Tackling health inequality through sport and active recreation
Overview
There are marked inequalities in health between different groups of people in Victoria, including differences in rates and patterns of death and disease, life expectancy and in how people rate their own health.
Victorians who have particularly poor health include people from lower socioeconomic groups, Indigenous people, people from refugee backgrounds and those with disabilities. People who live in low-income areas also have poorer health.
Many of these inequalities are preventable, as they are not due to genetic or biological factors. Instead, they are related to inequalities in access to the things we all need for good health, such as income, education and good living and working conditions. Poverty and inequality can also affect community networks and lifestyles which in turn influence health. In fact, a community with poor health and limited resources can lead to a slowing economy with unemployment and low paying jobs. This can create poverty and social issues across generations that will result in an unhealthy community. This is called the reverse cycle of prosperity. [1]
While working to improve the health of all Victorians, VicHealth is committed to reducing inequalities in health and targets many of its activities toward improving the health and wellbeing of the most disadvantaged people in our community.
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Factors associated with health inequalities
One of the main factors affecting health inequalities is socioeconomic position. Those who are less well off generally have poorer health than their more advantaged counterparts.[2-6]
This can be explained largely by unequal access to the material resources needed for health, such as good housing, adequate income and healthy food.[7]
Socioeconomic status can also affect psychological and social conditions that have an impact on health. [7-9] For example, someone who is unemployed or on a low income may become socially isolated and feel excluded from the community. They may not have the confidence or enough money to take part in physical activity or join a local sporting club. As well as the direct physical health benefits of being active, the social connections formed through activities like these are important for good mental health.[10-12]
Health inequalities are most marked between Indigenous and non-Indigenous Australians. Aboriginal men and women have a life expectancy which is 17 years lower that the national average.[13] This is a result of both long standing and contemporary cultural dislocation, deprivation and social disadvantage.[14]
People who have recently arrived as refugees also have relatively poor health. This is due to a number of factors, including exposure to deprivation, human rights abuses, conflict and violence in their countries of origin and asylum, and the stresses involved in establishing life in a new country.[15]
Many refugees settling in Australia come from countries rated by the United Nations to have among the lowest levels of human development and life expectancy in the world.[16,17] Sporting and recreational organisations provide good opportunities for refugees to become involved with their new community.
However, getting involved can be particularly difficult for those newly arrived as their time and energy may be focused on other activities of resettlement, such as getting a job, finding suitable housing and settling into school. They may also have had little or no experience of similar formal organisations in their countries of origin or asylum.
For example, they may not understand how to join a club or what is expected of them when they do join. They may not have had experience of taking part in ‘training sessions’ or realise that events may take place at a variety of venues outside their local area. They may also think all activities are organised through the school, and not realise there are other opportunities to get involved, for people of all ages.
People with disabilities also have limited access to the social and economic resources required for health. They are less likely than those in the general population to be in the workforce (53% compared with 81%) and more likely to be unemployed or in receipt of a low income.[18] They may also experience social and physical barriers to participating in sport and active recreation.
Where you live can also have an impact on your health.[2,4,19] Some local environments are more likely to support good health than others. For example, localities can vary in the number and types of sporting and recreation organisations available, the availability of accessible, cheap and healthy food or in the safety of their streets.[20]
Ethnicity and gender can also contribute to health inequalities or make them worse.[21-24]
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Addressing the factors affecting health inequalities
Most health inequalities are avoidable. Strategies and approaches to address them are not currently well developed, however.
A challenge for health promotion is to find a balance between focusing on the most disadvantaged (who clearly have the worst health) and population-wide approaches that address health issues across all groups.
Where all things are equal, population-wide approaches should have the greatest impact on health problems among the most disadvantaged since this group has the highest risk at the outset.Such approaches always need to be carefully monitored, however, to ensure they are not having the opposite effect of actually increasing health inequalities. This can occur when the intervention is more effective among people of higher socioeconomic status.[25,26]
VicHealth has adopted the WHO goal of ‘creating equal opportunities for health and bringing health differentials down to the lowest level possible’. VicHealth believes that societies that try to ensure all individuals participate fully in the social, economic and cultural life are more likely to have healthy citizens than societies that allow individuals to be excluded, marginalised and deprived. Sport and active recreation associations and organisations can play a key role in fostering such participation.
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The role of sport and active recreation organisations
Sport and active recreation organisations are well-placed to help VicHealth address the health inequalities that result in poorer health outcomes for many groups in the community.
They have a tradition of providing opportunities for individuals and groups to:
- participate in physical activity;
- connect with other members of the community;
- feel part of their local community; and
- develop knowledge and skills that can be used in a range of contexts.
These opportunities are provided at local, regional and state levels, and through a range of activities, including active participation, supporting, coaching, management and administration.
Many of those who could benefit most from increased participation in sport and active recreation have the least access and opportunity to participate. Many social, economic and physical barriers need to be addressed to make sure people from all groups feel welcome and are able to participate. This is particularly true for those of low socioeconomic status, Indigenous Australians, refugees and people with disabilities.
As well as providing benefits for the health of the whole community, sporting and active recreation organisations that widen access and opportunity and reduce inequalities will in turn benefit from the participation of a greater diversity of people in their activities.
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Health inequalities and the PICSAR program
One of the main aims of VicHealth’s Active Participation Grants Program is to support initiatives that address health inequalities. This will be done by supporting initiatives that:
- address the social, economic and physical barriers to participation faced by groups particularly affected by health inequalities, such as those of low socioeconomic status, Indigenous and refugee communities and people with disabilities;
- have an impact at a range of levels (local, regional, state) and encourage participation in a range of areas (e.g. active participation, supporting, coaching, administration and management);
- are based in relatively disadvantaged socioeconomic areas;
- work with people and organisations from other sectors to respond to the needs of the most disadvantaged;
- are targeted to people of different ages;
- ensure groups particularly affected by health inequalities are actively involved in decision-making.
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References
[1] Adapted from Oregon Shires 1989 www.econ.state.or.us
[2] Australian Institute of Health and Welfare. Australia’s health 2004. Canberra: Australian Institute of Health and Welfare; 2004.
[3] Draper G, Turrell G, Oldenburg B. Health inequalities in Australia: mortality. Health Inequalities Monitoring Series No. 1. AIHW Cat. No. PHE 55. Canberra: Queensland University of Technology and Australian Institute of Health and Welfare; 2004.
[4] Public Health and Development Division. The Victorian burden of disease study: mortality. Melbourne: Department of Human Services; 1999.
[5] Turrell G, Mathers C. Socioeconomic status and health in Australia. MJA 2000;172:434–8.
[6] Lynch J, Kaplan G. Socioeconomic position. In: Berkman L, Kawachi I, editors. Social epidemiology. New York: Oxford University Press; 2000.
[7] Mackenbach J, Bakker M, Kunst A, Diderichsen F. Socioeconomic inequalities in Europe: an overview. In: Mackenbach J, Bakker MA editors. Reducing inequalities in health a European perspective. London: Routledge; 2002.
[8] Lynch J, Davey Smith G, Kaplan G, House J. Income inequality and mortality: importance to health of individual income, psychosocial environment or material conditions. BMJ 2000;320:1200–04.
[9] Wilkinson R. Unhealthy societies: the afflictions of inequality. London: Routledge; 1996.
[10] Baum F, Bush R, Modra C, Murray C, Cox E, Alexander K et al. Epidemiology of participation: an Australian community study. J Epid Community Health 2000;54(6):414–23.
[11] Lindstrom M, Merlo J, Ostergren P. Social capital and sense of insecurity in the neighbourhood: a population-based multilevel analysis in Malmo, Sweden. Soc Sci Med 2003;56:1111–20.
[12] Pevalin DJ, Rose D. Social capital for health: investigating the links between social capital and health using the British household panel survey. London: National Health Service Health Development Agency; 2002.
[13] Australian Institute of Health and Welfare and the Australian Bureau of Statistics. Health and welfare of Australia’s Aboriginal and Torres Straight Islander Peoples. AIHW Cat. No. IHW 14. ABS Cat. No. 47140. Canberra: Australian Institute of Health and Welfare and the Australian Bureau of Statistics; 2005.
[14] http://www.vaccho.org.au/html/about.htm
[15] Porter M, Haslam N. Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: a meta-analysis. JAMA 2005;294(5):602–12.
[16] United Nations High Commissioner for Refugees. Refugee resettlement: an international handbook to guide reception and integration. Melbourne: United Nations High Commissioner for Refugees; 2002.
[17] United Nations Human Development Program. Millennium goals: a compact among nations to end human poverty [Online]. 2003 [cited 2005 Jun]. Available from http://hdr.undp.org/report/global/2003
[18] Human Rights and Equal Opportunity Commission. National inquiry into employment and disability issues paper 1: employment and disability – the statistics [Online]. 2005 [cited 2005 Jun]. Available from: http://www.humanrights.gov.au/disability_rights/employment_inquiry/papers/issues1.htm
[19] Public Health and Development Division. The Victorian burden of disease study: morbidity. Melbourne: Department of Human Services; 1999.
[20] MacIntyre S, Ellaway A. Neighbourhoods and health: an overview. In: Kawachi I, Berkman L, editors. Neighbourhoods and Health. Oxford: Oxford University Press; 2003. p. 20–42.
[21] Davey Smith G, Chaturvedi N, Harding S, Nazroo J, Williams, R. Ethnic inequalities in health: a review of UK epidemiological evidence. In: Davey Smith G, editor. Health inequalities lifecourse approaches. Bristol: The Policy Press; 2003.
[22] Department of Human Services. Victorian women’s health and wellbeing strategy. Policy statement and implementation framework 2002–2006. Melbourne: State of Victoria; 2000.
[23] Krieger N. Discrimination and health. In: Berkman L, Kawachi I, editors. Social epidemiology. New York: Oxford University Press; 2000. p. 36–75.
[24] Nazroo J, Karlsen S. Ethnic inequalities in health: social class, racism and identity [Online]. Health Variations Programme. Research findings #10. 2001 [cited 2005 Jun]. Available from: http://www.lancs.ac.uk/fss/apsocsci/hvp/newsletters/10findings.htm
[25] Macintyre S, Chalmers I, Horton R, Smith R. Using evidence to inform health policy: case study. BMJ 2001;322:222–5.
[26] Woodward A, Kawachi I. Why reduce health inequalities? J Epidemiol Community Health 2000;54:923–9.