The Significance of Subject Wellbeing and How It Is Connected to Social-Economic Determinants of Health.
Presenting on the topic that I chose: The subject wellbeing and its relationship to social-economic determinants. I was very nervous, and I am pretty sure I had tachycardia. I got to use a clicker which was pretty nifty.
Introduction
I decided to talk about the subject wellbeing of the Indigenous people on Palm Island and the relationship it has to the social-economic determinants of health which evidently is linked to their general health. Even though I did use Palm Island as an example (the reason is that I expected low social-economic determinants of health) the relationship of subject wellbeing may well be applied to any other population whether Indigenous or not. In the end, I had 2 minutes to answer the questions from the panel and the floor.
Overall, I had a lot of fun learning about this topic and felt that I have improved on my public speaking and the delivery of quality and researched material to academic staff and medical students.
As a group of students, we really enjoyed each other’s presentation as the variety of topics was broad and the research was especially well done. I would gladly do this again!
About my presentation
I presented about the relationship of subject wellbeing, a scientific word for happiness, and the health of individuals. I then researched how high or low their subject wellbeing was and compared to their social-economic determinants which were very interesting and new to me. Health is essentially connected to happiness and it is very important! When you come to think about it you may say “well of course, it is obvious” but to me, I did not think how much it influences your health. That is not to say everybody needs to walk around with enormous smiles on their faces and fake the sensation of happiness as it is much, much deeper than that.
By looking at the subject wellbeing (happiness) and the social-economic determinants of health of individuals, a comparison could be made between each factor and how much they influence each other. These relationships are intricately connected to an individual’s health. For my presentation, I had to look for a rural or remote Indigenous town in Australia. I decided to use Palm Island since it was a perfect example of having low social-economic determinants which meant low subject wellbeing and hence poor overall health. What I discovered was very interesting and I learned a lot about subject wellbeing and its relationship to social-economic determinants of health!
It is important to note that having low social-economic determinants of health is strongly associated with low subject wellbeing across all type of population whether Indigenous or not. I just happen to choose an Indigenous group in Australia as they were isolated, demonstrated a third world country population graph and demography, and had overall poor social-economic determinants of health. What was interesting is that I used data from the Victorian Happiness Report which is from the Victoria State Government. I still believe it is reliable and accurate data, however, it would be very interesting to have data on rural and remote Indigenous population as culture may have an influence on the description of happiness, its meaning and how a certain population deal with it such as: socially, spiritually, culturally, philosophically and so on.
All references are at the end.
Slide 1.
Slide 2.
Before I started to talk about Palm Island, I decided to show where it is geographically, demonstrate its remoteness and its demography as I believe it plays a huge role in health. The history should also be considered and taken seriously as Aboriginal and Torres Strait Islanders are very connected spiritually and have a strong identity with their land. An imbalance or an event that has been upsetting can still affect the younger generation to this day. Unfortunately, Palm Island has been subjected to a dark and unpleasant past.
On Palm Island, there are about 42 tribes where everyone comes together under the name of Bwgcolman.
Bwgcolman means: ‘many tribes – one people’.
There is an unpleasant past on Palm Island such as incarceration, aggregation and at one stage independence - this will affect the people’s health living on the island.
Overall view: there are so many factors affecting the health of the people making the tasks very complicated.
Slide 3.
The take-home message, in the slide above, is the life expectancy which is 10 years less than the non-Indigenous population living in Australia and the high percentage of unemployment.
What struck me was: why is there such a big gap at the life expectancy? It is interesting to note that Palm Island is just 20 minutes away from Townsville, Queensland, by plane and demonstrating a population pyramid of what a third world country would demonstrate. That is: a wide base meaning a high percentage of young people and a high death rate which results in a low percentage of the elderly. The rest of Australia and Queensland demonstrates what a first world country would show as a population pyramid.
Slide 4.
Slide 4 represents the statistics of the Indigenous population living on Palm Island and compares them to the mainland Australian population. Basically, if you live on Palm Island, pick any disease and it will favour the undesirable outcome and even enhance them. For example, if you were to live on Palm Island you are 4x more likely to commit suicide as a man, 5x more as a woman and 8x more if you are a youth/teenager (CS, 2019). The World Health Organisation (WHO) says that if the ear infections or damaged hearing exceed 4% it is classified as a public health emergency - did you notice how much percentage Palm Island is demonstrating?
The story of my interest in this topic went like this. Earlier on this year, I was presenting on Palm Island about the rise of Sexual Transmitted Illness (STI) where Palm Island is an Indigenous remote area. Whilst listening to my colleagues, who also presented on Palm Island on different diseases, I noticed a trend. All of the diseases presented was disproportionately favouring the Indigenous population in a negative outcome compared to the non-Indigenous population of Australia. As I sat in my chair, I wondered “why is this happening to these people?” and decided to investigate on my own accord. It turned out that the social-economic determinants of health played a huge role in the Indigenous population on Palm Island. I also learned that the social wellbeing (a scientific term on happiness - more to come) was also connected deeply to the social-economic determinants of health which is connected to general health. This got me really excited to learn about these links and relationships!
After seeing these statistics in slide 4, do you think you would have a fair chance at life compared to your typical Australian Population?
Slide 5.
So, I asked myself;
- Why is this happening?
- Why is the health on Palm Island so poor?
- Surely Palm Island is part of Australia so why are they not displaying a population pyramid of what a first world country should demonstrate.
- Why is the demographic statistics so different?
- Why are the social-economic determinants of health so low?
It turned out that these were very tough questions which are complicated and intricately connected with many factors. What is useful is that the social-economic determinants of health are extremely powerful predictors of health, death, disease and injuries. The social-economic determinants of health are demonstrated in slide 5 with three major groupings: socioeconomic determinants, psychosocial risk factors and social capital.
What do these mean? The socioeconomic determinants describe the person, where they come from, the unmodifiable factors you are born with, the environment you grew up with and your education. The psychosocial risk factors describe more how the person is doing mentally or psychologically. It describes how you perceive yourself, your confidence, stress, self-esteem, et cetera. The social capital describes more how a person fits in society as do you trust your society, do you give back to the community or are you well integrated.
There is a strong and consistent relationship with the social-economic determinants of health and the health of a population or individual. These indicators are well integrated with the subject wellbeing of an individual. We shall talk about the subject wellbeing in later slides.
Slide 6.
So how is the social-economic determinant of health (including psychosocial risk and social capital), health and subject wellbeing all connected?
The health care is the infrastructure and it is thought that the social-economic determinant of health plays a much more important role than the healthcare system itself. Isn’t that interesting? I always thought of focusing more on the infrastructure of health will solve the gap in health between the Indigenous and non-Indigenous population. That is not the case. However, increasing the primary healthcare is seen to improve health in rural and remote areas with a population that has a low social-economic determinant of health. What I am trying to say is that: yes infrastructure is very important especially in remote areas however, we should start focussing a lot more on the social-economic determinant of health (i.e. making new policies and new approaches) as they may be a missing gap that can be tapped into.
Interestingly, it was found that most socio-economically disadvantaged groups tend to use more primary and secondary health services but make the least use of preventive antenatal, immunisation, screening and dental services, whilst rural residents are less likely to visit the doctor.
Behavioural risk factors (disease induce behaviour) in individuals include: tobacco smoking, poor diet and nutrition, physical inactivity, alcohol and drug use. Basically, all the bad behaviours that an individual can have which ultimately impacts their health. This is where policies and laws/rules target as they try and improve the health of individuals and the overall population. These can be: a higher tax on sugar, tobacco and alcohol, laws that stipulate you must be 18 years old before using alcohol or smoking cigarettes, or banning the usage of recreational drugs, et cetera. However, it is small compared to the social-economic determinant of health. For example, people are more likely to do these risky behaviours when they are unemployed (a factor of socio-economic determinants) as research demonstrates a strong relationship with unemployment and low subject wellbeing. Another example, in Japan coronary heart disease has declined where fat consumption has increased as they target more the socio-economic determinants rather than the behavioural risk factors.
We can use this to make proper policies, but these are largely ignored and there is a focus on the disease-induced behaviour with a modest contribution to ill-health and subjective wellbeing. Isn’t interesting that we are bombarded with advertisement telling us to eat better, exercise better, stop smoking and not to drink alcohol excessively but do we listen? Do we really eat 5 fruits and vegetables per day? Do we really decrease our salt and sugar intake? I think not. Hence, let the policies target more the social-economic determinant of health rather than the disease induce behaviours.
Slide 7.
Slide 7 describes what is Subject Wellbeing as essentially it is a fancy and scientific name for happiness. What the report did is ask how people are doing in their lives, how content they are, and if their lives measure up to their expectations (such as life satisfaction). Then the report underpins the social-economic determinant of health which is very useful for mental health, physical health and the connection one has to society.
Slide 7 also demonstrates the positive outcome of having high subject wellbeing. Remember that the subject wellbeing is strongly connected to the social-economic determinant of health which is strongly connected to general health. Hence, we can assume high subject wellbeing (a high amount of happiness - not forced happiness) can lead to a healthy individual. Hence, favourable and good social-economic determinant of health = high subject wellbeing = healthy individual.
Slide 8.
The big questions:
- Is our Indigenous population happy on Palm Island?
- Is their subject wellbeing high?
- How strong is the relationship between these factors (social-economic determinants) and the subject wellbeing?
To describe slide 8 we have to define and understand its relationship and meaning. The first columns are the headings and the major groups. The second column describes the types, factors and different situation someone can have in their lives. The third column represents the subject wellbeing whether it is high, moderate or low. Remember in the previous slide, having high subject wellbeing gives you a lot more opportunities and positive outcomes in your life. The last column represents how strongly connected the subject wellbeing is to the factors in the second column. For example, people who are from a ‘one parent family’ or grew up with only one parent will usually have low subject wellbeing and it was found that these two were moderately connected in terms of strength. In other words, it was noted that there is a moderate relationship between ‘one parent family’ and having low subject wellbeing.
Of course, it is not to say that if you are part of a ‘one parent family’ or that you grew up with only one parent will result in having low subject wellbeing. Another example shows that there is a strong relationship between people who are unemployed and having low subject wellbeing. This makes a lot of sense after all. No employment results in having no jobs, no income, no proper stability, increased insecurities, more stress, less self-confidence, less likelihood of being involved in the community and so on. This results in having a low perception and low life satisfaction, hence low subject wellbeing. It is important to note that having one factor with low subject wellbeing that is strongly connected does not mean you will have low overall subject wellbeing. I am actually quite intrigued to see how many low or high subject wellbeing you need gain to obtain high overall subject wellbeing and what is the weight of each individual subject wellbeing. Maybe you can have a few low subject wellbeing factors but have one strong and impactful high subject wellbeing factor which may push the overall subject wellbeing to a high or medium.
It was also interesting to find that people with very high psychological distress were 45 times more likely to have low subjective wellbeing than people who were not psychologically distressed. Imagine if there were no psychologist or mental health facilities near you or near your town - how detrimental would that be? You will find in the next slide that having no mental facilities or visits is strongly related to having low subject wellbeing.
Recognising these factors can help an individual to change (if they can change it) that particular factor and turn it into high subject wellbeing. For example, getting a permanent job will strongly favour an individual towards higher overall subject wellbeing. Higher subject wellbeing will eventually result in a healthier and much more satisfying life.
The statistics in the brackets on slide 8 are from the Australian Bureau Statistics as they represent the population of Palm Island. Do note that I couldn’t find all the statistics for each factor (although I wish I could as it would be very interesting!). Notice the statistics of Palm Island always favour the unwanted social-economic determinants of health such as unemployment or one-parent families.
Slide 9.
Are you now shocked that the previously mentioned disease statistics on slide 4 are happening on Palm Island and that there is low subject wellbeing? Remember: having low subject wellbeing due to low social-economic determinants of health impacts negatively on health.
The next question would be how did we arrive at these low subject wellbeing in the first place? I would like to think that the past moulds the present and the future. How you treat people for generations will show on their health. Genetics could also play a role where a certain group cannot handle certain products such as refined sugar and alcohol. Culture also plays a huge role such as different beliefs (traditional medicine vs western medicine) or language barrier. Access to education and health as remoteness and rural areas can make these services a lot more difficult. Trust in the government such as: would a population believe and trust their government after the way they were treated for so many years?
I must say I do not have the answers to why is Palm Island is favouring almost all the time the low subject wellbeing factors (especially the factors that are strongly connected). This is why I thought this topic was interesting as it is complicated and intricate. There must be a lot of reasons and factors each connected to each other. I would love to hear and read more about the topic.
The subject wellbeing and its relationship to socio-economic determinants of health were taken from “The Victorian happiness report”, see the referencing at the end. One of the challenges was that most of the research and information came from the State of Victoria which is a lot different in terms of demography compared to Queensland, let alone Palm Island. However, we can always speculate and use this as a start to predict outcomes. It would be very interesting if there were to be more data especially on remote and rural Indigenous population of Australia. Therefore, I must admit that my data collection of subject wellbeing (the one taken from Victoria) may be flawed when comparing the Indigenous population on Palm Island. The other statistics, such as the ones taken from the Australian Bureau Statistics or other scientific papers are deemed to be reliable and accurate data.
Slide 10.
What can be done nowadays?
Can generations forgive and move on together as a nation?
On the stakeholders’ point of view, are government spending and government intervention a waste of money compared to the benefits that come out of it?
Ongoing justice: 190 million dollars has been given to Indigenous workers in Queensland as back then the farmers and the industries were heavily dependent on the vulnerable workers who were exploited. So, there is some good news but was it too late?
The good news is that it is improving but is it enough and what more could be done?
Slide 11.
Is education a solution? It is definitely the right step towards having a better and higher subject wellbeing. I am a strong believer in education especially if it is for woman and the poor.
Education, as seen in slide 11, is very well connected to many different social-economic determinants of health and could be key towards bringing the health of individual up with higher subject wellbeing.
However, would an Indigenous community trust western establishments after an unpleasant history?
Slide 12.
In conclusion, Australia is healing and learning from its mistakes and past actions.
Reforms are being made in a positive outcome, communities are being consulted and ran by elders, and there is a consensus of moving forward.
The road will be long, tedious and twisted with challenges and barriers but as a nation, it can be done.
Published 10th October 2019. Last reviewed 1st December 2021.
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