Social Determinants of Indigenous Health

Abstract

SOCIAL DETERMINANTS OF INDIGENOUS HEALTH Bronwyn Carson, Terry Dunbar, Richard Chenhall and Ross Bailie (eds) Crows Nest: Allen and Unwin 2007, 336 pp, $AUD49.95 (ppbk) ISBN 978 1 74175 142 0The 17-year gap in life expectancy between Indigenous Australians and non- Indigenous Australians sets the Social Determinants of Indigenous Health in context. Many of us believe that efforts to close this gap will be strengthened by addressing inequalities in the social determinants of health. Since I became involved in Indigenous health research in 1999 I have longed for a book which analyses the social determinants of health as applied to Indigenous people. This book, developed from some of the contributions presented during 2004 and 2005 in Darwin as a series of short courses on the Social Determinants of Indigenous Health, does not disappoint. The Indigenous and non- Indigenous contributors to this edited volume are respected academics, researchers and/or practitioners in the fi eld of Indigenous health. Without exception, the complex issues covered in the 13 chapters are well written and edited. All chapters contain a comprehensive reference list for those who want to access primary sources. One of the best things about the book is the set of summary points and discussion questions at the end of each chapter: these are useful for any reader, but would be a particularly benefi cial for teaching purposes.The book begins by setting the scene with three introductory chapters. In the fi rst, Saggers and Gray refl ect on the history of associations between health and social inequalities. This is followed by Ian Anderson's chapter on social models of health before Jessie Mitchell provides the historical context in chapter three. Subsequent chapters focus on racism; poverty and social class; social capital; education; employment and welfare; country; housing; and human rights. The penultimate chapter covers the history of Australian health policy as applied to Indigenous people. Kathleen Clapham, Kerin O'Dea and Richard Chenhall complete the volume with three examples of sustainable programs.Several contributors emphasise that simplistic application of existing models developed on the basis of non-Indigenous people will not provide solutions to address inequalities in the social determinants of health. Anderson also points out the importance of sociological theory to understanding health inequalities. The chapter on poverty and social class (which takes us back to Marx and Weber) is typical of the strong theoretical underpinning of the volume.In their chapter on country, Burgess and Morrison (citing Hunter 1993) remind us that 'When culturally proscribed practices of socialising (Indigenous) adolescents break down the ensuing confusion may result in violence, substance use and suicide' (2007:193). They link this to Durkheim's explanation of suicide resulting from the loss of social capital. Baum also reminds us of Durkheim as she catalogues some of the causes of Aboriginal anomie, including racism, violence, the devastation of the Stolen Generations, and the lack of autonomy, particularly over the land. She refers to the more recent work by Marmot and colleagues on autonomy, also mentioned by other contributors to the volume.A proper understanding of the destructive impact of colonisation on Indigenous peoples is central to addressing inequalities in the social determinants of health, and this theme reappears throughout the volume. Mitchell shows how diseases such as smallpox, tuberculosis and measles took their toll on the health of Indigenous peoples during the early years of white settlement. In the early twentieth century, reserves, missions and government compounds were breeding grounds for epidemics of parasites and infectious diseases.Another recurring theme is the damaging effects of racism, most notably documented by Yin Paradies. He refers to 138 recent articles on racism, and demonstrates the strong relationship between experiencing racism and poor mental health. …