Biosociocultural Determinants of Health for ATSI Communities

Biological Determinants:

1. Genetic Susceptibilities:
   • Certain health conditions like diabetes and rheumatic heart disease have higher prevalence rates among ATSI populations due to genetic predispositions.
2. Age Distribution:
   • A younger population structure affects the prevalence and type of health conditions prominently seen in the community.

Other Health Concerns:

1. Chronic Diseases:
   • Diabetes: High prevalence of type 2 diabetes, often with complications such as diabetic nephropathy and retinopathy.
   • Cardiovascular Diseases: Increased rates of hypertension, heart disease, and stroke.
2. Infections:
   • Otitis Media: High rates, leading to hearing loss and subsequent communication and learning difficulties.
   • Respiratory Infections: Higher incidence of pneumonia, bronchitis, and other respiratory infections.
   • Rheumatic Heart Disease: Due to untreated streptococcal infections.
3. Mental Health Issues:
   • Depression and Anxiety: Higher prevalence due to various social determinants.
   • Substance Use Disorders: Elevated rates of alcohol and drug abuse.
   • Suicide: Significantly higher rates compared to the non-Indigenous population.
4. Maternal and Child Health:
   • Infant Mortality: Higher rates of infant mortality.
   • Low Birth Weight: Increased prevalence of low birth weight babies.
   • Childhood Development: Delayed developmental milestones due to various health and social factors.
5. Nutrition and Obesity:
   • Malnutrition: Both undernutrition and overnutrition are prevalent, leading to obesity and related health issues.
6. Renal Disease:
   • Chronic Kidney Disease: Higher incidence, often related to diabetes and hypertension.

Social Determinants:

1. Socioeconomic Status:
   • Lower Income: Contributes to poorer health outcomes due to limited access to health resources and healthy living conditions.
   • Education: Lower levels of education correlate with lower health literacy, affecting the ability to seek and adhere to medical advice or make informed health choices.
   • Employment: Higher rates of unemployment or engagement in lower-wage jobs limit access to healthcare and resources necessary for maintaining health.
   • Housing: Poor housing conditions, overcrowding, and inadequate sanitation facilities increase the risk of diseases and negatively impact mental health.

Cultural Determinants:

1. Cultural Practices:
   • Traditional diets and the use of medicinal plants can influence health positively, but changes in lifestyle and loss of traditional knowledge may negatively impact health.
2. Language and Communication:
   • Barriers in communication can affect the quality of healthcare received. Misunderstandings due to language differences can lead to misdiagnosis or ineffective treatment.
3. Disconnection from Land and Culture:
   • The loss of cultural identity and connection to land due to historical policies and ongoing discrimination impacts mental and emotional well-being.
4. Racism and Discrimination:
   • Ongoing experiences of racism and discrimination in healthcare settings and the broader society contribute to stress and reduce utilization of health services.

Environmental Determinants:

1. Geographical Location:
   • Many ATSI communities are in remote or rural areas, where healthcare services may be less accessible, affecting timely access to diagnosis and treatment.
2. Issues with Water Access in Rural Australia:
   • Quality of Water: Contaminated water sources with natural harmful substances like arsenic or agricultural runoff can lead to health problems, such as gastrointestinal illnesses and long-term chronic conditions.
   • Infrastructure Deficits: Outdated or insufficient water infrastructure can result in irregular water supply and poor water quality. Lack of infrastructure investment exacerbates the problem.
   • Impact of Drought: Frequent and intense drought conditions strain water supplies, making it difficult to maintain a steady, safe water supply. During droughts, water sources can become more concentrated with harmful substances.
3. Housing Conditions:
   • Overcrowding and inadequate housing contribute to the spread of communicable diseases and can exacerbate chronic health conditions.

Judicial Concerns:

1. Overrepresentation in the Criminal Justice System:
   • High Incarceration Rates: ATSI peoples are disproportionately represented in the prison population.
   • Juvenile Detention: Higher rates of detention among Indigenous youth.
2. Legal Discrimination and Bias:
   • Racial Discrimination: Experiences of racism and discrimination within the justice system.
   • Bias in Sentencing: Evidence of harsher sentencing and less favorable legal outcomes.
3. Access to Legal Services:
   • Legal Aid: Limited access to legal aid and representation.
   • Cultural Competency: Lack of culturally competent legal services and support.
4. Impact on Families and Communities:
   • Intergenerational Trauma: The legacy of past policies, such as the Stolen Generations, impacting current interactions with the justice system.
   • Community Disruption: High incarceration rates contributing to social and family disruption.