Decomposing Indigenous life expectancy gap by risk factors: a life table analysis
ABSTRACT BACKGROUND: The estimated gap in life expectancy (LE) between Indigenous and non-Indigenous Australians was 12 years for men and 10 years for women, whereas the Northern Territory Indigenous LE gap was at least 50% greater than the national figures. This study aims to explain the Indigenous LE gap by common modifiable risk factors. METHODS: This study covered the period from 1986 to 2005. Unit record death data from the Northern Territory were used to assess the differences in LE at birth between the Indigenous and non-Indigenous populations by socioeconomic disadvantage, smoking, alcohol abuse, obesity, pollution, and intimate partner violence. The population attributable fractions were applied to estimate the numbers of deaths associated with the selected risks. The standard life table and cause decomposition technique was used to examine the individual and joint effects on health inequality. RESULTS: The findings from this study indicate that among the selected risk factors, socioeconomic disadvantage was the leading health risk and accounted for one-third to one-half of the Indigenous LE gap. A combination of all six selected risks explained over 60% of the Indigenous LE gap. CONCLUSIONS: Improving socioeconomic status, smoking cessation, and overweight reduction are critical to closing the Indigenous LE gap. This paper presents a useful way to explain the impact of risk factors of health inequalities, and suggests that reducing poverty should be placed squarely at the centre of the strategies to close the Indigenous LE gap.
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ABSTRACT: Over the period 1990–2010, the increase in life expectancy for males in New York City was 6.0 years greater than for males in the United States. The female relative gain was 3.9 years. Male relative gains were larger because of extremely rapid reductions in mortality from HIV/AIDS and homicide, declines that reflect effective municipal policies and programs. Declines in drug- and alcohol-related deaths also played a significant role in New York City's advance, but every major cause of death contributed to its relative improvement. By 2010, New York City had a life expectancy that was 1.9 years greater than that of the US. This difference is attributable to the high representation of immigrants in New York's population. Immigrants to New York City, and to the United States, have life expectancies that are among the highest in the world. The fact that 38 percent of New York's population consists of immigrants, compared to only 14 percent in the United States, accounts for New York's exceptional standing in life expectancy in 2010. In fact, US-born New Yorkers have a life expectancy below that of the United States itself.Population and Development Review 12/2013; 40(1). DOI:10.1111/j.1728-4457.2013.00648.x · 2.22 Impact Factor
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ABSTRACT: Executive Summary: What is the problem? Obesity rates are higher among Indigenous, compared to non-Indigenous, Australians, and this problem begins in early childhood. If this trend of increasing obesity among Indigenous children continues, there will be a corresponding negative impact on health, and the gap in life expectancy will widen, not close. Childhood is a critical life stage, and early intervention strategies can reap a lifetime of rewards. Childhood obesity prevention programs have predominantly targeted individual behaviours (such as physical inactivity and unhealthy diet) and have been unsuccessful to date. The approach needs to shift to addressing social and economic factors, rather than individual behaviours in isolation. Why is it relevant to policymakers? In February 2014, Prime Minister Tony Abbott acknowledged that progress against the Closing the Gap targets was disappointing and that a change of direction was needed. This should encompass a shift in focus away from individual factors and onto social and economic factors. As an example of relevance to state and territory policymakers, the ACT Chief Minister and Minister for Health Katy Gallagher has called for obesity prevention efforts to move beyond the health portfolio, towards a coordinated effort across all arms of government. This requires action on the food environment, schools, workplaces, urban planning and social inclusion. As part of her plan, Gallagher recently announced a ban on soft drinks in public schools in the ACT. What does the evidence say? To date, there has been a limited evidence base to guide the development of programs and policies for obesity prevention among Indigenous children. It has been recognised that social and economic factors are important, but empirical evidence is required to quantify the relative contribution of these factors and to work out which factors are the most important ones to target first. Data from the Longitudinal Study of Indigenous Children (LSIC), a national study managed by the Australian Government Department of Social Services, show that individual choices are strongly influenced by the broader context. In 2011, Indigenous children experiencing disadvantage at both the individual and the neighbourhood level consumed significantly more soft drink than more advantaged Indigenous children in the survey. Maternal education, housing stability, urbanisation and neighbourhood disadvantage are important factors affecting Indigenous children’s soft drink consumption, and therefore risk of obesity. What should policymakers do? If programs are to change the health behaviours and health outcomes of Indigenous children successfully, they must address social and economic factors—the context in which individual choices are made. Factors influencing obesity are not confined to the health portfolio; policy development should occur across portfolios including housing, education, employment, social welfare and community development. The broader benefits of such programs should be considered when weighing the cost. Research conducted at the National Centre for Social and Economic Modelling, University of Canberra, estimated that if Australia were to adopt the recommendations of the WHO Commission on Social Determinants of Health report "Closing the gap within a generation", half a million Australians could avoid suffering a chronic disease; 170,000 more Australians could enter the workforce (generating earnings of $8 billion); and $4 billion in redundant welfare support payments would be saved. The implications for the wellbeing of Indigenous Australians, and for health equity, have not been calculated, but are undoubtedly considerable.
- Drug and Alcohol Review 06/2014; 33(5). DOI:10.1111/dar.12159 · 1.55 Impact Factor