There is the importance of the articulation of gender, race and ethnicity, and poverty in structuring of health inequalities and their manifestations!

Introduction

Australia is one of the highest ranked countries in terms of health care. (Peel, 2003)

However, this does not undermine the fact that there are existing inequalities in health care based on a number of factors such as race, ethnicity, poverty and gender. These disparities have manifested themselves through higher mortality rates among the disadvantaged groups, higher prevalence of both preventive and treatable diseases. Consequently, there is a need to look into the extent of these inequalities in the Australian context but also through comparative analysis.

Importance of the intersections of gender, race, ethnicity and poverty in the structuring of health inequalities

In the year 2005, the Howard government released a report intended on studying health inequalities in the Australian government. A number of issues revealed in this report were crucial in understanding the nature of this problem. First of all, it was found that mortality rates of individuals with high poverty rates were much higher than those how did not lie in this bracket. Also, the report revealed that this gap has increased tremendously over the past one and half decades.

In response to the findings in this report, the Australian government did what many political bodies are fond of doing; it shifted the focus of the report. The government asserted that mortality rates have decreased over the past few years and little emphasis was placed on the changes in health inequalities. While it may be true that mortality rates have reduced over the past years, this fact de-contextualizes the issue of health inequality in Australia. (Blendon et al, 2002)This is because decreased mortality rates are usually caused by increased investment in medical technology and heightened exposure to medical information. These have nothing to do with the social economic status of the respective populations or with any other underlying inequality issues. The report was essential in understanding how so many individuals have been sidelined in the public health system and this damage is usually felt by the economically disadvantaged group. This was the same assertion made by Farmer (1999) in his book infections and inequalities. He asserted that many stakeholders in the public health system tend to place too much emphasis on the issue of health interventions for the entire population rather than focus on social economic factors that could be causing these disparities as is the case with the Australian government.

The latter report revealed that at the beginning of this century, the Australian government could have saved close to twenty three thousand lives if they had exposed themselves to similar health care and living conditions that their counterparts in wealthy groups had. Additionally, the report also revealed that persons within the high income bracket lived approximately four to two years longer than their counterparts in other groups. Consequently, this reveals that there is a wide health gap which begins at one’s birth and is then propagated throughout their lives.

Social economically disadvantaged areas were important in revealing health disparities in Australia. Most of the mortality rates in various stages of life were significantly higher in poverty stricken areas than in other areas. This assessment was done by comparing the nature of an individuals’ cause of death. If the cause of death was found to be one of the major causes, then it would be used a basis for classification. These mortality rates were studied through different stages in life and most of them reflected disparities in income. Some of the stages utilized in this study included

Infancy

Childhood

Adolescence

Young adulthood

Working age

Late adulthood

The latter report also brought to bear the fact that mortality rates between individuals in the highest twenty percent of the wealthy groups was much higher than the lowest twenty percent of the poor in the study period than in other years of study. Consequently, one can assert that the inequality gap has continually risen. This assertion was made after looking at some of the common causes of death such as heart related diseases and also cancers. This finding was in relation to individuals aged between twenty five to sixty four years old. (Australian Institute of Health and Welfare, 2006)

Inequalities in the Australian health care systems are also manifested as a result of racial factors. This is in relation of the native Aboriginal Australians and the predominant race in the country. This group is highly oppressed in terms of health care. (Harding, 2002) Research shows that Aboriginal people account for forty nine point three percent of all the persons classified as rural populations.

This racial group is characterized by devastating cases of poverty and most of them have been isolated by the state. There is substantial evidence to show that most of the underlying problems faced by the Aboriginal people in health care are associated with the lack of support from the Australian government. This is because the group lacks access to basic medical services. Additionally, those medical services that are present are poorly equipped. Also, the Aboriginal people have very little knowledge about the importance of living healthy lifestyle. This is the reason why they are likely to depict greater cases of mortality than the predominant racial group within the country. It should be noted that overwhelming evidence also points to the fact that there is a correlation between an individual’s education level and their health status. Many Aboriginal people are not well educated; consequently, most of them may not have the ability to deal with certain health problem as they occur. In other words, there is an interrelation of race and poverty status or social economic advantage among the Aboriginals. This could explain their disparities in health currently. (Beyrer & Pizer, 2007)

It should be noted that one’s income group also affects the quality of their health. In Australia, blue collar employees have reported higher death rates that their counterparts in administrative, professional or managerial positions. This assertions was supported by the fact that the latter group had higher cases of deaths due to the following diseases

· Lung cancer

· Suicide

· Injury

· Accidents

· Digestive disorders

· Circulatory diseases

· Respiratory diseases

As it can be seen from the latter group, some of the causes of death are voluntary such as suicide. Additionally, others are affected by lifestyle patterns and are usually linked to substance abuse e.g. lung cancer, circulatory diseases among others. This implies that blue collar workers are increasingly at risk in developing behavioral disorders and they lack the ability to access help for coping with disorders hence leading to their declining health and high mortality rates. However, Farmer (1999) asserts that one should not place too much blame on the group under analysis as they are. Instead, there should be greater focus on the reason behind such behavior patterns. The reason why blue collar workers engage in substance abuse and other potentially devastating lifestyle choices is that they may not be fully aware of the repercussions of their actions. Additionally, their social economic status could be leading them to these behavioral patterns as most of them are not satisfied with their lives. Overly, most of them end up getting problems and this may be manifested in the way they lead their lives. (Greig, Lewins & White, 2003)

Farmer (1999) also claims that stakeholders in public health care systems have been tackling the problems in the wrong way. Instead of dealing with inequalities as the major cause of these high prevalence rates among sidelined groups, most stakeholders tend to assume that social cultural factors are largely to blame. The Australian government claimed that blue collar workers tended to over eat or engage in substance abuse hence the reason why they have higher mortality rates. Such an explanation is not sufficient at all because it was ignoring the fact that many individuals in the high income groups also engage in the latter habit. The government did not consider some of the factors that relate to this kind of observance especially with regard to the nature of its respective lifestyles.

There are certain issues that are interrelated in inequality studies. For instance, there is a link between the following issues

-Indigenous ethnicity

-Geographical remoteness

-Poverty

-Social class

A study conducted among indigenous ethnic groups also found that the same group is likely to depict geographic remoteness and is also likely to belong to lower social classes. Additionally, their health status is much lower than it is for other types of groups. For instance, it has been found that there a person’s mortality rate is likely to increase by twice of four time s as much as those person who do not belong to ethic indigenous groups.

Additionally, age and gender in Australia are only important factors when linked to social economic status. For instance, the cases of accident and injury or suicide among males in lowermost social classes are much higher than that in higher social classes. The same thing may be said about similar diseases among females. (Senate Select Committee on Medicare, 2005)

The issue of age is also linked to an individual’s social economic status. For instance, the health of children lying between the ages of six to nine in remote regions to poverty stricken areas is much higher than it is in areas with minimal struggles for wealth. These ties in with Farmer’s (1999) argument where he explains that persons lying in the low income bracket or the unemployment sector are likely to lack basic education, decent housing and other basic needs. Consequently, such person is subjected to poor physical and psychological conditions that may result in certain health related problem. These scenarios may include injury, accidents, and psychological problems among others. This can be applied to the Australian setting because when one examines how the Aboriginal people live, it is common to find that the youth there are tackling major psychological problems. This is the reason why Aboriginal youth have as much as two hundred and eight percent suicide rates more than other youth in the Australian population or in other cities.

Other manifestations of low quality health care among the disadvantaged groups can be linked to their respective access to medical health care. This is increasingly alarming because public health stakeholders have the opportunity to intervene in this situation in order to curb such disparities. The Medical Care system in Australia favor high income groups or at least financially stable groups rather than ethnic/ racial minorities, lower social classes or poverty stricken individuals. This is because a substantial number of doctors use the direct pay method as they tend to mistrust the bulk billing system (as a result of poor streamlining in the medical insurance system). Additionally, many groups have to tackled the problems that revolve around soaring medicinal prices. (New South Wales Department of Health, 2004) This has occurred regardless of the government’s subsidization in this area.

The overall effect of the inadequacies in the health care system is that many unemployed/ low income groups tend to look for public hospital casualty wards that offer free treatment. The overall consequence of this is that a large number of wards have been closed and the numbers of staff members dealing with the issue are much lower. As if this is not enough, the units available tend to be overcrowded thus minimizing the time that doctors spend with their respective patients. Also, such hospitals are characterized by poor hospital equipment. In the end, many Australians find that they have to buy insurance. Those who cannot, are forced to succumb to these poor quality systems without having any form of problem being laid out. (Levy & Sidel, 2005)

Some of the problems encountered in the health cares system are largely related to the fact that many people simply cannot afford their own health care. A study conducted in 2007 revealed that twenty percent of all patients within the Australian medical system cannot afford to purchase prescribed medications; consequently, such patients put themselves at considerable risks of mortality. Additionally, poor people earning much less than their counterparts in other income groups (for instance, those who earn thirteen thousand dollars) have to dedicate huge amounts of their salary to cover medical expenses. For example, the latter mentioned income group may have to dedicate about twenty eight percent of the income to cover medical costs. Those earning less than thirteen thousand dollars annually have to dedicate even larger sums. In other words, the government needs to look for ways in which it can improve health care accessibility and costs among these disadvantaged groups.

Conclusion

A series of economic and social conditions have a direct effect on public health. Depending on how a particular society decides to treat it, these effects can cause inequality or equality. In Australia, overall health has improved and is even ranked as one of the most successful. However, gap between various disadvantaged groups have been widening over the past few years. The most outstanding issue in health inequality is that of poverty. It can be linked to disparities in age, gender, ethnicity or even race. Consequently, if the government or other public health stakeholders steeped in order to reduce these barriers to health care among such groups, then the inequalities would drastically reduce.