Low socioeconomic status is linked to higher death and hospitalisation rates, as well as to lower self-rating of health. Recent death rates for young Aboriginal and Torres Strait Islanders are close to three times higher in males and twice as high in females compared with rates for non-Indigenous youth. High levels of mental disorders and substance abuse are major contributors at one level, but the fundamental causes are more likely to be found in social and economic conditions, the loss of cultural identity and the disaffection of youth in many of these communities. The report's findings will inevitably prompt questions about current health provision for young Australians. At present, young people's primary care attendances, for example, are mostly for relatively minor respiratory conditions, musculoskeletal problems or acne.
Health promotion has an even greater role.
Health problems cluster not only in particular groups but also in individuals. For example, the young regular tobacco user is more likely to engage in heavy alcohol consumption and illicit drug use, have poorer mental health and an overall less healthy lifestyle. The clustering can mostly be traced back to common determinants of health in family, community, school and developmental backgrounds. Recent North American research has emphasised the protective influence of family and school attachment on problems ranging from deliberate self-harm and emotional distress to tobacco and illicit substance use, violence and early sexual activity. 5 Such findings have been mirrored in recent Australian research.