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 older, that affect a wide range of health, functioning, and quality-of-life outcomes and risks.

The SDOD, also called the social determinants of health or the social determinants of crime, are contributing to widening disparities of life outcomes across different groups and increasing inequality in Australia.

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 life expectancy relative to people who do have access to healthy foods. 

Simply telling people to eat more healthily doesn't eliminate the disparity in health outcomes because many people do not have the option to do this, regardless of any motivation or need.

This is when governments, NGOs and other community partners in sectors like education, social services, transport, justice and housing need to work together to coordinate actions to improve the conditions in which people are living to enable them to exercise real choices.

The social determinants of disadvantage have widespread impacts across multiple parts of the community from educational participation and attainment, engagement with the criminal justice system, the likelihood of being unemployed and rates of community safety.

To address the SDOD requires a strategic focus on equity rather than equality. Equality means each  individual or group of people is given the same resources or opportunities. Equity recognises that each person has different circumstances and that we need to apply different resources and approaches to achieve an equal outcome.

For example, a tomato in a high income area may cost $3 per kilogram, while the same tomato in a remote community may cost $30 a kilogram (because of transportation costs and the lack of a competitive grocery market).

An equality approach would tell us that as long as everyone has the opportunity to buy a tomato then everyone is equal, regardless of whether everyone has an equal capacity to pay.

An equity approach is different. Under this approach we look at the circumstances of individuals and groups and their ability to equally enjoy the same opportunities as others, such as buying a tomato.

By focussing on the root cause of inequity we can then begin to identify the factors that are holding communities back, or creating disadvantage, and then address the source of inequity more strategically.

For example, implementing freight subsidies may reduce the price of tomatoes in remote communities by lowering one of the factors that increase cost. Running a community cooking class might help members of a community to engage with nutrition and the value of preparing fresh food and how to do so.

Addressing the SDOD requires communities to be engaged in designing solutions, and for governments to coordinate responses around community-identified needs.

Collarenebri (Galariinbaraay) is a community of 634 people that falls in the highest quintile for relative socioeconomic disadvantage, economic resources and second highest area of disadvantage in the education and occupation index. 

While the 2021 Census records Aboriginal people as comprising 39% of the population, that figure is an under-estimate as many Aboriginal people resident in Collarenebri did not complete the Census reflecting concerns that government may use this information adversely to their interests. Anecdotally, Aboriginal people are estimated to be more than 50 percent of the population.

Collarenebri also has high rates of chronic disease, preventable illness, avoidable deaths and poor access to health services.

The project explores how a bottom-up approach to health planning, focussed on addressing the causes of poor health in local communities, may contribute to longer term improvements in health and a reduction in avoidable hospitalisation.