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So far, this paper has established some of the health inequalities suffered by those who are of lower socioeconomic status. This section will look at gender inequalities, particularly those from disadvantaged areas. In order to keep this relatively brief, the focus will be on the South Western Sydney Health Area Service.
In general, it is assumed that women live longer than men. This claim is quite apparent in South Western Sydney where the age-adjusted death rate for all causes is 818.5 deaths per 100000 for men and 513.6 deaths per 100000 for women. However, in the context of the inner outer divide, these rates are relatively high. In the Northern Sydney area for example, the age-adjusted death rate for all causes is 676.8 deaths per 100000 for men and 453.9 deaths per 100000 for women [NSW Chief Health Officer 2000]. The variance in death rates between Northern and South Western Sydney illustrates differences in lifestyle, socioeconomic status and health awareness.
Men are more likely to smoke and drink too much alcohol, while their traditional involvement in high-risk activities such as sport, dangerous jobs and driving means they are injured, or die of injuries, more frequently than women. Furthermore, men tend to visit the doctors less than women do. The NSW Health Surveys for 1997 and 1998 show that the percentage of males from the SWSHSA who visited a GP in the last 12 months was 86.7% whereas the same figure for women was 89.8% [NSW Health 2000: doctor]. Although a lot of the causes for higher death rates in men are difficult to remedy, more can be done in the way of the promotion and awareness of these issues so that men (particularly in Western Sydney) can have a better chance at mitigating the impacts.
Despite the fact that women have higher life expectancies, they are not excluded from health inequalities. Women from low socioeconomic groups are significantly more likely to suffer from cardiovascular and lung disease and diabetes than women from high socioeconomic groups [SWSAHS Women 2001].
In regards to older women, social isolation and physical disabilities such as osteoporosis and arthritis significantly affect their general health and are the main impacts on morbidity. Younger women on the other hand are more likely to suffer from stress, eating disorders, body image, smoking, sexuality and relationship issues. It is also essential that plans designed to prevent violence against women and ameliorating its long term effects are implemented [SWSAHS Women 2001].
The previous two sections have concentrated on the social and economic consequences of health from structured social inequalities – this section will look at the impact of politics. There have already been some mentions of political decisions and how they effect the lesser off in this paper (investment into private health insurance at the expense of government funding for public hospitals and community-based services and care). Everyday new decisions are made which ultimately affect the health outcomes of Australian citizens. Unfortunately however, these decisions cannot and do not satisfy everyone’s needs. Once again, those who do not have the capacity, opportunities or access to decent health care facilities often end up even more disadvantaged. In the case of Sydney, these people are largely represented by those living in the West.
One of the more recent additions to the gap between rich and poor, healthy and sick, was the abolition of the Commonwealth Dental Health Program in 1996. This has had serious implications for people most in need, especially in the rural areas of NSW. Dental care of the preventive type is an optional service which is affected by the ease or difficulty of accessing it. Without the support of the Commonwealth Dental Health Program people who need oral care most no longer have the same opportunities as they did and most likely will choose not to pursue it. ACOSS, the Australian Council of Social Service, is determined to “get this gap filled” [Acoss 1997].
If the whole of NSW had experienced the mortality rate of the least socio-economically disadvantaged group, we calculate that from 1990 to 1994 there would have been 18,800 fewer premature deaths” [Crowe 2000]. There is a strong correlation between socio-economic status and health. Income level is positively correlated with health status: the lower the income, the lower the status of health. This situation is compounded by the fact that people on low income are less able to buy goods and services related to health and less able to pay the costs involved in accessing them.
Additionally, gender differences (physiological, psycho-social, average income etc) make the development of mitigating strategies difficult as they are so complex. A way in which gender differences can be overcome needs to be devised.
This paper has shown that social polarisation is evident. The involvement of politics, Government officials and policy makers, need to look at ways of “narrowing the gap” between the two distinct class groups which are emerging. It would be irresponsible to allow current trends to persist, strategies to reduce health inequalities need to be formed.
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Marcus Bingemann
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