challenging beliefs and bias based on assumptions, and remaining culturally sensitive in the course of practice.