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-a-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-a-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.

/pdf/socioeconomic-determinants-of-health-towards-a-national-52j6sbqrjm.pdf

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

Historical, cultural, political, and social influences on dietary patterns and nutrition in Australian Aboriginal children

BACKGROUND: Obesity in childhood and adolescence is associated with health problems, increases in cardiovascular disease (CVD) risk factors and a greater likelihood of becoming overweight as an adult. A description of the sociodemographic distribution of overweight and obesity among children and adolescents in the population may allow us to determine if health promotion resources should be differentially allocated to particular groups. METHODS: The New South Wales Schools Fitness and Physical Activity Survey, 1997 (n=5518) was a cross-sectional survey which measured height, weight, waist and hip girths and skinfold thicknesses of randomly selected New South Wales students in school years 4, 6, 8 and 10. Height and weight only were measured among Year 2 students. The mean ages of students in school years 2, 4, 6, 8 and 10 were 7.3 y, 9.3 y, 11.3 y, 13.3 y and 15.3 y, respectively. The values of body mass index (BMI), waist girth, waist-to-hip ratio (WHR) and sum of three skinfolds for students resident in urban and rural areas and in tertiles of socioeconomic status (SES) were compared. RESULTS: There were no differences on any of the anthropometric measures between urban and rural boys and girls, with the exception that WHR was higher among urban girls. Among boys, there were no differences between the SES tertiles on any of the measures. Among girls, each of the anthropometric measures (except sum of skinfolds) was inversely associated with SES, with body fatness tending to be lower in the high SES tertile, compared with the low and middle SES tertiles. None of the statistical interactions between school year and body fatness was significant, suggesting that the relationship is consistent from childhood to adolescence. CONCLUSION: On the basis of these results, we suggest that health promotion programs aimed at weight management among Australian girls of lower SES are not warranted. We recommend that health promotion programs emphasize regular physical activity, a healthy diet and acceptance of the normal range of body shapes.

Sociodemographic distribution of measures of body fatness among children and adolescents in New South Wales, Australia.

A controlled trial of health promotion programs in 11-year-olds using physical activity “enrichment” for higher risk children☆☆☆★★★♢

Social class may have an important influence on dietary intakes and health. Information on specific nutrient differences between children of high and low social classes may help explain health inequalities and identify target areas for nutrition education. In this study, energy and nutrient intakes were estimated in 136 7-8-year-olds, from a range of social backgrounds, using 7-day weighed inventories. A structured questionnaire was used to establish social class. Lower social class children had significantly lower daily intakes of many micronutrients, which nevertheless met dietary reference values, and a higher percentage energy from fat. In addition, lower social class children consumed less breakfast cereal, more full fat milk, were more likely to take school meals and received a greater proportion of energy and nutrients from snacks than higher social class children. Lower social class children were significantly shorter, but this association was independent of diet. The results suggest that lower social class children are a vulnerable group nutritionally. Nutrition education should focus on influencing the dietary patterns of lower social class children to favour a decrease in percentage energy from fat.

Relationships between social class, nutrient intake and dietary patterns in Edinburgh schoolchildren

Intakes of selected nutrients in year 7 Western Australian children: comparison between weekdays and weekend days and relationships with socio-economic status

D.A. Jenner

Papers

Intakes of selected nutrients in year 7 Western Australian children: comparison between weekdays and weekend days and relationships with socio-economic status