It’s complicated.
Family history, genetics and increasing age play a role—but probably no more than that of the general Australian population. In large part we have to look at the social and cultural determinants of health. These can be summed up by:
- factors such as poverty, economic inequality and social status
- employment and job security
- poor and overcrowding housing, with very high rates of homelessness
- social exclusion, including isolation, poverty, discrimination, incarceration, trauma and racism
- education and care in early life
- food security and access to a balanced and adequate diet
- addictions, particularly to alcohol and tobacco.
For Aboriginal people, the social and cultural determinants of health are directly linked to low birth weight, diabetes, high blood pressure, overweight and obesity, tobacco smoking, physical inactivity and poor nutrition. Poor maternal health and low birth weight, childhood infection and chronic inflammation, have also been associated with increased risk of developing, for example, Chronic Kidney Disease.
As public health expert Fran Baum has put it, Aboriginal people face a panoply of disadvantage which has a direct impact on life expectancy, in which she summarises the stark contrast.
Swapping unhealthy conditions for healthy ones
| Unhealthy conditions | Healthy conditions | |
| Poverty | Wealth | |
| Homelessness | Safe, secure housing | |
| Unemployment | Satisfying employment | |
| Racist assaults | Cultural acceptance | |
| Low literacy and educational achievement | Literacy and high educational achievement | |
| Polluted environment | Clean environment | |
| Healthy diet unaffordable | Healthy diet affordable | |
| Living in a violent family | Living in a family free from violence | |
| Unsafe neighbourhoods with high crime rate | Safe neighbours with low crime rates |