Socioeconomic determinants of health: towards a national research program and a policy and intervention agenda

Abstract

This report has four primary objectives:
1. To review Australian research pertaining to socioeconomic health inequalities;
2. To provide a descriptive profile of Australia’s research capacity vis-à-vis socioeconomic
health inequalities;
3. To critically examine the policies and interventions that have been suggested to reduce
socioeconomic health inequalities;
4. To make a number of preliminary recommendations about the development of a national
health inequalities research program and a policy and intervention agenda.

This report utilises a conceptual framework that identifies the multi-level and diverse determinants
of socioeconomic health inequalities. The structure and content of the framework, and the identified
relationships between each of its major components, are based on the existing scientific evidence.
Its conceptualisation has also been informed by a broader understanding of the determinants of
health. The framework consists of three discrete yet closely interrelated stages or levels, namely,
upstream, midstream, and downstream. The upstream (or macro-level) factors include international
influences, government policies, and the fundamental determinants of health (i.e. social, physical,
economic and environmental). The midstream (or intermediate-level) factors include psychosocial
factors, health-related behaviours and the role played by the health care system. The downstream
(or micro-level) factors include changes to physiological systems and biological functioning brought
about as a consequence of the influence of factors operating at the midstream and upstream levels.

Taken as a whole, the evidence on SES and health in Australia is unequivocal: those who occupy
positions at lower levels of the socioeconomic hierarchy fare significantly worse in terms of their
health. Specifically, persons variously classified as ‘low’ SES have higher mortality rates for most
major causes of death, their morbidity profile indicates that they experience more ill-health (both
physiological and psychosocial), and their use of health care services suggests that they are less
likely to act to prevent disease or detect it at an asymptomatic stage. Moreover, socioeconomic
differences in health are evident for both females and males at every stage of the life-course (birth,
infancy, childhood and adolescence, and adulthood) and the relationship exists irrespective of how
SES and health are measured.

The report considers some of the important and relevant components of the country’s existing
research capacity and infrastructure vis-à-vis SES and health, and it examines the Australian
performance in terms of its contribution to the international evidence base. By all accounts, the
Australian research performance in this area, although hard to quantify precisely, has been significant
both nationally and internationally. However, there are a relatively small number of universities
and research centres that have made a very significant contribution. Considering the lack of critical
research mass and the complexity of this area of research, the performance has been very impressive by any standards.