1.2 Analyse groups experiencing inequities in health, including Aboriginal and Torres Strait Islander Peoples and one other group (socioeconomically disadvantaged people, rural and remote, culturally and linguistically diverse populations, people with disability or older people)

Aboriginal and Torres Strait Islander Peoples

1. What the data tells us

1.1 Overview of the data

The data shows a clear and consistent pattern of health inequity between Aboriginal and Torres Strait Islander Peoples and non-Indigenous Australians. This inequity appears across key epidemiological measures such as life expectancy, mortality, infant mortality, morbidity, burden of disease, and potentially avoidable deaths. Morbidity refers to levels of illness, disease, and poor health in a population. Burden of disease combines the impact of living with illness and disability with the impact of dying earlier than expected.

Although some statistics may be affected by under-identification and data quality issues, the pattern is still clear. Aboriginal and Torres Strait Islander Peoples experience poorer health outcomes across many areas, and these outcomes reflect unequal living conditions, unequal access to protection, and long-term structural disadvantage.

It is also important to recognise that Aboriginal and Torres Strait Islander Peoples are not one uniform group. There are many distinct Nations, language groups, and cultural practices. Aboriginal Peoples are the First Nations of mainland Australia and Tasmania, while Torres Strait Islander Peoples are from the Torres Strait Islands between Queensland and Papua New Guinea. This diversity matters because health experiences, barriers, and protective factors are not identical in every community.

Aboriginal and Torres Strait Islander Peoples also have a much younger age profile than the non-Indigenous population, with a median age of about 24 years compared with 38 years. This partly reflects higher birth rates, but it also reflects higher premature mortality, meaning more deaths occur at younger ages.

1.2 Life expectancy, mortality and infant mortality

One of the clearest indicators of inequity is life expectancy, which is the average number of years a person is expected to live. ABS estimates for 2020 to 2022 show life expectancy of about 71.9 years for Aboriginal and Torres Strait Islander males and 75.6 years for females, compared with about 80.6 years for non-Indigenous males and 83.8 years for non-Indigenous females. This gap of around 8 to 9 years shows that Aboriginal and Torres Strait Islander Peoples are more likely to die earlier across the life course.

This is also clear in premature mortality, which means deaths before the age of 65. Around 61% of Aboriginal and Torres Strait Islander deaths occur before 65, compared with about 17% for non-Indigenous Australians. This means the inequity is not just that average life span is lower. It also means there is a much greater chance of dying during childhood, early adulthood, or middle age.

The data also shows higher infant mortality and higher death rates in early childhood. This is important because it shows that inequity begins very early in life. These outcomes are closely linked to factors such as maternal health, housing, nutrition, overcrowding, and access to early and ongoing health care.

Location also affects outcomes. Aboriginal and Torres Strait Islander Peoples living in remote and very remote areas are expected to live about five years less than those living in major cities. This shows that where a person lives affects their access to services, continuity of care, and health outcomes.

1.3 Morbidity and burden of disease

Aboriginal and Torres Strait Islander Peoples experience much higher morbidity, which means higher levels of illness, disease, disability, and ongoing poor health. This is shown clearly in the burden of disease, which is around 2.3 times higher than that of non-Indigenous Australians.

This matters because burden of disease captures two things at once:

• years lived with illness, pain, or disability
• years of life lost due to early death

In other words, the inequity is not only that Aboriginal and Torres Strait Islander Peoples die younger. It is also that many live with greater illness and poorer health before death.

Major contributors to this burden include mental health and substance use disorders, injuries, cardiovascular disease, cancer, and endocrine disorders such as diabetes. This pattern shows that the inequity is broad. It affects physical health, social and emotional wellbeing, chronic disease, and injury-related harm.

The same pattern appears in leading causes of death. Important causes include coronary heart disease, diabetes, suicide, COPD, lung cancer, and, particularly for females, dementia including Alzheimer’s disease. This mix of chronic disease and preventable harm shows that inequity is shaped by many interacting factors rather than one single cause.

1.4 Potentially avoidable deaths and preventable harm

Another key pattern in the data is the high rate of potentially avoidable deaths. These are deaths that should not occur if there is effective prevention, early detection, and timely treatment. Aboriginal and Torres Strait Islander Peoples experience a rate of potentially avoidable death that is around three times higher than that of the rest of the population, and these deaths account for about 64% of Aboriginal and Torres Strait Islander deaths.

Other statistics show the same pattern. Aboriginal and Torres Strait Islander Peoples are:

• about two times more likely to die from injury and poisoning
• around 2.1 times more likely to die in the first few years of life
• about 2.1 times more likely to die from suicide
• around 4.7 times more likely to die from diabetes

These figures matter because they show that many poorer outcomes are linked to barriers in prevention, living conditions, early intervention, and access to care. The numbers do not just show difference. They show that much of the harm is linked to unequal conditions and unequal access to support.

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

To analyse determinant interaction, it is necessary to show how different determinants connect and reinforce one another. In Year 11, determinants were grouped as broad features of society, environmental factors, socioeconomic characteristics, health behaviours, and biomedical factors. These determinants do not act separately. They interact in ways that increase exposure to risk while reducing access to protection.

For instance, poor health can reduce a person’s ability to work or complete education. Lower education and employment can then reduce income. Lower income can limit housing quality, food security, transport, and access to health care. These effects then worsen health again. This is why health inequity is best understood as a pattern of accumulating disadvantage rather than one isolated problem.

2.1 Broad features of society

Broad features of society include the wider social, cultural, and political conditions that shape health. For Aboriginal and Torres Strait Islander Peoples, this includes racism, discrimination, social exclusion, community connection, cultural identity, language, family and kinship relationships, and wider systems such as the justice system.

Example: A person who has previously felt ignored or judged in hospital may delay returning for treatment when symptoms begin again. This shows how racism-related mistrust can reduce early help-seeking and worsen outcomes.

2.2 Environmental factors

Environmental factors include geographical location, housing quality, overcrowding, water and sanitation, infrastructure, transport, and access to health services. These factors shape whether daily living conditions support or damage health.

2.3 Socioeconomic characteristics

Socioeconomic characteristics include education, employment, income, and health literacy. Health literacy means the ability to understand health information, use health services, and act on health advice.

2.4 Health behaviours

Health behaviours are the actions and patterns that affect health, such as help-seeking, screening participation, nutrition, physical activity, smoking, alcohol use, and whether people continue treatment and follow-up care. These behaviours matter, but they are not shaped by personal choice alone.

Because of this, exposure to risk factors is often increased by underlying disadvantage. These risk factors can include:

• tobacco use
• alcohol consumption
• illicit drug use
• poor nutrition
• physical inactivity
• overweight and obesity
• exposure to violence
• poorer participation in screening, follow-up, and early treatment

AIHW reports that daily smoking among First Nations people aged 15 and over fell from 37% in 2018–19 to 29% in 2022–23. This shows improvement, but it also shows that major health behaviour risks remain shaped by broader disadvantage rather than by individual choice alone.

This means health behaviours should be understood in context. A person may delay treatment, miss appointments, or stop medication not because they do not care about their health, but because cost, transport, mistrust, and unstable living conditions make consistent care harder.

2.5 Biomedical factors

Biomedical factors are the physical and biological conditions that affect health, such as existing disease, blood pressure, blood glucose levels, hearing and vision status, and overall disease burden. These factors are important because they influence how serious health problems become and how much ongoing care is needed.

Biomedical factors can also affect other determinants. For instance, untreated hearing or vision problems can reduce educational participation and make learning harder. Chronic disease can reduce work capacity, increase health costs, and make transport and daily routines more difficult. In this way, biomedical factors do not sit apart from the other determinants. They can both shape and be shaped by them.

2.6 Interaction of determinants

These determinants do not act alone. They interact in ways that deepen inequity. For example, remoteness can reduce access to health care and education. Lower access to education can reduce employment opportunities. Lower employment reduces income, which can worsen housing quality and food security. Poor living conditions and delayed care then increase illness and complications.

At the same time, these conditions can shape health behaviours. A person may delay screening, stop medication, or avoid follow-up because of cost, transport problems, or mistrust of services. If they already have a biomedical risk such as diabetes, high blood pressure, or respiratory illness, delayed care can lead to faster disease progression and more serious complications.

This interaction can become a cycle. Once health worsens, it can become even harder to work, study, or travel for treatment. In some cases, contact with the justice system can intensify this pattern by disrupting housing, income, employment, family stability, and mental health. This is why inequity is best understood as a pattern of connected disadvantage rather than one separate issue at a time.

These interactions can also be intergenerational, meaning their effects continue across generations. Historical and ongoing experiences of colonisation, forced removals, racism, exclusion, and structural disadvantage can shape service trust, coping patterns, educational opportunity, and family wellbeing over time.

Example: A 52-year-old Aboriginal woman living in a remote NSW community has type 2 diabetes. She knows she needs regular review appointments, but the visiting GP roster changes often, appointments are limited, and she has to organise transport while also managing caring responsibilities. After a past hospital experience where she felt dismissed, she delays follow-up until her symptoms become severe. By the time she is seen, her diabetes is poorly controlled and she has early kidney damage. This shows how broad features of society such as racism-related mistrust, environmental factors such as remoteness and transport barriers, socioeconomic characteristics such as caring demands and limited resources, health behaviours such as delayed help-seeking, and biomedical factors such as diabetes can interact to worsen health outcomes.

3. What are some of the causes that underpin the inequities in health?

The causes underpinning these inequities are broader than the determinants alone. Determinants describe the conditions shaping health now. Causes underpinning inequity explain why those unequal conditions exist in the first place. For Aboriginal and Torres Strait Islander Peoples, these causes are strongly linked to colonisation, forced removals, racism, and long-term structural exclusion.

3.1 Impacts of colonisation on Aboriginal and Torres Strait Islander Peoples

Colonisation is a major cause of health inequity because it disrupted the foundations of health and wellbeing. It involved dispossession from Country, suppression of language and culture, and the imposition of laws and policies that reduced autonomy, opportunity, and control across generations.

Colonisation also introduced infectious diseases to which Aboriginal and Torres Strait Islander Peoples had no immunity, causing severe population loss in many areas. The effects were not only immediate. Dispossession weakened access to land, food systems, cultural practices, community authority, and stable social structures. Over time, this contributed to long-term inequality in education, income, housing, and access to care.

Example: A community relocated away from traditional food sources may become more reliant on expensive, less nutritious store-bought foods. Over time, a poorer diet combined with reduced access to preventive care can contribute to higher rates of type 2 diabetes and cardiovascular disease. This shows how dispossession can be linked to present-day chronic disease patterns.

3.2 Stolen Generations and intergenerational trauma

The Stolen Generations are a major example of the lasting effects of colonisation. The forced removal of children from their families disrupted attachment, parenting, identity, cultural knowledge, language, and belonging. This caused deep trauma.

Intergenerational trauma means trauma experienced by one generation continues to affect later generations through family disruption, grief, chronic stress, mistrust of institutions, and reduced access to stable support. For Aboriginal and Torres Strait Islander Peoples, this trauma is closely linked to colonisation, frontier violence, forced removals, and ongoing discrimination.

This trauma can affect health directly through psychological distress and indirectly by reducing trust in health services, schools, and government systems. That can delay help-seeking, reduce follow-up, and increase the risk of later diagnosis and preventable complications.

Example: A young person growing up with family grief, housing instability, and repeated experiences of discrimination may be more likely to experience anxiety and disengage from school. Lower education can then narrow employment pathways, increase financial stress, and reduce access to health care. This shows how trauma can become part of a long-term pathway that affects health.

3.3 Racism and culturally unsafe health systems

Racism remains a major cause underpinning health inequity. It operates both between individuals and within systems. In health care, racism can appear through poor communication, dismissive treatment, unsafe environments, limited Aboriginal and Torres Strait Islander workforce representation, and services that do not respect kinship structures, family involvement, or cultural obligations.

When health care is not culturally safe, people may delay or avoid treatment, feel unable to ask questions, or disengage from follow-up. Culturally safe care is care in which people feel respected, free from racism, and safe to participate in decisions about their health. If that safety is missing, the quality of care is reduced even if the service technically exists.

Example: A policy requiring all patients to produce a Medicare card and photo identification before receiving care may appear neutral, but it can create a barrier for Aboriginal and Torres Strait Islander Peoples who may have unstable housing, difficulty accessing documents, or a history of exclusion from government systems. This can delay urgent care and contribute to poorer outcomes.

3.4 Geographical isolation, housing and underinvestment

Another major cause underpinning inequity is long-term underinvestment in housing, infrastructure, services, and community-led decision-making. When communities have fewer resources and less control over how services are designed, health inequity is more likely to continue.

Geographical isolation makes it harder to access consistent primary care, specialist care, and emergency support. Overcrowded housing and poor housing maintenance increase the risk of infection, respiratory illness, stress, and sleep disruption. Inadequate infrastructure related to water, sanitation, transport, and electricity can worsen both acute and chronic health issues.

Underinvestment also affects continuity of care. When services rely on short-term or rotating staff, it is harder to build trust and manage chronic disease well over time. As a result, people may receive treatment for immediate symptoms without the deeper causes of illness being addressed.

4. What actions can be implemented to improve the health status of these groups?

Actions need to match the causes of the inequity. Health inequities for Aboriginal and Torres Strait Islander Peoples are shaped by colonisation, intergenerational trauma, socioeconomic disadvantage, and systemic racism. This means effective action cannot focus only on individual behaviour. It must also address the structural and cultural factors that affect trust, access, living conditions, and long-term health outcomes. Additionally, action must be culturally appropriate, inclusive, community-driven, and focused on both immediate health needs and the broader conditions that shape health.

4.1 Support self-determination and community control

Self-determination means Aboriginal and Torres Strait Islander Peoples have genuine authority in decisions that affect their health and wellbeing. This matters because programmes and policies are more effective when they reflect local priorities, cultural protocols, family structures, and the barriers communities identify themselves.

A major action is to fund and expand Aboriginal Community Controlled Health Organisations (ACCHOs). ACCHOs are important because they place health care under community governance and deliver care in ways that are locally relevant, culturally appropriate, and holistic. They also strengthen trust, improve engagement, and support continuity of care.

Supporting self-determination also means ensuring communities are involved in the planning, design, delivery, and evaluation of health programmes. Respect for cultural knowledge, local leadership, and community decision-making is essential. Without this, services are more likely to miss local needs and reproduce barriers rather than remove them.

Example: A maternity care programme designed and led by the local community includes culturally safe antenatal visits, transport support, and flexible family involvement. More women attend because the service is trusted and fits community life. This leads to earlier antenatal care and fewer preventable complications.

4.2 Deliver culturally safe healthcare

Cultural safety means care is provided in a way that is respectful, free from racism, and responsive to cultural identity, family structures, and community needs. This is critical because many Aboriginal and Torres Strait Islander Peoples have experienced discrimination, dismissal, or misunderstanding in healthcare settings. These experiences can lead to mistrust and lower use of services.

Healthcare workers therefore need ongoing training in cultural safety and cultural awareness. However, training alone is not enough. Health services also need broader organisational change so that care is delivered in ways that are inclusive, respectful, and consistent.

This includes reducing racism and discrimination in healthcare settings and incorporating relevant cultural practices into care where appropriate. It also includes better communication, stronger Aboriginal and Torres Strait Islander leadership within services, and systems that support family and community involvement. When care feels culturally safe, people are more likely to seek help earlier, return for follow-up, and stay engaged with treatment.

4.3 Improve access to healthcare services

Better care is only effective if people can actually reach and use it. Many Aboriginal and Torres Strait Islander Peoples, especially those in rural and remote areas, face barriers linked to distance, transport, workforce shortages, limited opening hours, and inconsistent services. These barriers increase the risk of delayed diagnosis and delayed treatment.

Action is needed to increase healthcare services in rural and remote areas, where access is often most limited. This includes more regular primary care, stronger specialist pathways, and better continuity of care for chronic disease management.

It is also important to expand mobile clinics and outreach programmes. These services reduce barriers by bringing screening, follow-up, and early intervention into communities rather than expecting people to travel long distances. Transport support and flexible service delivery are also important because a service is not truly accessible if people cannot afford to get there or cannot attend at practical times.

Example: A mobile health service that visits a remote community each month to provide diabetes reviews, childhood immunisation, and basic screening reduces the need for long-distance travel and improves early detection of illness.

4.4 Address social determinants of health

Health inequities are strongly linked to living conditions, not only to healthcare access. This means action must also address the social determinants of health, which are the conditions that shape health before a person enters the healthcare system.

Priority areas include:

• improving housing quality
• reducing overcrowding
• strengthening education opportunities
• improving employment pathways
• increasing income support
• creating safer and more stable job pathways

These actions matter because poor housing, unstable employment, and low income increase stress, reduce food security, limit transport, and make healthcare harder to access. In contrast, stable housing, stronger education, and secure employment improve both immediate wellbeing and long-term health outcomes.

Reducing housing instability is especially important. Poor quality or overcrowded housing can increase infection, disrupt sleep, add stress, and make chronic disease management harder. Increasing income support and employment opportunities can also reduce deep poverty and make it easier for people to meet daily health needs.

4.5 Strengthen early intervention and prevention

Many poorer health outcomes are preventable or could be reduced through earlier action. This means stronger investment in early intervention and prevention is essential.

One major area is maternal and child health. Early support during pregnancy, infancy, and childhood can improve health across the life course. Strong maternal and child health programmes can reduce preventable complications, improve developmental outcomes, and strengthen engagement with services from an early stage.

Prevention also includes increasing vaccination, screening, and chronic disease prevention. This is especially important because Aboriginal and Torres Strait Islander Peoples experience higher rates of conditions such as diabetes, cardiovascular disease, and other preventable illnesses. Earlier screening and follow-up can reduce complications and improve long-term management.

Community-led programmes that promote healthier lifestyles are also important. These are more likely to succeed when they are built around local priorities, cultural strengths, and practical realities rather than relying on generic messages about behaviour change.

4.6 Improve health education and health literacy

Health literacy is a person’s ability to find, understand, and use health information. It affects whether people recognise symptoms, understand prevention, know when to seek help, and can manage treatment properly.

Improving health literacy requires culturally appropriate communication methods. Health information is more effective when it is clear, relevant, and connected to community realities. This includes using plain language, appropriate formats, and communication that respects local language and cultural context.

Programmes are also more effective when they are delivered through community leaders and community organisations that people already know and trust. This can improve understanding of prevention, treatment, and service access, while also reducing barriers linked to mistrust or unfamiliar systems.

Example: A diabetes education programme delivered through a local Aboriginal health service, using plain language and examples relevant to local food access and family life, is more likely to improve understanding than a generic written pamphlet.

4.7 Address systemic inequality and racism

Health inequity will continue unless the broader systems producing disadvantage are also challenged. Systemic inequality and racism affect healthcare access, service quality, education, employment, housing, and contact with institutions more generally. These are not separate issues from health. They are part of the structural causes of poorer health outcomes.

Action is needed to implement anti-racism policies in healthcare and broader systems. This includes setting clear expectations, monitoring discriminatory practices, and making services more inclusive and equitable. Anti-racism action is important because historical and ongoing disadvantage is reinforced when systems continue to operate in ways that exclude or marginalise Aboriginal and Torres Strait Islander Peoples.

It is also important to increase Aboriginal representation in the health workforce and in policy-making. Representation matters because it improves cultural knowledge within services, strengthens trust, and increases the likelihood that policy decisions reflect Aboriginal and Torres Strait Islander perspectives and priorities.

4.8 Government-led strategies and long-term commitment

Long-term, coordinated action is needed to reduce entrenched inequities. Government-led strategies are important because the causes of inequity extend across health, housing, education, employment, and community services. No single programme or short-term funding cycle can resolve these issues on its own.

The National Agreement on Closing the Gap is important because it provides targets and a framework for shared responsibility. However, progress depends on more than setting targets. It requires sustained funding, clear accountability, and willingness to change strategies when progress is too slow.

Monitoring progress should involve both data and community feedback. This matters because improvements need to be visible not only in broad national figures, but also in the everyday experiences of communities. Governments and organisations must be able to show that actions are reducing barriers, improving trust, and producing measurable gains in health status over time.

Long-term commitment also means recognising that health improvement is not only about clinical indicators. Cultural continuity, community strength, trust, and connection are also protective factors that support long-term wellbeing and stronger engagement with care.

To analyse health inequities for socioeconomically disadvantaged people, identify patterns in the data (for example, earlier death and higher chronic disease), explain these patterns through interacting determinants (for example, low income plus insecure work plus housing stress plus cost barriers), and link this interaction to avoidable outcomes (for example, delayed care and preventable complications). Across Australian reporting, the consistent pattern is a social gradient of health: as socioeconomic status (SES) decreases, average health outcomes worsen.

1. What does the data tells us

Across Australian reporting, people experiencing socioeconomic disadvantage have higher mortality, higher levels of illness and disability, and lower average health-related quality of life than more advantaged groups. These differences are systematic, occur across the life course, and reflect the unequal distribution of resources, opportunity, and access to care.

1.1 Defining socioeconomic disadvantage

Socioeconomic disadvantage refers to lower access to the social and economic conditions that support health. It is commonly linked to lower income, lower education, unstable or limited employment, and poorer housing. These factors are closely connected. Lower education can reduce employment opportunities, which can reduce income. Lower income can then limit housing quality, food security, transport, and access to healthcare.

This means socioeconomic disadvantage is not only about having less money. It is also about having fewer resources and fewer practical options across daily life. As socioeconomic status (SES) decreases, average health outcomes also tend to worsen. This pattern is often called the social gradient of health, which means health usually becomes poorer as disadvantage increases.

1.2 Life expectancy, premature mortality and infant mortality

The data shows that socioeconomically disadvantaged people experience poorer outcomes across major indicators of health status. Australians living in the most disadvantaged areas have lower life expectancy, meaning the average number of years a person is expected to live, than those living in the most advantaged areas. Recent national estimates show a gap of about 4.9 years for females and 6.6 years for males between the lowest and highest socioeconomic areas from 2020 to 2022.

This inequity is also seen in healthy life expectancy, which measures how many years people are likely to live in good health. Estimates show a gap of around 7.6 years between the most and least disadvantaged groups. This means the issue is not only that socioeconomically disadvantaged people may die earlier. It also means they are likely to spend more years living with illness, disability, or reduced quality of life.

The gap begins early. Babies born into higher SES groups have a lower infant mortality rate, while disadvantage increases exposure to early-life risks such as lower access to antenatal care, housing stress, and financial pressure. These early differences can then build across childhood, adolescence, and adulthood.

1.3 Morbidity and burden of disease

Socioeconomically disadvantaged people experience higher morbidity, which means higher levels of illness, disease, and poor health. They also experience a higher burden of disease, which combines the impact of living with illness and disability with the impact of dying earlier than expected.

This burden is especially clear in preventable chronic disease. Conditions that commonly show a strong SES pattern include cardiovascular disease, type 2 diabetes, chronic kidney disease, respiratory disease such as COPD, and some cancers linked to risk exposure and screening access. Mental health conditions and high levels of psychological distress are also more common where long-term disadvantage creates ongoing stress and fewer opportunities for support.

The scale of these differences is clear in the data:

• Heart attack rates are higher in disadvantaged areas, around 1.55 times for men and 1.76 times for women compared with the most advantaged areas.
• Cardiovascular death rates are also higher, about 1.5 times for low-SES men and 1.3 times for low-SES women.
• Type 2 diabetes prevalence is around 70% higher in low-SES men and more than double in low-SES women compared with the highest SES group.
• Treated end-stage kidney disease is about 1.5 times higher for men and 1.75 times higher for women in the lowest SES areas.

These figures show that socioeconomic disadvantage is strongly linked to earlier illness, more severe complications, and greater long-term health burden.

1.4 Risk factors, prevention and access to care

Socioeconomically disadvantaged people are also more exposed to key risk factors and are less likely to use important preventive health services. These patterns are sometimes described as the result of personal choice, but the data shows they are strongly shaped by affordability, environment, stress, and opportunity.

Key patterns include:

• much higher daily smoking rates, with 22.4% in the lowest socioeconomic areas compared with 6.7% in the highest in 2022 to 2023
• lower health literacy, meaning lower ability to find, understand, and use health information
• higher cardiometabolic risk, including higher BMI, higher blood pressure, and higher LDL cholesterol in some groups
• lower use of preventive services such as immunisation, family planning, dental check-ups, and cervical screening

These patterns increase the risk of later diagnosis, poorer disease control, and preventable complications.

Socioeconomically disadvantaged people are also more likely to face access barriers that delay treatment and reduce continuity of care. They may rely more on emergency care and less on early intervention. In some NSW communities, patients may need to travel more than 100 kilometres to reach a hospital or specialist. This increases time, transport costs, and the chance of missed appointments.

Example: A woman living in a low-income area puts off breast cancer screening because transport is difficult, she cannot easily take time off work, and other expenses are more urgent. This shows how cost and access barriers can delay preventive care even when screening services exist.

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

To analyse determinant interaction, it is necessary to show how disadvantage builds through linked conditions rather than isolated causes. In Year 11, determinants were grouped as broad features of society, environmental factors, socioeconomic characteristics, health behaviours, and biomedical factors. For socioeconomically disadvantaged people, these determinants interact in ways that increase exposure to risk while reducing access to protection.

For example, lower income can limit housing quality, food choices, transport, and access to health care. Poorer health can then make it harder to work, study, or maintain stable employment. This can further reduce income and deepen disadvantage. This is why socioeconomic disadvantage is best understood as a pattern of connected disadvantage rather than one separate problem at a time.

2.1 Broad features of society

Broad features of society include the wider social conditions that shape health, such as social inclusion, social support, community safety, discrimination, and the way services and systems are organised. These factors influence whether people feel supported, safe, and able to participate in daily life.

2.2 Environmental factors

Environmental factors include housing, infrastructure, transport, geographical location, and the local neighbourhood environment. These factors affect whether daily living conditions support health or make healthy choices harder.

2.3 Socioeconomic characteristics

Socioeconomic characteristics include education, employment, income, and health literacy. These factors are closely connected, and each one affects the others.

Example: A person on a very low income may choose fast food over fresh fruit and vegetables because it is a cheaper way to get more calories. This shows how income can shape diet through affordability, not just preference.

2.4 Health behaviours

Health behaviours are the actions and patterns that affect health, such as help-seeking, screening participation, nutrition, physical activity, smoking, alcohol use, and whether people continue treatment and follow-up care. These behaviours matter, but they are not shaped by personal choice alone.

Because of this, socioeconomically disadvantaged groups may be more exposed to risk factors such as:

• poor nutrition
• physical inactivity
• tobacco use
• harmful alcohol use
• delayed screening, treatment, and follow-up

These behaviours should be understood in context. A person may miss appointments, stop medication, or delay help-seeking not because they do not care about their health, but because cost, time pressure, transport problems, and unstable living conditions make consistent care harder.

2.5 Biomedical factors

Biomedical factors are the physical and biological conditions that affect health, such as existing disease, blood pressure, blood glucose levels, cholesterol levels, and overall disease burden. These factors matter because they influence how serious health problems become and how much ongoing care is needed.

Biomedical factors also interact with the other determinants. For example, a person with early diabetes is at greater risk if they also struggle to afford healthy food, attend regular appointments, or fill prescriptions consistently. Existing illness does not act alone. It becomes harder to manage when the surrounding conditions make prevention and treatment less accessible.

2.6 Interaction of determinants

These determinants work together rather than separately. A person with lower education may have fewer job opportunities. Lower employment may reduce income. Lower income may limit healthcare access, food quality, housing quality, and transport. These conditions then increase the risk of illness. Once health worsens, it may become harder to work consistently or continue study, which then worsens income and housing even further.

At the same time, these conditions shape health behaviours. A person may delay screening, stop medication, or avoid follow-up because of cost, transport problems, or difficulty getting time away from work. If they already have a biomedical risk such as high blood pressure or early type 2 diabetes, delayed care can lead to faster disease progression and more serious complications.

Environmental disadvantage can also combine in different ways depending on where people live. In some regional areas, long travel to hospitals and specialists can add cost and time burdens that make care harder to maintain. In some disadvantaged urban areas, limited access to fresh food, poor public transport, and fewer nearby services can shape diet and reduce preventive care. In both cases, the result is similar: the local environment increases risk while making protective choices harder.

This is why socioeconomic disadvantage is best understood as a pattern of connected disadvantage. The determinants interact to increase risk while reducing access to protection.

Example: An adult living in a low-income outer-suburban area works casual shifts and has limited sick leave. Rent takes up most of their income, so they choose food based on cost and convenience. Local options are mainly fast food and convenience stores, and public transport makes it difficult to reach larger supermarkets and specialist appointments. They delay going to the GP because of cost and because missing work means losing pay. By the time high blood pressure and early type 2 diabetes are diagnosed, the conditions are already harder to manage. This shows how broad features of society such as social instability and low support, environmental factors such as transport and food access, socioeconomic characteristics such as low income and insecure work, health behaviours such as delayed help-seeking, and biomedical factors such as early chronic disease can interact to worsen health outcomes.

3. What are some of the causes that underpin the inequities in health?

The causes underpinning inequity explain why these unequal determinants are present in the first place. For socioeconomically disadvantaged people, these causes are strongly linked to poverty, cost barriers, unequal service distribution, and systems that are often designed around the needs of more advantaged groups.

3.1 Poverty and low income

A major underlying cause is poverty and ongoing low income. When wages or income support do not cover the cost of living, people may experience constant financial stress and may be unable to meet basic needs. This affects access to nutritious food, healthcare, transport, stable housing, and opportunities that protect health.

Around 13.4% of people were living below the poverty line in 2019 to 2020, including 16.6% of children. The JobSeeker payment for a single adult was estimated to be $269 per week below the poverty line in March 2023. These figures matter because they show that, for many people, disadvantage is not temporary. It is an ongoing condition that shapes health every day.

3.2 Cost barriers to healthcare

Another major underlying cause is the cost of accessing care. Even within a universal health system, out-of-pocket costs can decide whether people receive timely diagnosis, treatment, and prevention.

In 2024 to 2025, 16.1% of people delayed or did not see a dental professional because of cost, 8.6% delayed or did not see a medical specialist, and 7.7% delayed or did not see a GP because of cost. The pattern is strongest in the most disadvantaged areas, where 23.1% delayed or did not see a dental professional because of cost compared with 9.6% in the least disadvantaged areas.

These figures show that cost does not only affect convenience. It affects whether people receive care early enough to prevent complications. When early care is unaffordable, people are more likely to present later with more serious conditions, which increases avoidable hospitalisation, disability, and long-term health gaps.

3.3 Postcode-based service gaps

Where a person lives affects what services they can use in practice. Disadvantaged areas often have fewer local services, longer waits, and less access to specialists, dental, and allied health care. Even where a service technically exists, long distance, limited transport, and time away from work can make it practically difficult to use.

These service gaps are often postcode-based, which means access is shaped by where a person lives rather than only by what they need. This contributes to delayed treatment and later diagnosis, especially when cost and transport barriers operate together.

3.4 Systemic barriers and exclusion

Inequity is also underpinned by how people experiencing disadvantage are treated within systems and how services are designed. Stigma around poverty can discourage help-seeking and can shape the way people are judged in healthcare settings. A person may be labelled as careless or non-compliant when the real issue is limited time, money, transport, or support.

Underrepresentation in policy and decision-making can also mean services are designed around middle-income assumptions, such as having stable internet, flexible work hours, reliable transport, and spare money for gap fees.

A newer structural issue is digital exclusion. As more services use online booking systems, telehealth platforms, and digital health portals, people without reliable devices, internet access, data, or digital confidence may be left behind. 20.6% of Australians were digitally excluded, with much higher exclusion among public housing residents (45.2%) and adults aged 75 and over (66.5%). This means digital systems can become another barrier to care when they are not supported by non-digital alternatives.

4. What actions can be implemented to improve the health status of these groups?

Improving the health status of socioeconomically disadvantaged people requires action at several levels. Immediate barriers need to be reduced, but long-term social conditions also need to improve. The most effective responses improve access, reduce financial pressure, and strengthen the conditions that support good health over time.

4.1 Affordable and accessible healthcare

A major priority is improving access to affordable healthcare. This includes stronger access to bulk-billing practices, telehealth appointments, and community health centres. It also includes reducing the cost of medicines and improving access to dental, mental health, and allied health care.

Reducing cost barriers is one of the most immediate ways to reduce preventable illness and avoidable outcomes. Key actions include strengthening access to no-fee primary care for priority groups and improving the affordability of medicines. Recent policy directions have included increased bulk-billing incentives for key groups, including children under 16 and concession card holders. A further affordability measure is the planned reduction of the maximum PBS co-payment for general patients to $25 from 1 January 2026. This matters because it can reduce the likelihood of people rationing medication, delaying prescriptions, or stopping treatment because of cost.

Dental care remains a major equity pressure point because it is not fully covered by Medicare. Increasing public dental services, reducing waiting lists, and making it easier for low-income adults to access care can reduce pain, infection, emergency hospital visits, and impacts on nutrition and ability to work.

Mental health care also needs to be affordable and easy to use. Low-barrier pathways that reduce cost, waiting times, and administrative complexity are especially important for people dealing with ongoing financial stress, insecure housing, or unstable work.

Example: A low-income adult with high blood pressure is more likely to keep taking medication and attend follow-up appointments when GP visits are bulk-billed and prescriptions are cheaper. This improves early management and lowers the risk of later complications such as heart attack or stroke.

4.2 Health literacy

Improving health literacy is another key action. People need to be able to understand health information, know what services exist, and feel confident using them. Lower health literacy can delay help-seeking and reduce disease management, so improving it can strengthen prevention and treatment.

This can include free community courses on hygiene, nutrition, and healthy habits, as well as clearer health communication and support to navigate referrals, appointments, and treatment plans. Health education is more effective when it uses simple language, practical examples, and delivery in familiar community settings.

Example: A community health session that explains cervical screening, blood pressure checks, and medicine labels in plain language is more likely to improve early help-seeking than a general information sheet full of technical terms.

4.3 Job security, income support and training

Improving health status also requires action on job security, income support, and access to training. Stable employment reduces financial stress, improves living conditions, and increases access to the resources that protect health. Income support also matters because people cannot maintain health when basic needs are not being met.

Important actions include increased access to training programmes, apprenticeships, income support, and housing subsidies. The National Skills Agreement, which began on 1 January 2024, is one example of investment in training. For training programmes to improve equity, they also need to reduce barriers such as fees, transport costs, childcare needs, and digital access. Without that support, the people who would benefit most may still be unable to participate.

Example: A person in insecure casual work is more likely to improve their long-term health if they can access subsidised re-skilling, childcare support, and transport assistance, because these measures can make stable employment more realistic.

4.4 Housing, infrastructure and local environments

Housing and local environments are also major areas for action. Better housing quality, more affordable housing, reduced overcrowding, and stronger local infrastructure can reduce infection, stress, and day-to-day barriers to health.

Useful examples include outdoor park equipment, clean roads, proper sewerage, and affordable housing. These changes matter because they improve the local environment in ways that support safety, activity, and disease prevention.

Housing policy is also health policy. Programmes that increase social and affordable housing are important because stable housing reduces emergency hospital visits and makes it easier to manage chronic conditions. One named example is the Housing Australia Future Fund target of 30,000 social and affordable homes. This matters because housing stability affects whether people can maintain routines, store medication safely, get regular sleep, and stay connected to health services.

Example: Installing outdoor park equipment in a low-income community does more than add recreation space. It creates a safe and accessible opportunity for physical activity close to home, which can support cardiovascular health and reduce barriers linked to transport and cost.

4.5 Monitoring progress and accountability

Improvement will be limited unless progress is tracked and acted on. This means setting clear goals, reporting openly, and changing strategies when results are too slow. Important indicators include reductions in potentially preventable hospitalisations, smaller gaps in life expectancy and healthy life expectancy, and fewer delays in care due to cost.

Monitoring matters because health inequity can continue even when policies exist on paper. Progress needs to be visible in the communities experiencing the greatest disadvantage so it is clear whether barriers are actually being reduced.

4.6 Reduce systemic barriers and exclusion

Some barriers are built into the way services operate. These systemic barriers can exclude low-income users even when a service appears to be available.

Services need to be designed with low-income users in mind. This can include flexible opening hours, including longer opening hours in high-need areas, simpler booking processes, and lower or no-gap fees. These changes matter because many people in insecure or casual work cannot easily attend appointments during standard business hours.

It is also important to reduce exclusion linked to digital systems. Telehealth can reduce travel barriers, but it only improves equity when digital barriers are also addressed. Equity-safe telehealth means keeping phone options, providing local places with digital access, and making sure non-digital alternatives remain available for people who are digitally excluded.

High-impact strategies can also include care coordinators or navigator roles to help people manage referrals, forms, follow-up appointments, and service pathways. This is important because missed appointments and broken follow-up are often caused by practical barriers rather than lack of motivation.

Healthcare workers also need training to reduce stigma and bias. If a person is judged as careless or non-compliant without recognising the financial and practical barriers they face, this can damage trust and reduce future help-seeking.

Example: A clinic that offers evening appointments, phone booking, no-gap care for concession card holders, and staff trained to communicate respectfully is more accessible for low-income patients than a clinic that only offers weekday appointments and online booking.

4.7 Targeted government policies and programs

Broad reform is important, but targeted policies and programmes are also needed for groups at greatest risk. These strategies can focus resources where the burden of disease and the barriers to care are highest.

Public health campaigns can be designed for high-risk groups and focused on specific issues such as smoking, diabetes risk, screening participation, or mental health. Subsidised programmes can also improve access to smoking cessation, mental health support, and chronic disease management.

Cross-sector collaboration is especially important. Health inequity cannot be addressed by the health system alone. Effective responses require health, education, housing, and employment systems to work together because the causes of disadvantage overlap across these areas.

Example: A local programme that combines smoking cessation support, free mental health counselling, housing referral, and employment assistance is more effective than a programme that addresses only one issue in isolation.