S.TRUEMAN PhD THESIS 2016

13

Shepherd, Li, Mitrou & Zubrick, 2012; Shepherd, Li & Zubrick, 2012; Zubrick et al., 2005). Having considered the demographics of the remote population the next step was to examine the contextual factors of living remotely and how these factors impact and contribute to the general health disadvantage and status of remote communities (Smith, Humphreys & Wilson, 2008; Dixon & Welsch, 2000). This examination utilised social determinants of health which are a combination of material, environmental, social and psychosocial factors and conditions of life (Marmot & Wilkinson, 2006). These factors extend to income, employment, occupation, poverty, housing, education, access to community resources, and demographic factors such as gender, age and ethnicity (Commonwealth Department of Health and Aged Care, 2000). Importantly, most determinants do not occur in isolation, and many have cumulative effects over the lifespan (Zubrick, Holland, Kelly, Calma & Walker, 2014). There are strong correlations between serious mental illness and high unemployment, poor nutrition, over-crowded housing, economic disadvantage, low social capital, racism, chaos, stress (particularly early in life), marginalisation and low rates of education in communities; notably, these features often characterise Aboriginal and Torres Strait Islander remote communities (Carson, Dunbar, Chenhall & Bailie, 2007; Marmot, 2011; Marmot & Wilkinson, 2006; Susser, 2006). Throughout the research process, the researcher maintained awareness and cultural sensitivity to these issues, particularly when making health comparisons between communities with different remoteness classifications, developing the major findings (Chapter 9) and formulating the recommendations (Chapter 10).