Approach
Our Community Plan adopts a "Community Development for Health" (CDH) approach developed by the Healthy Communities Foundation Australia, a charity that works with communities like ours to address 'wicked problems'.
The social determinants of disadvantage (SDOD) are the conditions and environments into which people are born, and where they live, learn, work, play and grow old, that affect a wide range of health, functioning, and quality-of-life outcomes and risks for individuals.
The SDOD are contributing to widening disparities of outcomes and increasing inequality in Australia between different parts the country, and different groups within communities.
For example, if its cheaper for low-income people in remote communities to buy processed foods rather than fresh fruit and vegetables, they are less likely to be able to maintain good nutrition for themselves and their children. That increases the risk of health conditions like heart disease, diabetes, and obesity — and reduces their life expectancy relative to people who do have access to healthy foods.
Many of these underlying social determinants can be influenced by effective public policies and locally coordinated community action.
Having a grocery stores that sells affordable fresh foods may help people make healthier choices in the foods they eat. Better quality housing can provide healthier places to live and may reduce the prevalence of conditions such as childhood asthma.
There is substantial research and evidence on programs and initiatives that help to reduce, or even reverse, the impact of social determinants on disadvantage and inequity in our communities.
Despite this knowledge, we continue to see increasing rates of obesity, mental illness, alcohol related harm and incarceration among certain disadvantaged communities and groups.
In 2017, the Deloitte Center for Health Solutions surveyed nearly 300 health system leaders and found that while 80 percent were committed to establishing and developing processes to systematically address the social determinants of disadvantage "the activity was ad hoc, and gaps remained in connecting initiatives that improve health outcomes or reduce costs".
As noted by PwC:
"For all the investments already made in healthcare, countries have not been able to bring about the necessary societal shifts to encourage habits that could prevent chronic conditions from developing ... The social determinants ... often-ignored social factors such as employment; housing; income inequality; and level of access to clean water, education and transportation — undermine progress and can swamp the .. systems that ignore them. Because even the most advanced .. interventions are rendered ineffective when people struggle with social isolation, income inequality, poor nutrition and pollution. As social factors counteract ... systems often remain focussed on creating solutions at the wrong interaction point: after people are already sick and in crisis".
The key challenge for the most disadvantaged communities in Australia, including Collarenebri-Galariinbaraay, is to change the way we address the social determinants including greater community leadership and more investment in local coordination and program delivery. This is a challenge which requires us to work out how to balance the need for greater community control and ownership and the responsibility of governments to meet its accountability and fiscal obligations. That is what the Collarenebri-Galariinbaraay Community Plan is intended to do.
The diagram above shows how each of the projects our community has identified will positively address the social determinants of disadvantage and lead to improvements in health, education and the economy.
