National Aboriginal and Torres Strait Islander Health Plan 2013–2023

The Social Determinants of Health

Page last updated: 27 June 2013

“It is important to address the social and cultural determinants of health as there are many drivers of ill health that lie outside the direct responsibility of the health sector.” 9 Close the Gap Steering Committee


Effective strategies that address environmental, economic and social inequalities which are pivotal to achieve health equality.

This requires action across key social determinants such as health, housing, education, employment, the alignment of program goals across sectors of government and the development of collaborative cross-sectoral programs at a local level.


Between one third and one half of the life expectancy gap may be explained by differences in the social determinants of health.10 They affect the health of people and can also influence how a person interacts with health and other services. For example, Aboriginal and Torres Strait Islander adults are less likely to smoke if they have completed Year 12, are employed and if they have higher incomes.11 Additionally, higher levels of education are associated with healthier lifestyle choices and improved health literacy. Alternatively, rheumatic heart disease is associated with environmental factors such as poverty and poor living conditions, and Aboriginal and Torres Strait Islander people will remain at risk while socioeconomic disadvantage and barriers to accessing health care persist.

Research has demonstrated associations between an individual’s social and economic status and their health.12 For example poor education and literacy are linked to low income and poor health status (e.g. ear disease), and affect the capacity of people to use health information; poverty reduces access to health care services and medicines; overcrowded and run-down housing associated with poverty contributes to the spread of communicable disease; and smoking and high-risk behaviour is associated with lower socio-economic status.13 Where a person lives also contributes to health, with isolation in remote and very remote communities reducing access to services.

The health sector also has a role in realising necessary improvements in education and employment outcomes. For example, chronic ear disease negatively affects the education attainment of Aboriginal and Torres Strait Islander school children, and poor health explains 42.7 per cent of the known gap in labour force participation for Aboriginal and Torres Strait Islander males, and 13.9 per cent of the gap for Aboriginal and Torres Strait Islander females in non-remote locations.14 Top of page

Improvements in Aboriginal and Torres Strait Islander people’s health requires an integrated approach encompassing the strengthening of community functioning, reinforcing positive behaviours, and improving education participation, regional economic development, housing and environmental health, and spiritual healing. It is vital for communities and individuals to have the ability and freedom to be empowered and able to translate their capability (knowledge, skills, understanding) into action.

While acknowledging that there is a growing level of education and affluence for some Aboriginal and Torres Strait Islander people, generally the relative socio-economic disadvantage experienced by Aboriginal and Torres Strait Islander people compared to non-Indigenous Australians means they are more likely to be exposed to behavioural and environmental health risk factors because a higher proportion of Aboriginal and Torres Strait Islander households live in conditions that do not support good health.15

The need to progress action across all these related areas has been recognised by all governments in the Closing the Gap framework - the building blocks and targets focus efforts on key areas of disadvantage and provide a framework for ongoing action to improve outcomes across social determinants of health.

The targets under the Closing the Gap framework are:
    • close the life expectancy gap within a generation (by 2031);
    • halve the gap in mortality rates for Indigenous children under five within a decade (by 2018);
    • ensure all Indigenous four-year-olds in remote communities have access to early childhood education within five years (by 2013);
    • halve the gap for Indigenous students in reading, writing and numeracy within a decade (by 2018);
    • halve the gap for Indigenous people aged 20-24 in Year 12 attainment or equivalent attainment rates (by 2020); and
    • halve the gap in employment outcomes between Indigenous and non-Indigenous Australians within a decade (by 2018).

Key Strategies to achieve this Goal:

    • Governments work together across all building blocks to:
      • leverage existing frameworks and strategies to achieve the Closing the Gap targets;
      • take action across key social determinants such as health, housing, education and employment; and
      • align program goals across sectors of government.
    • Support innovative local programs that create opportunities for effective collaboration between local services from different sectors to address social inequalities and determinants of health and that reflect local priorities and need.Top of page