Naughton William, Baumann Angus A, Neal Kirsten, Wilson Dan, Johnson Richard, Holwell Anna
Department of Medicine, Alice Springs Hospital, Alice Springs, Northern Territory, Australia.
School of Medicine, Flinders University Rural Clinical School, Adelaide, South Australia, Australia.
Intern Med J. 2024 Dec;54(12):2077-2082. doi: 10.1111/imj.16548. Epub 2024 Oct 26.
The persisting life-expectancy 'gap' between First Nations and non-First Nations Australians is fundamentally driven by the social determinants of health. These include income and social protection, access to adequate housing and food security, among others. These factors are particularly prominent in Central Australia. Inadequate housing has led to some of the highest rates of Streptococcus pyogenes infection in the world, which in turn drives an extremely high prevalence of rheumatic heart disease. Food insecurity and inadequate social protection manifesting as energy insecurity result in inadequate nutrition and have resulted in a huge burden of diabetes in Central Australia. These factors, combined with social exclusion, racism and the pervasive effect of colonisation, also drive a high rate of alcohol misuse. Only by prioritising equity in these 'social determinants' and emphasising the importance of First Nations leadership in formulating and implementing solutions will health inequity be addressed.
澳大利亚原住民与非原住民之间持续存在的预期寿命“差距”，根本上是由健康的社会决定因素驱动的。这些因素包括收入和社会保护、获得适足住房和粮食安全等。这些因素在澳大利亚中部尤为突出。住房不足导致了世界上一些最高的化脓性链球菌感染率，进而导致风湿性心脏病的极高患病率。粮食不安全和表现为能源不安全的社会保护不足导致营养不足，并在澳大利亚中部造成了巨大的糖尿病负担。这些因素，再加上社会排斥、种族主义和殖民化的普遍影响，也导致了高比例的酒精滥用。只有优先考虑这些“社会决定因素”中的公平性，并强调原住民领导力在制定和实施解决方案中的重要性，健康不平等问题才能得到解决。
