Australian Indigenous

This section of the Bulletin contains a review of recent books of relevance to Indigenous health. Books are reviewed by experts in the field. If you know of a new book of interest to our users, please contact us. If you are publisher and would like a book reviewed, please supply us with the book and relevant details.

Social determinants of Indigenous health

Carson B, Dunbar T, Chenhall RD, Bailie R, eds. (2007)
Social determinants of Indigenous health.
Crows Nest, NSW: Allen and Unwin
(xxix + 306pp, RRP $49.95) ISBN 978 1 74175 142 0

Reviewed by Denise Tallis
Australian Indigenous HealthInfoNet

In recent years the social determinants model of health has received increased attention in health research world-wide. Until now, however, there has been a distinct lack of publications with specific reference to the inequalities that impact so significantly on the health of Indigenous Australians.

This book of thirteen chapters aims to synthesise a broad theoretical, historical and methodological framework for viewing Indigenous health from a social determinants perspective. Material has been drawn from the content of a series of short courses on the Social Determinants of Indigenous Health, conducted in Darwin 2004 and 2005. In consultation with Indigenous health professionals and researchers the authors have produced an invaluable resource for understanding the complexities of Indigenous health and a broad-based appraisal of why the health of Indigenous Australians is so bad.

The social environment and its influence on health are the focus of the first two chapters. Epidemiological models that incorporate a social determinants perspective are examined and a framework for understanding the complexities inherent in Indigenous health is linked with general theory. Sherry Saggers and Dennis Gray explain that models of social determinants have undergone a considerable reworking in recent years, particularly in reference to the health of Indigenous people. Their definitional chapter highlights the interrelations between social inequality and poor health. Ian Anderson's in-depth analysis of relevant theoretical models provides an understanding of the processes that have shaped Indigenous health. Of particular concern to the application of these models is the relevance of social connectedness, trans-generational disadvantage and how these factors influence access to health care.

The historical, cultural and political tensions bound in with colonisation and the exclusion and dispossession of Indigenous people are contextualised in relation to Indigenous health by Jessie Mitchell in the following chapter. She points out that combined with the process of colonisation, the unequal distribution of power and resources has shaped contemporary health outcomes for Aboriginal and Torres Strait Islander people.

The impact of exclusion on Indigenous health is discussed in the next three chapters. Yin Paradies' chapter on racism provides evidence that the exclusion of Indigenous people is entrenched in Australian society and has a significant impact on their health. He argues that, before racially-based inequalities of health can be addressed, a fundamental revision of policy across all social structures is paramount. Maggie Walter and Sherry Saggers examine social class and the fundamental differences between Indigenous and non-Indigenous poverty. They express the need for understanding these differences before a realistic picture of the inequalities experienced by Indigenous people can be mapped. Fran Baum's chapter argues that an analysis that includes social capital explains not only the exclusionary process that denies respectful attention to Indigenous culture, but potential ways of addressing that shortfall, particularly in the area of policy.

Specific social determinants of relevance to Indigenous health are examined in the next four chapters. The chapters on education (by Terry Dunbar and Margaret Scrimgeour), employment and welfare (by Maggie Walter and Gavin Mooney), country (by Paul Burgess and Joe Morrison) and housing (by Ross Bailie) outline these critical determinants. What is clearly emphasised is that these factors operate along contested and tangled pathways that do not necessary conform to non-Indigenous preconceptions or definitions of social determinants. For example, as Walter and Mooney argue, while Indigenous participation in mainstream education has obvious benefits, these advantages should be carefully weighed against potential losses incurred when Indigenous people are denied culturally appropriate education.

The final three chapters centre on policy processes (by Ian Anderson), human rights (by Natalie Gray) and nterventions and sustainable programs (by Kathleen Clapham, Kerin O'Dea and Richard Chenhall). They reveal that, over time, Indigenous health policy has been determined by an historically conditioned dynamic that reflects varying degrees of exclusion and incorporation of Indigenous populations into general Australian society. What epitomises Indigenous health policies, regardless of the time frame is a distinct lack of consultation with Indigenous people, a tendency to marginalise their needs and an over reliance on short-term solutions. However, as stressed in the final chapter, the on-going fight for a part in the consultative process and an active engagement in seeking solutions to the shortfalls endemic in health policy, advocacy and action by Indigenous Australians cannot be denied.

This book should have particular appeal to those involved in Indigenous health and facilitators of courses with content related to the social determinants approach to Indigenous health. The format is comprehensive, including summaries, and clearly defined conclusions are drawn. The content should leave the enquiring minds of Indigenous and non-Indigenous people with more evidence of injustice and a determined quest to seek solutions to addressing Indigenous disadvantages.

Last updated: 12 April, 2007