Primary Health Care – Indigenous Australian Inequalities
Primary Health Care – Indigenous Australian Inequalities
Page 1 The World Health Organisation (World Health Organisation, 2008) states that the indigenous peoples of Australia are one of the most disadvantaged indigenous groups in the developed world. The health of the Indigenous population of Australia is an increasingly pressing issue. Current research and statistics reveals great inequality in many areas of health care and health status between the Aboriginal people and the general population of Australia.
Couzos and Murray (2008, p.29) report that the Indigenous population has “the worst health status of any identifiable group in Australia, and the poorest access to health systems. ” This paper will examine the underlying historical contexts and contributing factors that have lead to the current disparity between the health of the Indigenous Australians and non-Indigenous Australians. Furthermore, the high prevalence of chronic health issues such as diabetes will be analysed and community health initiatives that are needed or currently being enacted will be identified.
Many reasons for the current appalling state of health and wellbeing of the Australian Aboriginal people can be explained by examining their recent history to the devastating impacts of colonisation, genocidal policy, loss of land and years of oppression. These several hundred years of cultural destruction, dispossession and social and political upheaval have resulted in generations of trauma and grief (Burke, 2006, para. 4).
As reported by Forsyth (2007, p.35-36), government policies enacted towards the indigenous population in the early 20th Century were concerned primarily with protection and segregation, as the prevailing attitude of the time was that the Indigenous people were largely inferior and were unable to care for themselves. Forsyth continues to explain of the injustice created by the New South Wales parliament with the Aborigines Protection Act of 1909, in which “every aspect of their lives was governed, regulated and controlled” (Forsyth, 2007, p. 36).
Furthermore the Indigenous people of this era were not able to imbibe alcohol, own property, vote or cohabit with non-Indigenous people, and the state of their health was largely ignored due to the belief that they were a dying race. (Couzos et. Page 2 al. 2008, p. 3). Due to this essentially complete lack of health care, Forsyth describes the Aboriginal people of the era living on the outskirts of larger towns as suffering from high rates of blindness, infectious diseases, bone diseases and sexually transmitted infections (Forsyth, 2007, p.36).
The severity of these health issues was made worse by fear and distrust of the Aboriginal people towards hospitals and white people (Forsyth, 2007, p. 37). As the 20th Century progressed it became obvious that the Aboriginal population was not a soon to be extinct race as earlier thought, and new political policy calling for assimilation and integration reflected this change, though protectionist and segregationist policies remained influential or continued until the 1970s (Couzos et.al. 2008, p. 4).
In the 1960s attitudes of Australian society began to became more concerned for the wellbeing Indigenous people, with increased social conciousness and awareness spreading throughout the Western World. As a result of increasing political activity and demonstration, many Aboriginals were forced off stations in 1966, causing a large movement of Indigenous people to more urban areas such as Redfern (Couzos et. al. 2008, p. 7).
This sudden increase in numbers highlighted the need for proper health care and services, with the first Aboriginal health service established in 1971. Throughout the 1970s an increase in research and reporting of Aboriginal health resulted in many state and commonwealth reports all with the same conclusion, that the health status of Aboriginal communities was appalling and that there was great “need for increased priority, increased resourcing, better coordination, and increased Aboriginal community participation and control” (Couzos et. al. 2008, p. 10).
However very little action was taken until the 1990s2000s where relevant political policy was brought in and funding made available for Aboriginal health services, though they mostly remain inadequately funded and Aboriginal health care is still largely unrepresented and avoided by the Australian Government. The ongoing effects of racist and unjust political policy and action can in part explain current aspects of dysfunction and overall disadvantage that occurs in many Indigenous Page 3 communities today.
Specifically this disadvantage is evident in many areas of community life, with Indigenous people being generally exposed to more risk factors for poor health than other Australians (Thomson, MacRae, Burns, Catto, Debuyst, Krom, Midford, Potter, Ride, Stumpers and Urquhart, 2010, para. 49). Examples of risk factors include social factors such as dispossession, dislocation and discrimination, educational factors such as poor schooling, resulting in much lower literacy and numeracy skills, economic factors such as lower income and higher unemployment, access to good quality health care and GP’s, and physical environmental factors such as poor and overcrowded housing.
Together these disadvantages provide for a higher likelihood of poor lifestyle choices such as alcohol, tobacco and illicit drug use, a poor and unbalanced diet, obesity and a lack of regular exercise (Thomson et. al. 2010, para. 49, Couzos et. al. 2008, p. 79). Poor access to good quality health care is one of the key predictors for the prevalence of poor health in a community. There are very few GP’s available in remote locations, and as a result of no or little access to professional health care providers, these remote areas are susceptible to poor health awareness and knowledge.
As reported by Thomson et. al. (2010, para. 3), almost one-quarter of Indigenous people are classified as living in a remote area with very little access to goods and services or opportunities for social interaction. Couzos et. al. (2008, p. 18) also consider poor access to GP’s as shown by a 2000-2001 survey of GP’s. As reported, only 0. 8% of GP visits were by Indigenous people, though they make up 2. 6% of the general population. Furthermore, more than 70% of GP’s did not see a single Indigenous person during the survey period.
This under representation of the Indigenous population visiting GP’s indicates a clear need for increased access to professional health care, and is just one factor of many which demonstrates the need for improvement in the health and wellbeing of the Australian Indigenous people. Page 4 Diabetes is a chronic metabolic condition which can result in many major long term health complications such as stroke, kidney disease, blindness and greatly reduced life expectancy (Allman, 2008, p. 80, Zeng, 2006, p. 73).
Diabetes can be classified into three main types, with the second type, non-insulin-dependant diabetes mellitus (NIDDM) the main form developed as a result of lifestyle factors. As reported by Thomson et. al. (2010, para. 2), NIDDM is currently “one of the most important health problems for Indigenous populations across Australia”, with only around half of those with the condition know they have it, and the proportion of affected Indigenous population estimated to be around 4 four times that of the general population.
Couzos et. al. (2008, p. 525) expand that Aboriginal people are also significantly more likely to develop NIDDM at a much younger age, more likely to be hospitalised, and to die from associated complications. This over representation of diabetes in the Indigenous population is a result of their poor health status and education. Thomson et. al. (2010) report that many studies have linked high levels of obesity among Indigenous populations and high prevalence of NIDDM.
The main factors linked to this high levels of obesity are the relatively recent availability of highly processed and sugary Western foods and drinks including alcohol and tobacco use, impaired glucose tolerence, hypertriglyceridaemia, hypertension, hyperinsulinaemia and a higher level of physical inactivity than non-Indigenous people (Thomson et. al. 2010). Diabetes prevalence is also linked to a lower socioeconomic status, and as previously examined, a high proportion of the Indigenous population suffer from many areas of disadvantage, which results in a lower socioeconomic status.
As further explained by Thomson et. al. (2010) these effects are further aggravated by poor health promotion and knowledge, mental illness and stress, early emotional development and social status, and recent trends indicate increasing development and prevalence of NIDDM. Clearly the Aboriginal population is exposed to many risk factors for diabetes and other chronic conditions, and with increasing development trends, explains poor mortality rates and overall poor health status of their communities. Page 5.
Community based programs are essential for the improvement of Indigenous health due to the close-knit nature of their culture and often remote location. This was begun in 2003 at national level with the development of The National Strategic Framework for Aboriginal and Torres Strait Islander Health, which targeted strengthening of health service infrastructure, accessibility to health services, and health promotion, most importantly the importance of balanced nutrition and regular exercise (Couzos et. al. 2008, p.522, Insel, Ross, McMahon and Bernstein, 2010, p. 653).
Cribbes and Glaister (2007, p. 167) describe the importance of health promotion and awareness at the community level, with a focus on re-establishing more traditional food choices and encouraging traditional hunting skills. The traditional Indigenous diet is highly nutritious, being high in protein, low in fat and high in complex carbohydrates, and as considered by Cribbes et. al. (2007, p. 167) is an excellent way to protect against chronic conditions such as diabetes.
However the majority of remote Indigenous peoples obtain their food from local stores, thus initiatives such as the Remote Indigenous Stores and Takeaway Project were undertaken to establish minimum healthy eating standards and to educate store managers in nutrition. By empowering local store managers in this way, they are able to further educate the local schools and wider community in healthy eating (Cribbes. et. al. 2007, p. 167).
As reported by the Dragon and Anderson (2011, p.28), Close The Gap (CTP) is another national level campaign which has a carry on effect to the community level. CTP aims to resolve the disparity in life expectancy rates and health equality between Aboriginal Australians and the general population, and has been endorsed by federal and state governments. CTP focuses on management of chronic conditions such as diabetes and follow up care. Management and awareness of diabetes is an essential component of improving health standards, and as King (2001, p.147-155) explains, Aboriginal people with diabetes commonly avoid mainstream health services for their health care.
This mismanagement can lead to the development of diabetes related complications and greatly reduced quality Page 6 of life and life expectancy. On going strategies and studies identified the need for Aboriginal health workers to deliver community level care and health services for successful diabetes management (King, 2001). In conclusion, Aboriginal health standards have been of an appalling standard for many years due to racist policies, attitudes and in-humane treatment.
The damage done and denigration of their lives, families and cultures has only recently began to be repaired by collective efforts nation wide, with a unified goal of self and community-empowerment, improvement of quality of life and living standards. With the expansion and ongoing deliverance of community focused solutions, many risks for ill-health and chronic conditions can be greatly reduced and the health status disparity between Indigenous and non-Indigenous Australians can in the future be eliminated. Page 7 References: • Allman, T.
(2008) Genes & disease : diabetes. New York; Infobase Publishing. • Dragon, N. and Anderson, K. (2011). Indigenous health. Australian Nursing Journal, 19(2), 24-8. • Burke, S. (2006). Changing practices, changing paradigms: working effectively with Indigenous clients. Australian Psychological Society. Retrieved October, 5, 2011 from http://www. psychology. org. au/publications/inpsych/changing/ • Couzos, S. & Murray, R. (2008). Aboriginal primary health care: An evidence-based approach. South Melbourne; Oxford University Press. • Cribbes. M. and Glaister. K.
(2007). ‘It’s not easy’: caring for Aboriginal clients with diabetes in remote Australia. Contemporary Nurse, 25; 163-172. • Forsyth (2007). Telling stories: nurses, politics and aboriginal australians, circa 19001980s. Contemporary Nurse, 24(1), 33-44. Insel, P. , Ross, D. , McMahon, K. and Bernstein, M. (2010). Nutrition. Massachusetts; Jones and Bartless Publishers. • King, M. (2001). The diabetes health care of Aboriginal people in South Australia. Contemporary Nurse, 10(3,4), 147-155. Page 8 • Thomson N, MacRae A, Burns J, Catto M, Debuyst O, Krom I, Midford.
R, Potter C, Ride K, Stumpers S, Urquhart B (2010). Summary of Australian Indigenous health, 2010. Retrieved October. 6, 2011 from http://www. healthinfonet. ecu. edu. au/health-facts/summary • World Health Organization. (2008). Closing the Gap in a generation. Health equity through action on the social determinants of health. Commission on Social Determinants of Health Final Report. Retrieved October, 6, 2011 from http://www. who. int/social_determinants/thecommission/finalreport/en /index. html • Zeng, Y. (2006). Longer life and healthy aging. Philadelphia; Springer.
Subject: Indigenous Australians,
University/College: University of Arkansas System
Type of paper: Thesis/Dissertation Chapter
Date: 5 January 2017
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