Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, Australia.
Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia.
BMC Public Health. 2020 Dec 4;20(1):1859. doi: 10.1186/s12889-020-09943-4.
Indigenous populations globally are continually striving for better health and wellbeing due to experiencing significant health and social inequities. The social determinants of health are important contributors to health outcomes. Comprehensive primary health care that is governed and delivered by Indigenous people extends beyond the biomedical model of care to address the social determinants of health. Aboriginal Community Controlled Health Organisations (ACCHOs) are known to provide culturally informed, holistic health services that directly and indirectly address the social determinants of health. The range and extent of their activities in addressing the social determinants of health, however, is not well documented.
The most recent ACCHO annual reports were retrieved online or by direct correspondence. For coding consistency, a dictionary informed by the World Health Organization's Conceptual Framework for Action on the Social Determinants of Health was developed. A document and textual analysis of reports coded ACCHO activities and the determinants of health they addressed, including intermediary determinants, socio-economic position and/or socio-political context. Summary statistics were reported. Representative quotes illustrating the unique nature of ACCHO service provision in addressing the social determinants of health were used to contextualise the quantitative findings.
Sixty-seven annual reports were collected between 2017 and 2018. Programs were delivered to population groups across the life span. Fifty three percent of reports identified programs that included work at the socio-political level and all annual reports described working to improve socioeconomic position and intermediary determinants of health through their activities. Culture had a strong presence in program delivery and building social cohesion and social capital emerged as themes.
This study provides evidence of the considerable efforts of the ACCHO sector, as a primary health care provider, in addressing the social determinants of health and health inequity experienced by Indigenous communities. For the Aboriginal and Torres Strait Islander population, ACCHOs not only have an essential role in addressing immediate healthcare needs but also invest in driving change in the more entrenched structural determinants of health. These are important actions that are likely to have an accumulative positive effect in closing the gap towards health equity.
由于经历了重大的健康和社会不平等，全球各地的土著人口一直在努力改善健康和福祉。健康的社会决定因素是健康结果的重要因素。由土著人民管理和提供的综合初级卫生保健不仅扩展了生物医学护理模式，还解决了健康的社会决定因素。众所周知，土著社区控制的卫生组织（ACCHOs）提供了以文化为导向的整体健康服务，直接和间接地解决了健康的社会决定因素。然而，他们在解决健康的社会决定因素方面的活动范围和程度并没有得到很好的记录。
在线或通过直接通信检索了最近的 ACCHO 年度报告。为了保持编码一致性，根据世界卫生组织关于社会决定因素健康行动的概念框架制定了一个字典。对报告进行了文件和文本分析，对 ACCHO 活动以及他们所解决的健康决定因素进行了编码，包括中间决定因素、社会经济地位和/或社会政治背景。报告了总结统计数据。为了说明 ACCHO 服务在解决健康的社会决定因素方面的独特性质，使用了说明性的代表性报价。
在 2017 年至 2018 年期间收集了 67 份年度报告。这些项目针对整个生命周期的人群提供。53%的报告确定了包括社会政治层面工作的项目，所有年度报告都描述了通过活动努力改善社会经济地位和健康的中间决定因素。文化在项目实施中具有强大的影响力，社会凝聚力和社会资本的建设成为主题。
本研究提供了证据，证明作为初级卫生保健提供者的 ACCHO 部门在解决土著社区面临的健康的社会决定因素和健康不平等方面做出了相当大的努力。对于澳大利亚原住民和托雷斯海峡岛民来说，ACCHOs 不仅在解决即时医疗保健需求方面发挥着至关重要的作用，而且还投资于推动更根深蒂固的健康结构决定因素的变革。这些都是重要的行动，很可能会对缩小健康公平差距产生累积的积极影响。
