Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, Darwin, NT, Australia.
Health Promot Int. 2010 Mar;25(1):42-53. doi: 10.1093/heapro/daq004.
Poor environmental conditions and poor child health in remote Australian Aboriginal communities are a symptom of a disjuncture in the cultures of a disadvantaged (and only relatively recently enfranchised) minority population and a proportionally large, wealthy dominant immigrant population, problematic social policies and the legacy of colonialism. Developing effective health promotion interventions in this environment is a challenge. Taking an ecological approach, the objective of this study was to identify the key social, economic, cultural and environmental factors that contribute to poor hygiene in remote Aboriginal communities, and to determine approaches that will improve hygiene and reduce the burden of infection among children. The methods included a mix of quantitative and qualitative community-based studies and literature reviews. Study findings showed that a combination of crowding, non-functioning health hardware and poor standards of personal and domestic hygiene underlie the high burden of infection experienced by children. Also, models of health promotion drawn from developed and developing countries can be adapted for use in remote Australian Aboriginal community contexts. High levels of disadvantage in relation to social determinants of health underlie the problem of poor environmental conditions and poor child health in remote Australian Aboriginal communities. Measures need to be taken to address the immediate problems that impact on children's health-for example, by ensuring the availability of functional and adequate water and sanitation facilities-but these interventions are unlikely to have a major effect unless the underlying issues are also addressed.
偏远地区澳大利亚原住民社区的环境条件差和儿童健康状况不佳，是劣势（并且只是最近才获得选举权）少数族裔人口与比例较大、富裕的移民人口之间文化脱节、有问题的社会政策以及殖民主义遗留问题的表现。在这种环境中制定有效的健康促进干预措施是一项挑战。本研究采用生态方法，旨在确定导致偏远原住民社区卫生条件差的主要社会、经济、文化和环境因素，并确定改善卫生状况和降低儿童感染负担的方法。方法包括基于社区的定量和定性研究以及文献综述的组合。研究结果表明，拥挤、卫生硬件无法正常运行以及个人和家庭卫生标准低下是导致儿童感染负担沉重的根本原因。此外，从发达国家和发展中国家借鉴的健康促进模式可以适用于澳大利亚偏远原住民社区的背景。在与健康决定因素相关的方面，劣势程度较高是导致偏远地区澳大利亚原住民社区环境条件差和儿童健康状况不佳的根本原因。需要采取措施来解决影响儿童健康的直接问题，例如，确保提供功能齐全且足够的水和卫生设施，但除非解决根本问题，否则这些干预措施不太可能产生重大影响。
