1.5. Discuss the range of determinants that influence the health and wellbeing of Australians

1. Determinants of health

1.1 Broad features of society

Broad features of society are upstream influences that shape what is normal, expected, and possible in everyday life. They include culture, affluence, social cohesion, social inclusion, political structures, public policy, and the role of media and language.

In Australia, policy settings can protect health by making services easier to access and by shaping environments where healthier choices are easier. For example, Medicare supports access to medical care. Public health laws and long-term campaigns can reduce exposure to harm (for example, smoke-free environments and anti-smoking strategies). Cultural norms also shape behaviour, such as attitudes to alcohol, help-seeking, and preventive healthcare.

Broad social conditions can also harm health. Discrimination, racism, and social exclusion can create long-term stress. They can reduce participation in education and employment and weaken trust in institutions. Over time, these pressures can increase psychological distress and the likelihood of harmful coping behaviours. Historical and structural influences, including the impacts of colonisation for Aboriginal and Torres Strait Islander Peoples, can contribute to intergenerational disadvantage and reduced access to culturally safe services.

Example: If a health service does not provide interpreters or culturally safe care, some communities may have lower access. This can delay diagnosis and treatment, even when effective treatment exists.

1.2 Environmental factors

Environmental determinants include the natural environment (climate, weather, disasters, air and water quality) and the built environment (housing, transport, workplace conditions, urban design, and local service availability). In Australia, these influences can be strong because of climate extremes and because many communities are far from specialist services.

Natural hazards can affect health directly (through injury) and indirectly (through smoke exposure, displacement, and long-term stress). Built environments shape daily behaviour and risk. Neighbourhoods with safe footpaths, green space, and reliable public transport tend to support more activity and easier access to services. Poor housing quality, overcrowding, traffic danger, and limited access to healthy food can raise infection risk, chronic disease risk, and psychological strain.

Geographical location and remoteness also shapes health outcomes. As remoteness increases, distance to hospitals, access to GPs and allied health, and affordability of fresh food often get worse. This contributes to higher rates of preventable illness and avoidable mortality in many rural and remote areas.

Example: In a very remote community where fresh produce is scarce and expensive, processed foods may become the default. This can increase risk of type 2 diabetes and cardiovascular disease, even when people know what healthy eating looks like.

1.3 Socioeconomic characteristics

Socioeconomic determinants include education, employment, income and wealth, housing security, and food security. In Australia, there is a clear social gradient. As socioeconomic advantage increases, average health outcomes tend to improve.

Education supports health literacy, such as understanding health information, navigating services, and judging risk. Education can also improve employment opportunities. This can increase income security and the ability to afford healthy food, stable housing, and preventive care. On the other hand, unemployment, underemployment, and insecure work can increase stress and reduce control over life circumstances. This can increase harmful coping behaviours and worsen mental health.

Socioeconomic disadvantage often clusters by place. Communities with higher disadvantage may have fewer health services, fewer safe spaces to be active, higher housing stress, and higher exposure to marketing of unhealthy products. Over time, these conditions can build up and raise chronic disease risk.

A clear Australian pattern is that premature deaths (age 35–74) in the most disadvantaged areas have been about double the rate of those in the most advantaged areas (across 2001 to 2016). This shows how strongly socioeconomic conditions can shape health outcomes.

Example: Two people with the same diagnosis can have different outcomes. Someone who can afford time off work, transport to appointments, and medicines is more likely to manage the condition than someone dealing with casual work, housing stress, and limited service access.

1.4 Health behaviours

Health behaviours are actions and patterns that influence health. They include dietary behaviour, physical activity, tobacco use, alcohol consumption, drug use, sexual practices, sun protection, vaccination uptake, and other safety behaviours. While behaviours are often described as modifiable, they are strongly shaped by other determinants, especially socioeconomic conditions, culture, and the built environment.

Diet and physical activity are major drivers of chronic disease in Australia. Around two-thirds of Australian adults are overweight or obese, which increases risk for conditions such as cardiovascular disease, diabetes, sleep disorders, and joint problems.

Tobacco remains a high-harm behaviour. Australia has reduced smoking through long-term prevention and policy, but smoking is still uneven across the population. In 2019, about 14% of Australians aged 15+ were daily smokers. Among Aboriginal and Torres Strait Islander Peoples, smoking prevalence has been much higher (for example, 41% in 2018–19), and it is also higher in very remote areas.

Alcohol and other drugs can cause acute harm (injury, violence, poisoning) and chronic harm (dependence, liver disease, some cancers, and mental health impacts). Australian guidelines highlight that risk rises as consumption increases. Commonly taught thresholds include no more than 10 standard drinks per week, and no more than 4 in any one day.

Example: A teenager who does not smoke can still be exposed to harm if smoking happens inside their home. This shows how determinants can overlap, because one person’s behaviour becomes another person’s environment.

1.5 Biomedical factors

Biomedical determinants are internal influences such as genetics, age, and sex, as well as measurable biological states like blood pressure, cholesterol, blood glucose, immune status, and existing disease. These factors can raise baseline risk, affect disease progression, and shape how a person responds to treatment.

Genetic predispositions can increase the likelihood of some conditions. However, genes often interact with behavioural, environmental, and socioeconomic determinants. Age is strongly linked with chronic disease risk. Sex-linked biological factors can influence patterns of disease risk across the population.

Biomedical risk factors can also cluster. For example, high blood pressure, high cholesterol, and abdominal obesity may occur together. This increases cardiovascular risk more than any single factor alone. Managing biomedical risk often depends on access to primary care and medicines, linking biomedical risk to access and socioeconomic conditions.

Example: Two people can have the same BMI but different metabolic risk. If one has persistently high blood pressure and elevated blood glucose, their cardiovascular risk is higher, even if both look similar on one measure.

2. How determinants interact to affect the health of population groups

Determinants form connected pathways. Upstream influences (broad social and environmental conditions) shape downstream influences (daily behaviours and biomedical risk). These then shape health outcomes. This helps explain why health inequities can continue even when people understand what healthy choices are.

Disadvantage in one determinant often increases disadvantage in others. For example, low income can limit housing options. This may place someone in an unsafe or poorly serviced area. That can then shape diet, activity, stress, and access to care. Over time, this can lead to biomedical changes such as obesity, hypertension, and insulin resistance.

The time and intensity of exposure matters. Short exposure to risk may cause temporary harm. Long exposure increases the chance of chronic disease. This is especially important for poverty, housing stress, discrimination, and limited service access, where long-term exposure can affect health across the life course.

Different population groups experience different patterns of interacting determinants. For example, Aboriginal and Torres Strait Islander Peoples may experience combined pressures across multiple determinants, including historical and structural disadvantage and reduced service access. These interacting determinants help explain the persistent health gap, including a life expectancy difference of about 8 years compared with non-Indigenous Australians.

Example: A person may delay seeing a GP because of cost or transport barriers. If early symptoms of diabetes are missed, the condition can progress. Later-stage illness can then reduce capacity to work, which can worsen income security. This creates a reinforcing cycle.

3. The sociological causes of risky health behaviours

Risky health behaviours are sometimes described as poor choices, but sociological explanations focus on how behaviour is shaped by social relationships, social interaction, culture, and daily living conditions.

Social environments can normalise behaviours through peer and family influence and local expectations. For example, if heavy drinking is seen as normal within a peer group, it can increase the chance of risky consumption. If a family relies on fast food because of time pressure, cost, or limited cooking facilities, dietary behaviour is shaped by circumstances, not just knowledge.

Social positioning can also shape stress and coping. Long-term stress linked to unemployment, housing insecurity, discrimination, or trauma can increase the chance of using alcohol, tobacco, vaping, or other drugs as short-term coping strategies. Stigma around mental health and limited access to support can make these patterns harder to change.

Media and marketing can shape what feels normal and desirable. Targeted advertising and online content can reinforce consumption patterns, especially when combined with easy local availability and low cost.

Example: In a community with few affordable recreational options and high exposure to alcohol promotion, drinking may become a default social activity, especially when stress and low perceived future opportunities are also present.

4. Where health inequities exist and how they can be addressed

Health inequities are differences in health that are unnecessary, unfair, and avoidable. In Australia, inequities often align with unequal distribution of determinants, especially socioeconomic disadvantage, remoteness, disability, and the impacts of racism and discrimination, including for Aboriginal and Torres Strait Islander Peoples and some culturally and linguistically diverse communities.

To reduce inequities, action is needed across multiple determinants. This connects to social justice principles such as equity, access, rights, and participation, because health improves when resources and opportunities match need.

Equity is different from equality. Equality provides the same support to everyone. Equity provides support based on need so outcomes can become fairer.

Action to reduce inequities can include:

• Strengthening access to healthcare and prevention through affordability, geographical reach (including telehealth), and culturally safe service design.
• Improving socioeconomic characteristics through education completion, employment opportunities, income security, and housing stability.
• Building health-supporting environments, including safe housing, reliable transport, clean air and water, and local access to affordable healthy food.
• Reducing exposure to harm through policy and regulation, including evidence-based approaches to tobacco, alcohol, and unhealthy food environments.
• Supporting participation and self-determination so programs reflect local strengths and priorities.

Example: A locally governed, culturally safe primary healthcare service can improve trust and early help-seeking. Earlier diagnosis and consistent management can reduce preventable complications. This shows how service design can shift both behaviours and biomedical outcomes.