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7311MED Social Determinants Of Health

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7311MED Social Determinants Of Health Question Learning Outcomes   1. Critically analyse social, economic, cultural and enviornmental influences on health and health outcomes, including the concept of gender and ethnicity and their role as determinants of health.   2. Apply sociological theories and perspectives to investigate and critique public health issues.   3. Critique explanations of health inequalities.   4. Reflect critically on current public health practice.   Task : Pick a health issue from the following list Diabetes, substance misuse, teenage pregnancy, maternal and infant nutrition, obesity, sexual health, trachoma, infectious disease (choose one specific disease), mental health Examine this issue within the context of two indigenous population from two different countries. One population from a developed country and the other from an emerging economy country context. Compare and contrast how the social determinants of health influence this problem in both population. How have the social determinants been addressed in an intervention aimed at combatting the problem (if any)? Use the following for a starting point in your research :United Nation 2009, The state of the world’s Indigenous Peoples, United Nation: New York.  Answer Substance Misuse Introduction Substance misuse is one of the major public health issues that have an adverse impact on the society. Almost every community is affected by substance misuse and taking a heavy toll on the society. It has deleterious social and psychological effects and is a major cultural and public health problem. Although, it affects the individuals directly, it also affects a segment of the indigenous populations in both developing and developed countries. Substance misuse among the indigenous populations has been associated with many health and social issues that is affecting the country as a whole. According to World Health Organization (WHO) in the Indigenous Peoples and Substance Use Project reported that among the twelve indigenous communities, Ogonis of Nigeria and Aboriginals of Australia have high context of substance misuse that have problems affecting the community and the country as a whole. The social and economic factors shape the drug users health and risk behavior. These social determinants of health greatly shape the behavior of the individuals towards the drug misuse affecting health, accessibility to healthcare systems, compliance with medication and marginalization. The ethnic and minority groups experience high disparity of social factors that adversely affect the health of the indigenous populations. Therefore, the following report deals with social determinants of health influencing this public health issue among the indigenous populations in the two countries of Australia and Nigeria. It will also deal with the interventions and policies that aim at combating this public health issue among the indigenous populations in the two countries. Social Determinants Of Substance Misuse According to the WHO Social Determinants of Health framework, the understanding of the specific social factors is important as it contributes to the risk of developing and sustaining the substance misuse and suffering from the heavy consumption of substance misuse. Low socio-economic status is a strong factor and has a causal relationship with the substance misuse. There is a weak link between the income levels and substance misuse; however, the social conditions that are related to poverty have strong associations with the vulnerability of an individual towards substance misuse (Allen et al., 2014). Low level of education has showed likelihood for risky behavior of substance misuse. Poor level of education leading to unemployment and poor level of income, thereby increases the vulnerability to social exclusion and substance misuse. These factors reinforce the people of low-socioeconomic status among the indigenous populations to live in near poverty and stressful life and vulnerable to substance misuse. Social exclusion of the substance abusers restricts them to access the healthcare services in order to improve their living conditions. The indigenous population affected with substance misuse is generally ignored by the mainstream primary healthcare services. This greatly limits the accessibility and effectiveness of the healthcare services that are aimed at decreasing the spread of harmful diseases. Crime prevalence among the people of low socioeconomic status also has a strong association with the high prevalence of substance misuse and risked behavior. These social determinants of health cause vulnerability factors that lead to substance misuse among the indigenous populations (Compton & Shim, 2015). Substance Misuse In Aboriginals Of Australia According to the National Indigenous Drug and Alcohol Committee (NIDAC) report, there is high prevalence of substance misuse among the Aboriginals and Torres Strait Islanders People (TSI). Every one in five Aboriginals and TSI Australians below the age of 18 years use illicit drugs where about 20% of them have tried illicit drugs in their last twelve months and about 39% have tried them at some point in their lifetime during the year 2012-2013 (Martin, 2016). Among all the illicit drugs, cannabis, amphetamines and marijuana are most commonly consumed by the indigenous population. It has become one of the largest contributors to burden of disease and reason for psychological distress among the young generation.   Well-being and poverty is not only an issue in the developing countries, but, it also prevails in developed countries like Australia among the indigenous populations like Aboriginals (Doty-Sweetnam & Morrissette, 2016). They have less access to education and health care with low life expectancy and high unemployment rates. Substance abuse is common among the indigenous population with high incarceration and suicidal rates. They are also likely to face violence and crime in the society. The injecting of the drug exposes the Aboriginals for human immunodeficiency virus (HIV) and hepatitis C infection. Moreover, substance misuse is also linked with the psychological distress and suicide, crime, violence and incarceration. The extent of substance misuse among the Aboriginals is well understood in context to the historical and social context of dispossession of culture and land, colonization and economic exclusion. Social Determinants Of Substance Misuse Among Aboriginals Substance abuse among the Aboriginals is determined by the social factors as a consequence of economic and social disadvantage. The social factors that operate within the contemporary Australian society are vital in determining the Aboriginal health. There are also historical factors like dispossession and colonization where the European colonization led to the loss of lands and customs of the Aboriginals and social exclusion. The socio-economic deprivation has strong association with the substance misuse among the Aboriginals where they experience continuous feelings of hurt and exclusion kind of behavior (Currie et al., 2013). Social determinants of health like education, employment and income levels are associated with drug abuse patterns. The attainment of education affects the employment opportunities and living standard of the people. Studies showed that the Aboriginal face educational disadvantage with low educational level and had been witnessed in many cases. Children who were disengaged from school were more likely to become drug users according to a study conducted during the year 2011-2013 (Goodman et al., 2017). Moreover, a survey conducted by the Australian secondary students showed that there was drug misuse among the indigenous population than the non-indigenous population. Similarly, low education levels resulted in unemployment among them. Unemployment sustains the substance abuse and discourages their ability to maintain employment. High levels of ill health are greatly associated with the level of income. As there is unemployment, low levels of family income among the Aboriginals resulted in ill health status. Apart from all these factors, family and peer support and community also play an important role and influence the substance abuse among the Aboriginal population. Strong family and peer support is likely to reduce the use of illicit drugs and helps in overcoming the drug dependence. Peer pressure is a common influencing factor that decides one’s substance misuse as reported by New South Wales (NSW) through a survey in 2011. About 66% of the Aboriginal population youths have been reported to influence their decisions of substance misuse. A dysfunctional community dynamics also acts as a risk factor that greatly affects the risk for substance misuse among the Aboriginals (Baydala, Ruttan & Starkes, 2015). Substance Misuse In Ogonis Of Nigeria The menace of substance abuse among the Ogonis of Nigeria has reached deep into the fabrics of the society. The adolescent indigenous population in Nigeria is involved in many delinquent acts and out of which, substance abuse is one of the major cause of burden of disease among them. It is a major public health problem among the adolescents in Nigeria where the school going children are experiencing mental health problems leading to maladjustment and drop out of the school (Beatrice, Okpala & Oghale, 2016). Hard drugs like cannabis and amphetamines are greatly consumed by the Ogoni youths between the ages of 15 and 30 years in large quantities. Among the youths, the factors like frustration, anxiety, unemployment, depression and social deprivation have strong associations to substance abuse. Kola nut and marijuana is the most commonly used drugs among the Ogoni youth population. One third of the Nigerian Ogoniland population is young between the ages of 10 to 24 years. They are considered to be the biggest asset of any nation and in a country like Nigeria where they represent the majority of the population, substance misuse prevalence among them is a major public health issue. There are many socio-economic factors that have strong association with the prevalence of drug abuse among the Ogoni people. The social and economic status of Ogonis in Nigeria is poor and is below average. There is poverty widespread with high levels of unemployment and broken homes where the youths are witnessed to roam looking for employment or subjected to begging. They lack skills and training opportunities that lead to unemployment and frustration that make them vulnerable to substance misuse in order to remove tension and escape stress (James & Omoaregba, 2013). Social Determinants Of Substance Misuse Among Ogonis There are five major predisposing factors that have led to the substance among the youths in Ogoni population. Curiosity, peer pressure, frustration and ignorance with lack of parental care are the factors that make them vulnerable to substance abuse. It has a significant psychological, medical and economic problem facing the indigenous population in Nigeria. The youths of the secondary and tertiary institutions are greatly involved in substance misuse (Senewo, 2015).   The social determinants of substance misuse are the peer pressure, academic workload and independence from the parents that compels the Ogoni youth to consume illicit drugs. In some instances, the students are not guided well by their parents or teachers and in that course; they choose wrong peers leading to experimentation of illicit drugs. Moreover, the youths among the Ogoniland population are characterized by the adventurism, peer selection, role confusion or excitement. These social factors make them subjected to substance misuse and take a heavy toll on their lives (Oyewo, 2016). Compare And Contrast After analyzing the social determinants of health in both the countries, it is evident that substance abuse is a major cause of mortality and morbidity among the indigenous population. The social determinants like the low education level, unemployment and low level of household income are the major factors that results in substance misuse among the Aboriginals. The Aboriginal population including the youth population is involved in substance abuse. This level of low education and employment opportunities among the Aboriginals is due to the historical factors like colonization and dispossession. This has resulted in loss of identity among the Aboriginals as compared to the non-indigenous populations. In contrast, substance misuse among the Ogoni population in Nigeria is greatly seen among the youths. The social factors like peer pressure, lack of parental support, academic workload and ignorance are the major reasons for the Ogoni youths to get involved in illicit drug misuse. The frustration, curiosity and independence among the Ogoni youths are a major reason for them to become vulnerable to substance misuse. The trends of substance abuse among the Ogoni youths have a detrimental effect on their health and future. The drug abuse among the Aboriginals is due to the social factors like low level of education, income and unemployment due to their colonization and dispossession from their culture and lands losing their identity in the contemporary Australian society. In comparison to the Nigerian population, school students are involved in illicit drug use as they are subjected to academic pressure, curiosity, frustration and anxiety. However, Australian government is trying their best to incorporate the Aboriginals into the mainstream healthcare services and policies as compared to Nigeria (Compton, 2017). Strategies And Policies There have been a lot of strategies and policies implemented by the Australian government to combat the substance misuse issue prevailing among the Aboriginals. As per the National Drug Strategy 2010-2015, there are demand reduction strategies that are aimed to reduce the drug misuse among the Aboriginals (Lancaster & Ritter, 2014). Supply and harm reduction also some of the strategies employed by the Australian government to minimize drug misuse. Drug strategy for Aboriginals includes capacity building through partnerships, law enforcement, culturally responsive programs to address the needs of the Aboriginals with effective monitoring and evaluation. Policies are also developed to focus on the illicit drug use or according to the route of administration like Cannabis, amphetamine related policies. Programs and services that target primary and secondary prevention also employed for the Aboriginals in Australia (Sutherland et al., 2016). Similarly, in Nigeria, National Youth Policy is also developed that provides a declaration and commitment towards the priorities that support the youth in reducing the substance misuse (Huaynoca et al., 2014). This policy is also aimed at incorporating the Ogoni youth population to meet their specific needs and in reducing the substance misuse among them. Moreover, they are setting up counseling units, parental support groups and educational policies in the schools and institutions to mitigate the drug abuse from the youth population (Babalola, 2015). Conclusion Substance misuse is a major public health issue that is affecting the indigenous population in both the countries. The social determinants of health have an influence on the prevalence of this issue affecting their health and well-being. The government of both the countries is trying to reduce the substance misuse among the indigenous populations. References Allen, J., Balfour, R., Bell, R., & Marmot, M. (2014). Social determinants of mental health. International Review of Psychiatry, 26(4), 392-407. Babalola, J. B. (2015). Achieving Nigerian Developmental and Educational Goals through Incorporation of Best Practices in National Education Policies: Priority interventions, proven practices and policy problems: A lead paper presented in the University of Nigeria. Nsukka, Nigeria. Baydala, L., Ruttan, L., & Starkes, J. (2015). Community-based participatory research with Aboriginal children and their communities: Research principles, practice and the social determinants of health. First Peoples Child & Family Review, 10(2), 82-94. Beatrice, O., Okpala, P. U., & Oghale, O. (2016). Prevalence of Drug Abuse Amongst University Students in Benin City, Nigeria. Public Health Research, 6(2), 31-37. Compton, M. T., & Shim, R. S. (2015). The social determinants of mental health. Focus, 13(4), 419-425. Compton, W. M. (2017). Department Of Health And Human Services National Institutes Of Health National Institute On Drug Abuse. Currie, C. L., Wild, T. C., Schopflocher, D. P., Laing, L., & Veugelers, P. (2013). Illicit and prescription drug problems among urban Aboriginal adults in Canada: the role of traditional culture in protection and resilience. Social Science & Medicine, 88, 1-9. Doty-Sweetnam, K., & Morrissette, P. (2016). Alcohol abuse recovery through the lens of Manitoban First Nations and Aboriginal women: A qualitative study. Journal of ethnicity in substance abuse, 1-18. Goodman, A., Fleming, K., Markwick, N., Morrison, T., Lagimodiere, L., Kerr, T., & Society, W. A. H. R. (2017). “They treated me like crap and I know it was because I was Native”: The healthcare experiences of Aboriginal peoples living in Vancouver’s inner city. Social Science & Medicine, 178, 87-94. Huaynoca, S., Chandra-Mouli, V., Yaqub Jr, N., & Denno, D. M. (2014). Scaling up comprehensive sexuality education in Nigeria: from national policy to nationwide application. Sex Education, 14(2), 191-209. James, B. O., & Omoaregba, J. O. (2013). Nigerian medical students’ opinions about individuals who use and abuse psychoactive substances. Substance abuse: research and treatment, 7, 109. Lancaster, K., & Ritter, A. (2014). Examining the construction and representation of drugs as a policy problem in Australia’s National Drug Strategy documents 1985–2010. International Journal of Drug Policy, 25(1), 81-87. Martin, W. (2016). Aboriginal alcohol and drug service: Launch of strategic plan 2015-2020. Brief, 43(1), 28. OYEWO, H. T. (2016). Nigeria: The challenges of Reintegrating Niger Delta Militants. Conflict Studies Quarterly, (17). Senewo, I. D. (2015). The Ogoni Bill of Rights (OBR): Extent of actualization 25 years later?. The Extractive Industries and Society, 2(4), 664-670. Sutherland, R., Peacock, A., Whittaker, E., Roxburgh, A., Lenton, S., Matthews, A., … & Bruno, R. (2016). New psychoactive substance use among regular psychostimulant users in Australia, 2010–2015. Drug and alcohol dependence, 161, 110-118.

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