The health and wellbeing of Australian people is impacted by a number of varying factors or determinants including broad features of society, environmental factors, socioeconomic characteristics, health behaviours and biomedical factors. There is a close relationship between people's health and the circumstances in which they grow, live, work, play and age (Commission on Social Determinants of Health 2008). These in turn influence various health behaviours and other determinants. (AIHW, 2024).

The determinants of health are closely interrelated and include risk or protective factors to influence the health of individuals and communities. These determinants have a significant impact on health and often they can not be altered. Simply by being born into a country, culture, family or location can affect the health of an individual without them having control.

According to AIHW (2024) a determinant of health impacts an individual's health and wellbeing by increasing or decreasing the risk of disease or injury occurring. For example, an Indigenous Australian living in remote Australia may be influenced by a number of determinants of health that are often non-modifiable including culture, social inclusion, remoteness, access to services, trauma and birthweight.

The Australian Institute of Health and Welfare identifies the broad features of society to include:

• Culture
• Affluence
• Social Cohesion
• Social Inclusion
• Political Structures
• Public Policy Decisions
• Media and Language 

Culture significantly influences the health and wellbeing of individuals. Australian culture is a blend of Indigenous traditions, colonial heritage and diverse immigrant backgrounds. It promotes 'mateship', fostering a strong sense of social connection.

Australians often engage in outdoor activities and sports, contributing to improved physical health and longer life expectancy. Although higher rates of alcohol consumption, processed food intake and sun exposure contribute to issues such as cardiovascular disease, obesity, cancers and mental health concerns such as depression and anxiety.

Cultural heritage also impacts wellbeing. For example; Lebanese Australians maintain strong family bonds, social lives and a Mediterranean diet, which supports their physical, social and spiritual health.

Affluence or economic prosperity, is a key determinant of health in Australia. As one of the world’s strongest economies, Australia ranked 12th in mean net financial assets per capita and 6th in gross financial wealth per adult in 2023, according to Allianz.

Australia's high standard of living and economic stability allow for improved access to essential services such as healthcare and education. This leads to positive health outcomes, as individuals benefit from well-developed healthcare systems, clean infrastructure, sanitation and adequate nutrition. Consequently, Australians tend to have higher life expectancies and an overall positive sense of wellbeing.

Affluence also brings challenges to the health of individuals. The lifestyle associated with prosperity often promotes sedentary behaviour and the consumption of processed foods, contributing to rising obesity rates and other lifestyle-related diseases.

Not all Australians are afforded this opportunity to have access to adequate shelter, education and employment. As a result there are still many individuals, groups and communities that live in poverty and suffer economic disadvantage thus impacting their access to safe and clean housing, adequate medical care and nutrition.  

Social cohesion refers to the level of connection, shared values and trust among individuals within a society. In most parts of Australia, social cohesion is strong, supported by shared values such as family, democracy and human rights.

Communities with higher social cohesion tend to experience better health outcomes. Individuals who feel connected to their community are more likely to adopt healthy behaviours, seek healthcare when needed and experience lower stress levels.

In contrast, areas with lower social cohesion may face greater health challenges. Limited social support can lead to unhealthy behaviours like drug use or excessive alcohol use, contributing to wider health issues.

Social inclusion involves creating an environment where all individuals, regardless of their background, feel valued and respected. This builds a sense of belonging, reduces stigma and ensures equitable access to opportunities and resources, which positively impacts overall health and wellbeing.

In Australia, efforts toward social inclusion are evident in policies aimed at reducing discrimination based on ethnicity, gender, age, disability and socioeconomic status. An inclusive society supports better mental health outcomes by fostering a sense of belonging, which helps reduce conditions like anxiety and depression.

Colonisation devastated most elements of Indigenous culture across Australia. While there has been an historical decimation of Aboriginal and Torres Strait Islander culture, the nature and resilience of Indigenous peoples has meant that the strong connection to tradition and land can positively impact health. 

Australia's political system is a federal (covering the entire country) parliamentary constitutional monarchy (a system with a monarch- king or queen as head of state) with a democratic (where citizens vote) structure. This system influences health outcomes in various ways.

The Australian Government allows each region to have a representative in parliament to vote and speak on behalf of its people. This helps ensure that parliamentary decisions reflect the interests of all Australians and can lead to policies that support and promote better health outcomes.

There are various government departments that provide support, funding, education and initiatives to improve the health outcomes of Australian's. For example, Department of Communities and Justice- Housing provides housing options for community groups in Australia. NSW Health provides medical support and services across NSW plus comprises the work of organisations such as NSW Ambulance and eHealth NSW. 

Government decisions on healthcare funding, public health initiatives and social welfare directly impact the population's wellbeing. Medicare, Australia’s national healthcare system, ensures access to healthcare without financial barriers, improving health outcomes.

Policies on education, employment and housing also affect social determinants of health. Access to quality education, job opportunities and stable housing are key to overall wellbeing. Additionally, policies like the 2006 ban on smoking in pubs and clubs, which reduced smoking rates and lung cancer, demonstrate how laws can improve public health.

 
There are a number of policies that have been implemented across Australia over the years that have had positive affects on the health of individual’s and group’s experiencing inequities, but some have also not been as successful as first hoped.

The media’s impact on health has grown with technological advances, increasing exposure through mass and social media.

Media communicates health information both explicitly and implicitly. Explicit examples include news articles on obesity or social media posts promoting fitness. Implicit communication, which often has a larger effect, occurs through movies, marketing and television.

The COVID-19 pandemic relied heavily on media to disseminate information about outbreaks, lockdowns, policies and vaccinations. These use of media then had both positive impacts by being able to share information widespread, but also negative impacts by causing anxiety and fear amongst some people. 

The use of filters and editing on social media influences how individuals view health and has been linked to rising rates of anxiety, depression and poor social wellbeing.

Australia's national language is English, but as a multilingual country, language barriers can create inequities in accessing healthcare and education. Limited English proficiency can hinder individuals' ability to understand health information, make informed decisions and navigate the healthcare system.

In Aboriginal and Torres Strait Islander communities, preserving Indigenous languages is essential for holistic healthcare. These languages carry cultural knowledge and healing practices. Integrating Indigenous languages into healthcare services improves cultural competence and can foster trust between providers and patients.

Environmental factors, both natural and built, significantly affect individual and population health by influencing geographical location and access to resources.

Natural Environment 

The natural environment, including the atmosphere, land, water, and biodiversity, directly impacts food, water, and air quality. For example, living in arid areas limits access to fresh produce and social connections, requiring longer travel. Australia's population distribution reflects this, with most people living on the coast where regular rainfall, fertile soil and vegetation support better living conditions.

Exposure to fine particulate matter (PM2.5) and other air pollutants increases the risk of respiratory and cardiovascular diseases, especially in urban areas where pollution often exceeds national standards. Additionally, high UV radiation exposure leads to higher melanoma rates, contributing to 0.7% of Australia's disease burden in 2018. This highlights the importance of reducing emissions and improving air quality. (AIHW, 2022).

Further Reading

https://www.aihw.gov.au/reports/australias-health/natural-environment-and-health

https://www.aihw.gov.au/getmedia/c6c5dda9-4020-43b0-8ed6-a567cd660eaa/aihw-aus-241.pdf

The built environment refers to human-made surroundings, such as buildings, parks and infrastructure (e.g. transport, water and energy networks). It influences activity levels, access to fresh food, living and working spaces, contact with nature and opportunities for social interaction. For instance, people in areas with parks and well-connected footpaths are 2.5 times more likely to walk for over an hour each week. Quality transport infrastructure also improves access to employment and healthcare (AIHW, 2022).

https://www.aihw.gov.au/getmedia/c6c5dda9-4020-43b0-8ed6-a567cd660eaa/aihw-aus-241.pdf

Across Australia, people typically live near the coast and in urban areas, primarily due to better access to fresh water and the ability to grow food. As you move towards central Australia, the land becomes less hospitable, with deserts and grassy plains, drier conditions and fewer resources.

Geographic location is closely linked to remoteness, often classified as urban, rural or remote. Generally, the further from a major city, the more remote the area. The map below of NSW shows remoteness levels, with MM1 representing major cities and MM7 indicating very remote areas.

Urban areas offer better access to quality food, water and healthcare services; including hospitals, GPs, physiotherapists and alternative practitioners like naturopaths and acupuncturists. These areas also tend to have a more active social scene, leading to stronger social networks and community support, which often contribute to better health outcomes. Urban environments tend to suffer from poor air quality and higher heat levels due to the concentration of concrete and increased pollution from transport and intensive farming practices, contributing to global warming.

In contrast, rural and remote areas provide limited access to healthcare, fresh food and clean water. Residents often face challenges in accessing advanced health technologies and may need to leave their communities for medical care. For instance, pregnant women in remote areas are sometimes flown to hospitals near their due dates, removing them from their support networks which could increase the risk of poorer emotional health. Other examples include limited access to surgical facilities or online health information.

Data from AIHW (2022) shows that people in rural and remote areas experience higher rates of hospitalisation, death and injury with poorer access to primary healthcare compared to those in major cities. The table below highlights the disease burden by remoteness, with certain diseases showing a higher impact. This is often due to the cost of travel for healthcare and engagement in riskier behaviours. The lower burden of dementia in rural areas may be linked to their lower life expectancy compared to city residents.

Socioeconomic factors, such as education, income and employment greatly affect an individual's health. These factors influence housing, neighbourhood and access to resources like food and services. Adults in the lowest socioeconomic areas are 1.6 times more likely to be obese, 2 times more likely to have chronic obstructive pulmonary disease and 1.9 times more likely to have diabetes compared to those in the highest socioeconomic areas- highlighting the strong link between socioeconomic status and health outcomes (AIHW, 2024).

https://www.aihw.gov.au/reports/australias-health/health-across-socioeconomic-groups 

Education

People with higher education levels typically have better health outcomes, making more informed health decisions and focusing on disease prevention. They are more likely to quit smoking, exercise regularly and maintain healthy eating. In contrast, lower education levels often lead to limited job opportunities, lower income, reduced access to resources and lower health literacy; increasing the risk of obesity, diabetes and poor social support which in turn affects the health of the entire family.

Income

Income affects health by influencing access to healthcare, nutritious food and healthy living environments. Low-income individuals face greater risks of obesity, diabetes and mental health issues due to financial strain. In contrast, higher incomes allow for spending on health services, reducing stress and improving wellbeing. For example, higher-income families may have better access to services like dental care, physiotherapy, optometrists, fitness centres and sporting involvement. 

Employment

Unemployed or underemployed individuals may face financial stress, social isolation and limited access to healthcare. Certain jobs, like shift work or high-stress roles such as policing or paramedics, can also lead to poorer health outcomes. Jobs with harmful environments, like lifeguarding with UV exposure or demolition with high pollutant exposure can negatively impact health. In contrast, roles like personal training can positively impact health by providing access to spaces for regular physical activity thereby improving health outcomes.

Health behaviours are actions people take that impact their health and/or prevent illness. These actions are often lifestyle choices such as diet and physical activity, but also include seeking preventive health care, such as breast screening and vaccines and avoiding risky behaviours, such as speeding. Health behaviours play a significant role in determining an individual's overall health status and that of the entire population (AIHW, 2024).

https://www.aihw.gov.au/getmedia/c6c5dda9-4020-43b0-8ed6-a567cd660eaa/aihw-aus-241.pdf 

Physical activity is crucial for maintaining good health and preventing chronic diseases like obesity, diabetes and heart disease. According to AIHW (2024) 7 in 10 Australian adults do not meet recommended activity levels, which poses a significant health concern. Promoting regular physical activity can improve outcomes and reduce the burden of chronic diseases in Australia.

Excessive alcohol consumption, the 5th leading risk factor for disease in Australia contributes to liver disease, cardiovascular issues and mental health problems (AIFS, 2018). Alcohol is also the most common drug for which people seek treatment.

Other factors like sufficient sleep, stress management and safe sex practices also affect health, with issues such as mental illness, obesity, STIs and cardiovascular disease arising from poor habits. 

Personal biomedical factors are unique biological traits, such as age, sex, genetics and underlying health conditions, that influence an individual's health and disease risk. These factors significantly affect a person's health status, which in turn impacts Australia's overall health.

Measured biomedical factors include birth weight, body weight, blood pressure, cholesterol, glucose tolerance and immune status. Monitoring these can help predict both current and future health outcomes. Family history of diseases also helps identify genetic predispositions.

As the population ages, the risk of chronic diseases like cancer, cardiovascular disease and diabetes increases, placing a strain on the healthcare system, with these conditions being leading causes of death and illness in Australia (AIHW, 2024).

https://www.aihw.gov.au/getmedia/c6c5dda9-4020-43b0-8ed6-a567cd660eaa/aihw-aus-241.pdf 

Genetics can also influence an individual's risk of developing certain health conditions. For example, several genetic mutations increase the risk of breast and ovarian cancer such as mutations in the BRCA1 and BRCA2 genes. Genetic testing can help identify individuals who are at increased risk. This information can be used to develop personalised prevention and treatment plans (Cancer Council, 2018).

https://www.cancercouncil.com.au/podcasts/episode-9-genetic-tests-and-cancer/ 

Health determinants are interconnected, influencing each other in complex ways. Broad societal factors like political structures and public policies shape environments, including access to green spaces. Education and income levels improve health literacy and access to healthcare while also determining where people live, affecting their health, employment and education opportunities.

In rural and remote areas, lower income and education levels, along with high-risk jobs can lead to poorer health behaviours, such as excessive alcohol use. Relocating to a city often improves access to healthcare, social opportunities and employment- leading to better health outcomes.

There are some groups in Australia that experience marginalisation often with lower income and lower education levels. There has been a correlation between these factors and higher rates of domestic violence, drug and alcohol use and poor diet. 

The framework below shows the causal connections between the determinants of health and is an extension of the previous determinants of health frameworks developed by AIHW. Health behaviours is one of these determinants and there are many other sociological causes identified that lead a person to take risky health behaviours (AIHW, 2024). 

Source: https://www.aihw.gov.au/reports/australias-health/australias-health-2020-data-insights/summary 

Risky health behaviours are often influenced by multiple sociological factors and this is further intertwined with health disparities that exist amongst various socioeconomic groups in Australia. Risky health behaviours often have more complex sociological causes that extend beyond individual choice.

Broad Features of Society

The culture an individual grows up in strongly influences their health behaviours. If sports are valued individuals are more likely to participate, while cultures that normalise smoking and alcohol consumption increase the risk of engaging in such behaviours.

Society's values and affluence also play a role. In affluent communities where health education is mandatory, health literacy improves helping individuals make better health choices.

Social cohesion is another major factor in health. In low-cohesion areas, civil unrest or war can arise. While Australia is generally cohesive, certain groups remain marginalised. Many cultures in Australia, who have faced historical disempowerment; still experience higher incarceration rates, lower employment and poorer educational outcomes.

Environmental Factors

The environment often limits health choices, particularly in rural and remote areas. There are fewer GPs, longer travel distances for healthcare and limited diet options. With restricted access to fresh fruits and vegetables and higher costs, people may opt for processed foods and sugary drinks. Additionally, limited public transport and a lack of green spaces for exercise can lead to difficulty accessing health services and encourage a sedentary lifestyle.

Socioeconomic Factors

Socioeconomic factors like education, income and employment influence an individual's health choices. Low income can limit access to healthy food and social activities, while inadequate education may hinder awareness of risky health behaviours and restrict job opportunities. Certain jobs, especially physical labour in the sun carry higher risks of injury and skin cancer. Additionally, workplaces with cultures of substance abuse can encourage participation in harmful behaviours.

Health inequities in Australia affect socioeconomically disadvantaged groups, Aboriginal and Torres Strait Islander peoples, those in rural and remote areas, people with a disability and elderly people.

Socioeconomically disadvantaged groups

Socioeconomically disadvantaged people are more prone to negative health outcomes due to limited access to healthy food, safe housing and healthcare services like dental care and alternative therapies. They are 2.6 times more likely to die from chronic obstructive pulmonary disease, twice as likely to die from lung cancer, and experience a 2.4 times higher burden of disease for type 2 diabetes (AIHW, 2024).

https://www.aihw.gov.au/reports/australias-health/health-across-socioeconomic-groups

Socioeconomically disadvantaged groups often neglect their health needs due to financial hardship, making it crucial to address this inequality with targeted interventions. Bulk-billing services under Medicare help reduce financial barriers by ensuring access to GPs and other services. The government also supports these populations through investments in affordable housing and income assistance via Centrelink.

Indigenous Australians

Indigenous Australians face significant health inequalities compared to non-Indigenous Australians with higher rates of chronic diseases like diabetes, cardiovascular disease and kidney disease along with lower life expectancy (AIHW, 2024). 

Indigenous Australians living outside of urban areas experience a greater disease burden and shorter life expectancy due to disparities in education, employment, healthcare access and housing. These health disparities are rooted in historical and ongoing factors such as colonisation, dispossession and discrimination; which can contribute to limited access to services, poor living conditions and intergenerational trauma.

https://www.aihw.gov.au/reports/australias-health/indigenous-health-and-wellbeing

The government has responded to health inequities in various ways, including those affecting Indigenous Australians through initiatives like the 'Close the Gap' campaign. Developed in collaboration with Indigenous representatives, the campaign aims to reduce the health disparity between Indigenous and non-Indigenous Australians with targets supported by funding for healthcare services, education and employment. In addition to addressing health differences, healthcare professionals are now required to complete cultural training to improve communication and understanding of Indigenous cultural practices and approaches within the healthcare system.

Rural and remote populations

People living in rural and remote areas do not have the same access to healthcare services because of distance, limited infrastructure and shortages of healthcare professionals. These populations also have higher rates of cancer, injury and death from accidents and environmental hazards, such as drought (AIHW, 2024).

https://www.aihw.gov.au/reports/rural-remote-australians/rural-and-remote-health

Improving rural and remote Australians' health requires better access to healthcare services, which is challenging to fund and maintain. Telehealth helps bridge this gap by delivering care digitally, while programmes like the Rural Health Outreach Fund offer financial support for services and professionals. Long-term government investment is essential to enhance service accessibility in these areas.