The Movement

 

                            ‘I just want to be the best I can’

These are some resonating words from a recent campaign led by GenerationOne. Why should it be more challenging for a person to achieve their goals just because they are an Indigenous Australian?

Whilst the statistics can be depressing we can’t afford to feel hopeless about the situation at hand. With an abundance of resources and infrastructure compared to most of the world, we need to be reminded that we really do have the capacity to make a real change.

Where there is a will there is a way.

GenerationOne was launched under the Rudd government (2010) to make an end to the inequality. By advocating for more sustainable job opportunities for Indigenous Australians, GenerationOne hopes to break the vicious cycle of unemployment, poverty and injustice.

We can all get involved in some way or another. Whether that may be inspiring family or friends to participate, volunteering with a variety of organisations such as GenerationOne, or donating money to campaigns, all of our efforts count. Blogs, news, forums and other online resources are a great and time efficient way to inform ourselves.

Be more proactive, inform yourself, and become a part of the movement.

Start by visiting http://generationone.org.au/ for more statistics and information on becoming more culturally aware.

Poor access to health services: ways Ethiopia is overcoming it

The limited distribution systems and weak infrastructure in low-income countries limit access to health services, particularly in rural areas.1

  • relatively few and widely dispersed government health outlets
  •  Private-sector sources often favour wealthier urban areas which result in uneven available service within a country.1
  • Reproductive health is generally poor in Ethiopia, with significant regional disparities in access to services and in health outcomes.1
http://www.msf.org.au/from-the-field/field-news/field-news/article/we-face-an-alarming-increase-in-malaria-cases.html
http://www.msf.org.au/from-the-field/field-news/field-news/article/we-face-an-alarming-increase-in-malaria-cases.html

Improving health in Ethiopia requires:

  • Improving in physical infrastructure
  • Strengthening primary health care system
  • Decentralising health service provision
  • Require major investments and time
  • Mobilising, educating and training communities and individuals1
  • Pay attention to quality of services, strengthening community participation
  • Provide reproductive and other health services through primary health care facilities1
  1. Population Action International (USA). Poor Access to Health Services: Ways Ethiopia is Overcoming it [Internet]. Washington, DC (USA): Population Action International (USA); 2007 [updated 2007 April; cited 2014 Mar 23]. Available from: http://populationaction.org/wp-content/uploads/2012/01/Health_Services.pdf

Income and Wealth Distribution affects Ethiopia Healthcare

The length of life inequality has decreased and life expectancy increased between 2000 to 2011 in Ethiopia.1 There is a larger length of life inequality between rural and urban residents, also between less wealthy and more wealthy people.1 The population level health in Ethiopia can be assessed by estimating length of life inequality and life expectancy to provide a baseline for priority setting and resource allocation.1 Therefore, distribution of money, income and wealth play a significant role in affecting in health which is measured by life expectancy.

1475-9276-12-52-1.jpg

Figure. 1. Mortality distribution for highest and lowest wealth quintile 2011. Mortality given as deaths per 1000 (y-axis) plotted against five-year age groups (x-axis).

From Figure 1, we can see a distribution of deaths among different five year age-groups for lowest wealth and highest wealth quintile respectively.

  • The highest number of deaths per 1000 for the highest wealth quintile is age group 75-79, with an estimate of 140 deaths per 1000.
  •  The highest number of deaths per 1000 for lowest wealth quintile is age group less than 5, with an estimate of 140 deaths per 1000.
  • Significant high death rate for age group less than 5 for highest wealth quintile, with an estimate of 85 deaths per 1000.
  • peak number of deaths for age group 70-74, an estimated 90 deaths per 1000 in highest wealth quintile.
  • lowest number of deaths for age group 5-9 for lowest wealth quintile, with estimate of 10 deaths per 1000.
  • lowest number of deaths for age group 5-9 for highest wealth quintile, with an estimate of less than 10 deaths per 1000.
  • Both curves show a steep drop in number of deaths per 1000, followed by a gradual increase across the age groups reaching a peak in age groups 70-74 and 75-79, before a steep decrease in mortality rate again.

1475-9276-12-52-2.jpg

Figure 2. Life expectancy (central dotes) and the absolute length of life inequality (high and low bar) for wealth quintiles indicates larger within- than between-group inequality.1

There is a clear socio economic gradient in Ethiopia

  • The life expectancy ranging from 53.4 years in the lowest wealth quintile to 62.5 years in the highest quintile, a significant difference of 9 years in life expectancies.
  • The middle and highest wealth quintiles have highest life expectancies of 60 and 62 years respectively.
  •  The lowest life expectancies are 54 and 55 years for lowest and second wealth quintiles respectively.

1.      Tranvåg EJ, Ali M, Norheim OF. Health inequalities in Ethiopia: modelling inequalities in length of life within and between population groups. International Journal for Equity in Health [Internet]. 2013 [cited 2014 Mar 10];12(52). Available from: http://www.equityhealthj.com/content/12/1/52

Ethiopia: The Threat from within

motherstarvingchild225ethiopia
http://abbaymedia.com/2008/05/31/ethiopian-children-go-hungry-as-government-response-faulted/

International aid and government funding have been misused for political gains rather than investing in social and economic rights. Corruption is reflected by the government policies which influences distribution of funding towards investments which benefit government politicians. These funds are taken away from areas of desperate need such as healthcare, food and agricultural resources.1

Human Rights Watch discovered inequalities in developmental projects and policies in Ethiopia. The government in Ethiopia has utilized donor-supported programs, training opportunities and salaries to control the population, punish those who dissent and suppress political opponents.1 Opposing party members are denied access to fertilisers, seeds, food aid, agricultural land and other resources for development because of conflicting political opinions. However, if these members write a letter of regret to the administration for siding with the opposing political party, local officials offer them food and money.   Discrimination is widespread in Ethiopia. People are excluded from development programs just because of their religion, gender, ethnic backgrounds and disability.1

Human Rights Watch research also shows that people in the Gambella region of Ethiopia are forced to move away from their existing homes to new model villages where they were promised to have improved infrastructure and better services. Sometimes the government orders soldiers to beat and abuse people who are opposed to moving away from their homes. Government pledges are not fulfilled as the relocated populations face hunger and starvation despite being promised food and agricultural assistance.1 There are serious human rights abuses against indigenous peoples and other ethnic minorities under the government’s “villagisation” program.

The Ethiopian government sold these areas of land to India for cheap farm lands.

Moreover, the Ethiopian government has failed to consult and compensate Indigenous groups for alternative means of livelihoods when they are forced to relocate. For the purposes of this ‘villagisation’ program there has been the creation of 245,000 hectares of state-run sugar plantations along the Omo River.1 Intimidation and assaults are forced upon these people who questioned and opposed to relocation plans.

Future commitment by the international community should be to protect the peoples rights and prevent violations of these rights. There is a need to recognise specific rights of Indigenous people and their right to ancestral lands.1 Education, healthcare, water and sanitation and other socio-economic rights should be considered for Indigenous people.1

Human Rights Watch raises awareness by posting online websites and urged international donors to ensure that they are not providing support for forced displacement or facilitating rights violations in the name of development.2

Cultural Survival increases awareness through a campaign known as Global Response Campaign Alert Ethiopia. Volunteers can post polite letters to governments of the United Kingdom and the United States to express concern of the Ethiopian government violating human rights through villagisation program. They can also urge UK and USA not to fund for villagisation schemes that violate human rights.3 Letters should encourage USA and UK should use their influence as donor nations to demand Ethiopia to reinforce its own constitution and laws to protect Indigenous people’s rights to their ancestral lands.3

References

1.  Human Right Watch (USA). Discrimination, Inequality, and Poverty A Human Rights Perspective [Internet].  United States of America: Human Right Watch (USA); 2008 [updated 2013 Jan 12; cited 2014 Mar 10]. Available from: http://www.hrw.org/news/2013/01/11/discrimination-inequality-and-poverty-human-rights-perspective

2.  Global Development. Thousands ‘forcibly relocated’in Ethiopia, says HRW report [Internet]. Global Development; 2012 [updated 2012 Jan 7; cited 2014 Mar 29]. Available from: http://www.theguardian.com/global-development/2012/jan/17/ethiopia-relocation-programme-report

3.  Cultural survival (UN). Global Response Campaign Alert Ethiopia [Internet]. United Nations: Cultural Survival (UN); 2012 [cited 2014 Apr 13]. Available from: http://www.culturalsurvival.org/sites/default/files/ethiopia_action_alert.pdf

 

What has Social Justice got to do with our Health?

Social determinants of health-ourselves and globally

 

http://www.local.gov.uk/image/image_gallery?uuid=0bda101e-b96c-402d-94c7-ba54784b9043&groupId=10180&t=1377822753450
http://www.local.gov.uk/image/image_gallery?uuid=0bda101e-b96c-402d-94c7-ba54784b9043&groupId=10180&t=1377822753450

 

WHO defines the social determinants of health:

“The social determinants of health are the conditions in which people are born, grow, live, work and age, including the health system. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels”

which itself is shaped by policy choices.3 Social determinants of health are the main cause of health disparities within and between countries. It is viewed as the unfair and avoidable differences in health status within and between countries.3 The social determinants of health on one hand includes accessibility to clean water and sanitation, food security, gender equality, economic and social security, and access to appropriate healthcare resources.3 On the other hand, international sanctions which lead to unhealthy living environments, war effects which results in refugees and internally displaced people, and poverty which includes labour and employment conditions and the distribution of resources within and among antions.3

Health is part of wellbeing, of how people feel and function and contributed by social and economic wellbeing. There are various determinants which contribute to health such as social, cultural, socioeconomic, environmental, behavioural and genetic factors.1

The inequitable distribution of money, power and resources will play a significant role in affecting health. The upstream (macro-level) factors of health include social determinants of health such as government, resources, culture and socioeconomic.2

Global health emphasises the improvement on health and achieve equity of health for all people worldwide. Moreover, global health focuses on geographical reach which transcend national boundaries and allows global cooperation for developing and implementing health solutions and promotes population-based prevention with clinical care of individuals. Global factors can directly affect government policies.

Upstream factors (macro-level) such as government policies, global forces and cultural factors affect economic, welfare, health, housing transport and taxation of the country. Environmental factors such as geographical location, remoteness, natural or built will also affect the socioeconomic factors.Socioeconomic factors are affected by government policies and contribute to  local economy, markets, wealth and education opportunities.2  Socioeconomic factors also include housing, migration status, food security and access to services. Education creates employment opportunities and occupations generate income and wealth of individuals.

These political, environmental and socioeconomic factors will affect midstream (intermediate-level) factors of health such as psychological factors which contribute to health behaviours.1 Psychological factors include stress, depression, anxiety and expectations which induce poor health behaviours such as the use of tobacco, illicit drugs and alcohol.

These psychological factors also affect health behaviours of individuals. Health behaviours include diet/nutrition, smoking, alcohol, physical activity, self-harm/addictive behaviours and preventative health care use. Accessibility, availability, affordability and utilisation of health care system is one of the midstream factors which affect the downstream factors.

Midstream factors directly affect downstream factors (micro-level) such as physiological, biological and health of individuals in a country or population. Physiological systems include endocrine and immune, which affects biological reactions such as glucose intolerance, body mass index, hypertension, fibrin production, adrenalin, suppressed immune response and blood lipid levels.1 Health outcomes of a population include life expectancy, morbidity and mortality.2

Individual physical and psychological makeup such as genetics, antenatal environment, gender, ageing, life course and inter-generational influences affect all levels of factors of health (from upstream to downstream factors).

Global interaction, communication and cooperation across nations and countries are global factors which contribute to the inequitable distribution of money, resources and power. Political structures, culture, affluence, social cohesion, social inclusion, media and language are community-level factors which contribute to health disparities due to inequitable distribution of money, resources and power. Individuals’ income, wealth, education and employment contribute to inequitable distribution of money, power and resources. Moreover, individuals’ health behaviours such as smoking and individuals’ psychological factors such as trauma and stress contribute to health disparities.

An inequitable distribution of money, resources and power in a country will definitely affect the state of health in the country and contribute to health inequalities of the people such as midstream (psychological and health behaviours) and downstream (health wellbeing) factors.1 Power represents government policies and culture, whereas money and resources refer to education, income level and job opportunities and healthcare access.2

People with higher income and social status generally have better health than people with lower income and social status.4 The greater the gap between the richest and the poorest people, the greater the differences in health.4 People with low education levels have poor health, more stress and lower self-confidence compared to people with higher education levels.4 Equal distribution and access of health services which prevent and treat diseases lead to better health. Social support network such as greater support from families, friends and communities provide better health outcomes. Culture, customs and traditions and the beliefs of the family and community affect health.4 Physical environment where there are equal distribution of safe water and clean air, health workplaces, safe houses, communities and roads all contribute to healthier lives. People in employment are generally healthier in particular to those who have control over their working conditions.4

References

1.  National Centre for Epidemiology and Population Health (AU). Health equity in Australia: A policy framework based on action on the social determinants of obesity, alcohol and tobacco [Internet]. National Centre for Epidemiology and Population Health (AU); 2009 [cited 2014 Mar 10]. Available from: http://www.preventativehealth.org.au/internet/preventativehealth/publishing.nsf/Content/0FBE203C1C547A82CA257529000231BF/$File/commpaper-hlth-equity-friel.pdf

2.  U.S Department of Health and Human Services (USA). Social determinants of health [Internet]. U.S Department of Health and Human Services (USA); 2013 [updated 2013 Nov 13; cited 2014 Mar 10]. Available from: http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=39

3.  Hixon, AL, Yamada S, Farmer, PE & Maskarinec GG. Social justice: The heart of medical education. Social Medicine [Internet]; 2013 [cited 2014 Apr 9];7(3):161-168. Available from: http://www.socialmedicine.info/index.php/socialmedicine/article/…/671/1380

4.  World Health Organisation. Social determinants of health [Internet]. World Health Organisation [cited 2014 Apr 9]. Available from: http://www.who.int/hia/evidence/doh/en/