Unequal Health Outcomes for Indigenous Australians - Essay Example

The Philosophy and Practice of Cultural Proficiency Offers Solutions to Unequal Health Outcomes for Indigenous Australians Introduction Indigenous Australians are descendants of the original inhabitants of the Australian continent and islands close by (Hastings, 2006). They are differentiated as Aboriginal and Torres Strait Islanders, both together constituting about 2.7% of Australia’s population (QCOSS, 2009). Indigenous Australians are the least healthy as compared to the remaining Australian population, with lower life expectancy at birth, and greater burden of illness including higher rates of mortality, disability, and hospitalization (O’Connor-Fleming & Parker, 2001). Further, Australia’s Aborigines have suffered a terrible and brutal past whose effects will take several generations to overcome. They still struggle against discrimination in all areas including health and social care. Australia’s Aboriginal population teaches two contrasting truths: “the crucial significance of culture in people’s lives” (O’Hagan, 2001, p.93), and the cultural insensitivity among those in authority including health care professionals towards minority cultural groups. Thesis Statement: The purpose of this paper is to investigate how the philosophy and practice of cultural proficiency resolves unequal health outcomes among Indigenous Australians. Discussion According to the RACP (2004), the inequality in health status of indigenous populations in Australia is directly related to systemic discrimination. Health inequalities can be corrected only by achieving fundamental changes in the dominant Australian population’s behavior towards Aboriginal people. Ensuring equality in the indigenous groups is vital for the improvement of their health. Thus, “racist treatment should be recognised as a social determinant of health” (Larson et al, 2007, p.322), leading to inequalities in well-being and protection from diseases. (CSDH, 2008). Together, the conditions of daily life and the structural determinants consisting of distribution of power, income, goods and services, and the consequent unfairness in access to basic amenities such as health care are the major reasons for health inequities among indigenous groups (CSDH, 2008). Appropriate and adequate provisions are required for health care. For example, Kildea et al (2010) state that poor maternal and infant health outcomes can be improved for indigenous populations through an intensive, coordinated strategy to close the gap between the requirement and the provision of facilities to fulfill the requirement. Further, there is a lack of sensitivity to the crucial cultural philosophies and practices of the indigenous groups, with attempts to compel them into the mainstream population, while depriving them of access to basic amenities. Since the health outcomes of the indigenous population are considerably lower than that of the rest of Australia in all respects; the practice of cultural competency at all levels and areas including nursing, is essential for improving Aboriginals’ health (Kosoki-Lasaki et al 2009). Cultural Proficiency Improves the Quality of Nursing Care Cultural proficiency or cultural competence has been defined as “a set of congruent behaviors, attitudes and policies that come together in a system, agency or among professionals to work effectively in cross-cultural situations” (NHMRC, 2005, p.7). Cultural competence is not only awareness of cultural differences, but increasingly focuses on the capability of the health system to improve health and wellbeing by including culture into the delivery of health services. Besides the competency standards of the Australian Nursing and Midwifery Council (ANMC), nursing practice is also governed by a code of ethics and professional conduct. The ANMC’s revised code of ethics, 2008, includes nurses’ responsibility in the critical relationship between health and human rights, and the need for reconciliation between the indigenous groups and non-indigenous Australians. The code of ethics indicates physical, spiritual and cultural well-being as essential components of human rights as a whole. Therefore, nurses have a responsibility “to provide just, compassionate, culturally competent and culturally responsive care to every person requiring or receiving nursing care” (Daly et al, 2009, p.308). The government is obliged to fulfill all human rights such as those related to health care, and facilitate their equal accessibility to different population groups (Calma, 2006). Increased cultural competence in Australian nursing practice would improve the quality of nursing, since cultural diversity is an important feature of the Australian health system. Chenoweth et al (2006, p.34) reiterates that “cultural insensitivity in care practices” is detrimental to the health outcomes of indigenous people. The implementation of strategies to reverse this practice would promote culturally competent nursing care in which overseas qualified nurses can be included. Significantly, according to the philosophy of cultural proficiency, nurses should prioritize interpersonal relationships and develop respect for the health consumer’s value systems and way of life. This approach will help to protect indigenous people’s rights, and prevent the stereotyping of individuals from specific cultures. Qualified nurses from different cultures can assist this process extensively. It is essential that legislation includes training in cultural proficiency for the caring professions such as nursing, to improve health outcomes among the indigenous populations (O’Hagan, 2001). For a health care system to become culturally competent, it needs to value diversity for the benefits it brings to Australian society; and help health care professionals as well as clients to achieve optimal care and services adapting service delivery to reflect an understanding of the diversity between and within cultures. Further, the health care system should have the capacity for cultural self-assessment, be aware of the dynamics in the interaction of cultures, institutionalise cultural knowledge, and hold governments, health organisations and managers accountable for meeting the needs of all members of the communities it serves (RACP, 2004). On the other hand, according to Eckermann et al (2010, p.185), the concept of cultural safety “does not differentiate between generic and professional care”. It opposes the call for cultural proficiency. Cultural safety does not believe that nurses should be asked to discover the cultural dimensions of any culture other than their own. Significantly, the client’s experience of the care provided is considered to be the most important factor determining effective nursing care. Aboriginal Knowledge and Philosophy: Adapting to Nursing Practice Providers of nursing care need to respect the wisdom of indigenous people. Frequently, indigenous knowledge systems of traditional remedies from natural sources, and holistic health have been fragmented over time. However, they are being rediscovered, resulting in new remedies being developed for the modern diseases. Indigenous knowledge is also known as traditional or local knowledge. It forms a part of culture unique to a given location or indigenous group; and is an important part of the lives of poor people. From indigenous knowledge emerge community decisions on all aspects of life including human and animal health (Stephens et al, 2006). There are significant impacts on health care outcomes from Aboriginal Australians’ philosophical perspective, which differs from that of Europeans in several important ways. Aborigines view their own identity as a holistic oneness of being with nature, society, knowledge, values and spirituality, all of which form their extended identity. Further, they prefer concrete knowledge and contextuality; moreover, they have an intense sensitivity to shame. Based on these reasons, there is a need to recognise and incorporate philosophical differences in nursing practice with appropriate changes to treatment settings and methods. Thus, with flexibility, it would be possible to achieve improved health outcomes for indigenous populations (Morgan et al, 1997). Evidence-Based Nursing Practice Among Indigenous Populations The health care needs of remote tribal and rural populations are complex, such as those of the indigenous Australians, requiring an approach tailored to their specific needs. In order to implement evidence-based practice among indigenous populations, it is essential that an initial community assessment is carried out. Resources such as the Primary Health Care Research and Information Service in Australia provide information about initiatives being undertaken, to health care workers, clinicians, researchers as well as the indigenous population (Kent & McCormack, 2010). According to NHMRC (2005, p.4), it is essential to “recognise the need for a culturally competent evidence-base in health promotion and health service delivery, supported by research into cultural competence issues” and resulting in culturally competent monitoring and assessment. To ensure that the best available research evidence is used optimally in health care work, the common health issues and the factors related to the location of the population need to be taken into consideration. Acknowledging the diverse cultural environment, “two-way flow of relevant and respectful information between Aboriginal health organizations and researchers” (Kent & McCormack, 2010) has to be facilitated. Further, best practices need to be evaluated, and training and awareness of future researchers about appropriate knowledge-transfer practices, have to be improved. Conclusion This paper has investigated the ways in which the philosophy and practice of cultural proficiency in nursing resolves unequal health outcomes for indigenous Australians. The conditions of daily life of the Aborigines, and discrimination in all aspects of life, together with structural social determinants such as the distribution of power, result in health inequities among indigenous groups. The quality of nursing care would be greatly improved by incorporating cultural proficiency in nursing with knowledge of the cultural characteristics of the health care client. The importance of adapting Aboriginal knowledge and philosophy to nursing practice, and the opposing view of cultural safety focusing only on client’s experience of the care provided, have been determined. Future research needs to focus on evidence-based best practices to optimize indigenous health outcomes. References Calma, T. (2006). 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Binan Goonj: Bridging cultures in aboriginal health. Edition 3. Australia: Elsevier. Hastings, T. (2006). Indigenous Australians. Australia: Macmillan Education Publishers. Kent, B. & McCormack, B. (Eds.). (2010). Clinical context for evidence-based nursing practice. New York: John Wiley and Sons. Kildea, S., Kruske, S., Barclay, L. & Tracy, S. (2010). “Closing the gap: How maternity services can contribute to reducing poor maternal infant health outcomes for Aboriginal and Torres Strait islander women. Rural and Remote Health, 10(1383): pp.1-18. Retrieved on 10th September, 2010 from: http://www.rrh.org.au/home/defaultnew.asp Kosoko-Lasaki, S., Cook, C.T. & O’Brien, R.L. (2009). Cultural proficiency in addressing health disparities. Boston: Jones & Bartlett Learning. Larson, A., Gillies, M., Howard, P.J. & Coffin, J. (2007). It’s enough to make you sick: The impact of racism on the health of Aboriginal Australians. 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QCOSS’s (Queensland Council of Social Service) submission to the Queensland state budget process. Retrieved on 10th September, 2010 from: http://www.qcoss.org.au/upload/5004__3.%20Aboriginal%20and%20Torres%20Strait%20Islander%20Communities.pdf RACP (Royal Australasian College Physicians). (2004). An introduction to cultural competency. Royal Australasian College Physicians. Retrieved on 10th September, 2010 from: http://www.racp.edu.au/page/policy-and-advocacy/indigenous-health Stephens, C., Porter, J., Nettleton, C. & Willis, R. (2006). Disappearing, displaced, and undervalued: A call to action for indigenous health worldwide. Indigenous Health 4. The Lancet, 367: 2019-2028. Read More