First do no harm

One’s socioeconomic position in society is linked to a number of psychological factors impacting on health including depression, psychosocial distress, individual and community level mastery, and disempowerment.

These factors are all interconnected. When people do not feel in control of their lives, there are a range of neuroendocrine responses - stress responses. Acute activation of our stress responses is important to our survival: “fight or flight”, activation of the immune system.

But chronic activation of our stress systems can be very counter-productive.

“Allostatic load” is the term used to define the cumulative biological “cost” of accommodating stresses. The greater the stress burden, the greater the cost.

There is a direct relationship between socioeconomic status and allostatic load.

Apart from the impact on mental health, excessive stimulation of these stress pathways (the so-called hypothalamic pituitary axis, or HPA axis) has direct impact on our physical health: high blood pressure; increased appetite - and a desire for sweet and fatty foods; weight gain, and central obesity; infertility; increased risk of stroke heart disease, diabetes and some cancers.

If that is not enough, there is also evidence that Low Birth Weight may be linked to over activity of the HPA (stress axis) in pregnant women. And LBW itself is linked with increased risk of central obesity, diabetes and cardiovascular disease in adult life.

In this way it is possible to link disempowerment and lack of mastery with depression and psychosocial distress which in turn activate biological pathways to the chronic diseases which are occurring in epidemic proportions in Indigenous populations across Australia.

Dr Alex Brown, an Indigenous doctor based in Alice Springs, talks about the “broken-hearted”. The accompanying social dysfunction is a symptom, not an underlying cause.

What are potential interventions?

Certainly not interventions that further impoverish and disempower communities and individuals, which is what the removal of CDEP and appointment of administrators to remote Aboriginal communities does. The people who would most appreciate “real jobs” are the Indigenous people living in those communities. Many of the CDEP positions really should be remunerated as “real jobs”: rubbish removal and “caring for country” through the ranger programs are just two obvious examples.

The blanket removal of half of the remaining welfare payments implies that no Indigenous adult in a remote community can manage money or look after their children responsibly. And while it is critical that children attend school, threatening parents with loss of welfare payments has meant that schools are having to deal with a large influx of students (many of whom have only attended school rarely if at all in the past) without the needed additional classrooms and remedial teachers.