PUBH1102 - Guide to Social Determinants PDF

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PUBH1102 Assignment 3 Table of Contents: Introduction

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Social Environment

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Natural Environment

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Economic Environment

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Political Environment

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Reference List

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Introduction Cairns and Hinterland region is located on the scenic east coast of tropical Far North Queensland, Australia. Cairns is a rapidly developing regional city with a population of approximately 152,798, growing at an average rate of 2.3% each year.1 Approximately, there are over 23,500 Aborginal and Torres Strait Islander residents making up over 10% of the Cairns population, the largest representation of Indigenuous peoples in Queensland.2 Government funding towards the expansion of Cairns as a tourist destination through industries such as tourism and hospitality encourage large proportions of short to mid term employment opportunities.2 Cairns has a well known reputation as a healthy, nurturing, family residential environment. The Cairns region is well equipped with a variety of educational and job opportunities as well as having access to adequate and tailored, bulk-billed medical services such as the Cairns Base Hospital and medical clinics that have a focus on tropical medicine and Indigenous health.

Social Environment According to the Australian Institute of Health and Welfare, fostering healthy, social and supportive relationships within the community’s living and working environments is a key determinant to promoting health and prolonging life.3 Resultantly, those who have strong, supportive and positive relationships in their life are less likely to experience feelings of depression and anxiety, thus improving the overall health of the community.4 The establishment of health social relationships facilitates greater social inclusiveness. Social inclusiveness through the understanding of culture or partaking in worship is a form of social cohesion among the community. Cairns is a multicultural region which fosters an inclusive social environment, where people can congregate and connect through common religious backgrounds. The various religious affiliations in Cairns provide many diverse communities with a sense of belonging that extends to locals and tourists alike. Studies 5 have found that spirituality promotes positive community cohesion and support networks, which improves an individual’s mental health.

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Therefore, having a religious association can improve the mental health of individuals, which positively impacts the health of the community. In Cairns, there are approximately 40 places of worship that accommodate healthy social and spiritual relationships.6 Various charities and volunteer programs established by religious communities and organisations that service the Cairns region support the social and emotional health of the residents. Charities such as Rosie’s Friends on the Street, assist the less fortunate in the community, through providing awareness and support on a volunteering basis to restore dignity to those in need.7 The establishment of numerous other charities, similar to Rosies, have a significant impact on the mental, emotional and physical health of both the volunteers and the patrons included. Organisations, such as these, highlight the importance of harbouring positive social networks within communities, where in Cairns particularly, this aspect of social health is enhanced greatly by the presence of religious communities and organisations.3 Studies have shown that involvement and association with spiritual ideals, including the promotion of good, charitable works, is highly beneficial to the mental and emotional health of those involved. A study conducted by Stanford University8 observes that people who volunteer generally experience a better quality of life. Cairns provides an open and welcoming social environment for both the local community and travellers. These places of worship and charity engagements provide an opportunity for people with common interests to engage in local social networks that encourage social inclusion which is pertinent to improving the social health of the community. In addition, there are several cultural centers in Cairns including the Tjapukai Aboriginal center and the Gab Titui center, where the Indigenous and Torres Strait Islander cultures are openly celebrated.9 Aboriginal and Torres Strait Islander cultures have deep connections to the past and the history of Cairns and Hinterland region. The passing on of knowledge about the Indigenous’ culture allows for these peoples to preserve their connection to the land during the twenty first century. Research has shown that when diversity is valued and respected, a community and the people in it are more likely to develop social connections to others, as well as, a sense of belonging to their community.4 This opportunity to immerse non-indigenous Australians into the culture of Aboriginal and Torres Strait Islander communities creates awareness of the rich history and deep spirituality of their cultures. This awareness is essential to the social, emotional and spiritual health and well-being of these peoples. Sharing stories about

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the connectedness to the land and the influence it has to well-being greatly improves the social health of the community.

Natural Environment The Australian Institute of Health and Welfare framework for health determinants argues that the environmental health determinant refers to the natural ecosystem in which a region resides.3 This includes the natural, external elements including air, water and food quality, levels of pollution, and the presence of green space.3 This determinant addresses the physical, chemical, and biological factors that impact health, separate to the individual. A healthy natural environment is achieved when access to adequate public green spaces, especially for urbanised regions, and to safe drinking water, food sourced separately from polluted soils, and clean air, has been established.3 Environmental health focuses on preventing disease and promoting healthsupportive and stable living conditions in communities.10

The Cairns region is well-renowned for its vast natural beauty as it is the site of the Great Barrier Reef and known for celebrating its locality in a tropical rainforest environment.11 The natural environment plays a critical role in the vibrancy and health in the Cairns community. Despite being regional, Cairns’ natural environment is representative of the recommended foundations for healthy living and healthy behaviours. Greenspace is abundant around Cairns through parks such as Munro Martin Park, the esplanade, and numerous suburban parks accessible to locals of all mobility.12 The proximity to the coast, namely the Great Barrier Reef, encourages tourists, and locals alike, to immerse themselves in natural wonders whether it be in the lush rainforests, by the beach, such as the esplanade, or amongst the reef itself. 11 Studies have found that exposure to these types of green spaces is highly beneficial to both overall physical and mental health of an individual.13 Full availability of walkways and cycling tracks across Cairns city and suburbs, established in partnership with the Queensland Department of Transport and Main Roads, promote healthy living and complement its natural surroundings. 14 People are therefore encouraged to take advantage of more physical modes of travel and exploration.

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Cairns City is densely populated in comparison to the suburban areas and is the central tourist district, with many people living in apartment blocks, share-houses and tourists residing in hotels.2 Aesthetically attractive outdoor spaces are abundant amongst the Cairns central business district, namely the Cairns esplanade. The esplanade green space stretches 2.5 kilometres along the beach front with various sporting fields available such as volleyball and soccer and includes water parks, a lagoon, barbeque areas, gym equipment, restaurants and cycling tracks and walkways.12 The presence of these areas promotes a social and healthy relationship with the natural environment, especially for those living in the densely populated and urbanised city of Cairns. Research supports that access to green scapes benefits mental health and reduces stress and promotes healthy and physically active behaviours.13 Air quality in Cairns is exemplary, as it contains large areas of rainforest and tropical features that mitigate greenhouse gas emissions and the region contains minimal pollutants such as factories and mines.14a Figure 1 from the Cairns Regional Council’s annual environment report represents a decline in greenhouse gas emissions in Cairns since 2007. 14a Presence of adequate local waste facilities and treatment centres, such as the Barron Gorge Waste Facility, decreases the impacts of destructive biological and chemical factors. 3,14a These interventions have positive domino effects on the water quality, sanitation, and food safety in Cairns, in turn, protecting and increasing the physical health of its population.3

Sustaining Cairns’ natural environment is crucial for the continuation of high quality health outcomes in the region. Reducing pollution in waterways, air, and food sources remains a health priority to the locals and government leaders.14a Prospective initiatives, outlined in the Cairns State of Environment Report 2018, aim to monitor energy and emission impacts through the Cities Power Partnership and the Greenhouse Gas Emissions Reduction Target. 14a The partnership has established a coalition of councils that aim to switch to renewable, green energy sources to reduce the impact of emissions on the outstanding, health-supportive environment Cairns offers.14a This initiative contributes to the overall Greenhouse Gas Emissions Reduction Target which aims to reach a 50% reduction by the 2021 new year, where in 2018, a 47% reduction has already been reached.14a

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Figure 1: Cairns Regional Council - Greenhouse Gas Emissions 14b

In an Australian study, released in 2014, found that Cairns had 79% of its total area covered by a canopy, the highest surface area of canopy coverage in regionalAustralia.14a Additionally, the Cairns Regional Council is committed to revegetation for lost canopy cover to sustain a healthy and green environment for the community to flourish.15 In 2018, over 14,900 native plants were raised for revegetation to harbour the numerous benefits to physical health and mental well-being that green space and natural environment provides.14aCommunity groups and environmentalists, such as Green Space Our Place and Tree Force, are supported by the local council to maintain and promote health through the environment.14,16

Economic Environment The economic determinant of health looks at how the socioeconomic position and employment status of a community determines their financial accessibility to health services and likelihood of adopting positive health behaviours.3 These economic determinants that influence health include education, occupation and industry, living standards, financial resources, and the health services and policies provided by governments.17

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Abundant employment opportunities and thriving, diverse businesses create a strong economic environment, which facilitates the creation of financially secure and healthy communities.18 Cairns’ strong economic base is founded on its abundance of natural resources and unique natural environment, which creates economic hubs that generate high employment in the aged-care, tourism and hospitality sectors - the future drivers for economic growth and development in the region.19 The rapid growth of Cairns’ economy as it aims to become a major regional city, has seen the fall in Cairns’ unemployment rate from 8% in 2016 to 4.3% in 2019 (as seen in Figure 2), which is below the 2019 unemployment rate for Queensland (6%) and Australia (5.2%).20a

Figure 2: Quarterly Unemployment Rate (Cairns) 20

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Therefore, Cairns’ low unemployment rate suggests a greater proportion of its residents are able to afford access to quality healthcare and foods. Studies21 have shown that increased affordability of healthy foods increases the likelihood of healthier diet and lifestyle choices, which decreases the risk of cardiovascular disease, resulting in better mental and physical health outcomes overall.22 However, what is missing from this picture is the fact that Cairns has a high Indigenous population2 of 10% - and 20.1% of this population is unemployed.23 The majority of the Indigenous population live about 50km out of Cairns CBD in Yarrabah, while another large proportion live in government housing in Daintree, a remote region.24 This unemployment rate for the Indigenous community is five-fold that of Cairns, highlighting the systemic barriers that Indigenous Australians face – as low levels of education translate to low levels of workforce participation and skills, resulting in high unemployment and lower incomes, and reduced ability to pay for health services despite having higher health expenditure needs.25 The Australian Institute of Health and Welfare26 states that high unemployment levels cause financial burden and psychological consequences, which create mental and physical health issues that perpetuate a cycle of unemployment and poor health outcomes. Despite Cairns’ strong tourism-driven economy, it is vulnerable to inherent inequalities that arise from its status as a regional city. Income and wealth inequality reduce social cohesion, a dynamic which leads to greater stress and insecurity, resulting in poorer health outcomes.27 The Index of Relative Socio-Economic Advantage and Disadvantage is a measure of the socioeconomic conditions of communities within an area. Cairns scores 971 on this index, whilst Brisbane scores 1060, indicating that Cairns experiences a slightly higher level of disadvantage relative to Brisbane.28 This disadvantage is likely due to Cairns’ distance from the metropolitan centre of Brisbane, which creates less opportunity for employment skills development. Further, the spread of Cairns’ population across the large geographic region, in combination with poor public transport systems, results in varied access to health and education services, contributing to health inequalities.25

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Economic policies have been put in place to address these existing socioeconomic and health inequalities. In 2020, the Queensland Government will deliver a $400,000 campaign to promote Cairns’ unique Indigenous tourism experiences.29 This funding will help develop more attractions and showcase Indigenous culture to the world, facilitating creation of new jobs and career pathways for Indigenous Australians within tourism and related industries. As more Indigenous people are employed, their disposable incomes will increase, improving their socioeconomic conditions which allows them to afford necessary healthcare services, resulting in better mental and physical wellbeing. In 2017, “My Health for Life”, a $27 million state-wide evidence-based healthy lifestyle program was introduced.30 The program targeted at-risk populations and aimed to inform communities on how lifestyle choices can impact individuals’ risk of developing chronic illnesses such as type 2 diabetes, heart disease or stroke. Greater health literacy would reduce the likelihood of developing lifestyle risk factors, thereby decreasing the prevalence of chronic illnesses, driving positive health outcomes. Cairns’ regional economy is strongly driven by tourism, hospitality and health services. Significant government investment in regional infrastructure, the $100 million Back to Work Regional Employment Package, investment in protecting the Great Barrier Reef will support existing jobs and industries, and ensure future sustained economic development and low unemployment levels, which are pertinent to better physical and mental health outcomes.31

Political Environment The political environment, as a determinant of health, refers to political systems and the policies enforced by all levels of government.32 Viewing health through the lens of the political determinant involves evaluating the impact on health by opposing power groups and institutions.33 Favourable health outcomes are ultimately dependent on political action; this includes laws and regulations that promote healthy behaviours as well as government initiatives that support citizens in making health-related decisions. The importance of political systems in determining health outcomes is highlighted in the action areas of the Ottawa Charter for Health

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Promotion; specifically, building healthy public policy.34 For Cairns, this is essential for the community’s health that public policies are built by local Cairns government bodies as policies and initiatives can be tailored to benefit the regional community. Queensland’s state laws regarding tobacco smoking have improved health outcomes for residents in Cairns; these regulations include retail laws, such as plain packaging and increased taxes, that can reduce the number of first-time smokers, as well as legislation against smoking in public areas, protecting non-smokers.35 The restrictions banning smoking within five metres of a variety of services and buildings such as schools can also reduce the rate of smoking uptake by teenagers.36 Supported by many locals, the regulations controlling tobacco smoking have a positive impact on physical health.37 This pattern of reduced smoking has seen promising benefits to the rates of lung cancers and other respiratory diseases.36 Furthermore, the impact on secondary smoking has lessened, especially for children, due to the restrictions placed regarding smoking near schools. The political arena can be utilised to further improve all residents’ healthrelated behaviour. By adding restrictions on alcohol consumption and increasing taxes on products such as sugar, governments can promote physical health and increase life expectancy.38 The Cairns Regional Council advocates for the equal opportunity for Aboriginal and Torres Strait Islander peoples in the region, supporting the Racial Discrimination Act of 1975 through the passing and implementation of Reconciliation Action Plans.38,39 By ensuring the council has a well-functioning First Peoples Advisory Committee, the Cairns local government provides the Indigenous community with a voice and representation.40 This encourages a sense of inclusion and acceptance in the Cairns community, promoting health, particularly emotional and mental health for Indigenous Australians residing in Cairns. This increased access to opportunities for Indigenous residents in Cairns increases their sense of belonging in their community and promotes feelings of self-worth.41 4.4% of Cairns’ population, 6,940 people, were in need of assistance with a severe disability in 2016.42 The Access and Inclusion Plan is a commitment by the Cairns Regional Council to promote equitable access within the community and eliminate discrimination based on disability.43 The council proposes to increase community participation by coordinating themed

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weeks such as Disability Action Week and implement awareness programs; by empowering all persons within a community and encouraging residents to support each other regardless of their abilities, the plan can increase citizens health and wellbeing43; spiritual and emotional health is promoted as individuals have a new-found sense of belonging in communities, and mental health can be improved by the positive self-esteem created through reduced social exclusion3 due to the initiatives implemented by the Cairns Regional Council. Enhancing participation levels of all people in the Cairns community allows individuals to foster new relationships with fellow residents, promoting the social dimension of health and wellbeing.18 A variety of grants are also available from the Cairns Regional Council to provide financial assistance fo...