Chapter 8 Conclusions
8.4. Final Comments
Overall, our study adds to a very large body of Australian and international literature that has pointed to the impact of socio-economic factors on health. This study is important because it provides some clues to ways in which local neighbourhood environments may work to reinforce broader social and economic factors. Our most affluent postcode area, Burnside, provides its residents with an environment that is perceived as being a better place to live in a considerable number of ways including safety, cohesion, levels of reciprocity and the quality of neighbourhood environment. The residents of this area, as well as reporting better health, also report that they have much higher levels of material resources (educational level, housing tenure and income) and of the factors in life that add up to better social capital. By contrast, the residents of the least affluent area, Playford, experience not only more problems in their personal life in terms of worse health, less material resources and less social support, but also live in an environment that compounds their disadvantage and social exclusion.
Our policy consultations confirmed that there is wide-spread agreement that reducing health inequities will rest on more effective co-ordination of action between government sectors. This approach receives strong endorsement from current international policies through the Commission on the Social Determinants of Health(which will report in 2008) and the European Union initiative of “Health in All Policies”. Both of these initiatives stress that equitable health improvement will result from more effective co-ordination of the work of all sectors for health (CSDH, 2007; Stahl et al, 2006). The focus of this research has been on the processes within local communities that reinforce and create health inequities, with a strong emphasis on social processes. As such, it is just part of the understanding required to underpin more effective action to reduce health inequities. Effective action will require an on-going process of reflection on progress and refinement of approaches at
SOCIAL STRUCTURAL CONDITIONS (MACRO)
• Unequal distribution of political and economic power according to class, gender, ethnicity
• Cultural support for inequities &
exclusion
• Systems that structure exclusion in access to health enhancing resources (e.g.
education, work
& health services)
SOCIAL &
ECONOMIC OPPORTUNITIES
& NETWORKS (MEZZO)
• Opportunities &
networks that either increase or decrease access to health enhancing aspects of life (e.g. work, housing, education, social engagement, reciprocity) & so access to services
& goods
PSYCHO-SOCIAL
& BEHAVIOURAL MECHANISMS
(MICRO)
• Social support, trust, self esteem, happiness
• Access to resources
• Interpersonal behaviour, health behaviours &
stress Impact on vulnerability to disease, death &
ability to negotiate systems to minimize consequences of disease
HEALTH OUTCOMES
• Immune system outcomes
• Disease rates
• Mortality
• Health Inequities Resulting from differential vulnerability, exposures &
consequences of diseases
People and Places |chapter 8: Conclusions
The South Australian Thinker-in Residence program (http://www.thinkers.sa.gov.au/home.html accessed 25th January 2007) will provide an ideal focus for this on-going reflection and discussion with the appointment of Professor Ilona Kickbusch, a leading global expert on the social basis of health, as one of the 2007 Thinkers. She has been a long-term advocate for action across sectors to reduce health inequities and to promote population health, as well as being one of the drafters of the WHO Ottawa Charter for Health Promotion and initiator of the WHO European Healthy Cities program. Her residency will focus decision-makers’ minds on the question of how achieving better health and well-being can inform the development of policies in all sectors. Thus, the stage is set for development of a more sophisticated understanding of the government processes required at state and local level to implement policies and actions to reduce health inequities through action on the social determinants of health. This report will make a valuable contribution to these on-going discussions within the state while also adding to international evidence on health inequities and their social determinants.
People and Places |chapter 8: Conclusions
References
Australian Bureau of Statistics (ABS). (2002) 2001 Census Community Profile Series: Adelaide (Statistical Division). Basic Community Profile.
http://www8.abs.gov.au/ABSNavigation
Baum, F., (ed.) (1995) Health for all: The South Australian experience, Adelaide:
Wakefield Press.
Baum, F. (2002) The New Public Health, Melbourne: Oxford University Press, 2nd Edition, (reprinted August, 2003).
Baum, F. & Ziersch, A. (2003) Social capital glossary, Journal of Epidemiology and Community Health, May, 57 (5) 320–323.
Baum, F. (2006) Social capital and Indigenous health. In Social Determinants of Indigenous Health (eds. by Carson, B. and Bailie R.). Melbourne: Allen &
Unwin.
Baum, F. (2007) How forms of social capital can be an asset for promoting health equity in E. Ziglio, A. Morgan and Chris Brown (eds) (2007) Health Assets and the Social Determinants of Health, Vienna: WHO European Office for Investment for Health and Development.
Baum, F., Jolley, G., Hicks, R., Saint, K. & Parker S. (2006) What makes for sustainable Healthy Cities initiatives? – a review of the evidence from Noarlunga after 18 years, Health Promotion International, 21,4. 21: 259–
265.
Berkman, L. & Glass, T. (2000) Social integration, social networks, social support and health. In Berkman LF, and Kawachi I. (eds.) Social Epidemiology. Oxford: Oxford University Press.
Commission on the Social Determinants of Health (CSDH) website.
http://www.who.int/social_determinants/en/ accessed 25th January 2007.
Considine, M. (1994) Public policy: A critical approach. Melbourne: MacMillan.
Diderichsen, F. & Hallqvist, J. (1997) Trend in occupational mortality among middle-aged men in Sweden 1961–1990. International Journal of Epidemiology, 26,4, 782–787.
Hancock, T. (1990) Developing healthy public policies at the local level. Healthy public policy at the local level. A. Evers, W. Farrant and A. Trojan. Frankfurt am Main, Campus Verlag: 7–11.
Lomas, J. (2000) Connecting research and policy ISUMA, Canadian Journal of Policy Research, 1(1) 140-144: http://www.isuma.net/v01n01/index_e.shtml Macintyre, S., Maciver, S. & Sooman, A. (1993) Area, class and health: should we
be focussing on places or people? Journal of Social Policy 22 (1) 213–234.
People and Places |References
Newman, L., Baum, F. & Harris, E. (2006) Federal, state and territory government responses to health inequities and the social determinants of health in Australia, Australian Journal of Health Promotion, 17, 3, 217–225.
Office of Crime Statistics and Research. (2002-5) Crime and Justice in South Australia. Offences reported to Police, the Victims and Alleged Perpetrators.
http://www.ocsar.sa.gov.au/publish_subject.html
SA Department of Health. (2006) A Social Health Atlas of South Australia. Government of South Australia.
Sen, A. (2001b). ‘Many faces of gender inequality’, Frontline 18, 22.
Stahl, T., Wisma, M., Ollia, E., Lahtinene, E. & Leppo, K. (2006) Health in All Policies. Prospects and Potentials. Helsinki: Ministry of Social Affairs and Health.
Stretton, H. (2005) Australia Fair. University of New South Wales Press Wilkinson, R.G. & Marmot, M. (2003) Social Determinants of Health: The Solid
Facts, World Health Organization - Europe.
World Health Organization (1978) Primary Health Care. Report of the International Conference on Primary Health Care, Alma–Ata, USSR, 6–12 September. Geneva: WHO
World Health Organization. (1986) The Ottawa Charter for Health Promotion, Health Promotion. 1 (4): i–v.
People and Places|References