Aboriginal Health Policy and Rural Health Alliance - Essay Example

?Week 2 – Rural Health Alliance Kevin Rudd – Labor Party leader who aimed to reform Australian health to end waiting lists, blame game -Rudd proposedthat the Commonwealth take over healthcare, with Canberra in control -After Rudd's election in 2007, new developments: National Health and Hospitals Reform Commission (NHHRC), a National Primary Healthcare Strategy, a Preventative Health Task-force, and a National Preventative Health Strategy -NHHRC was given terms of reference by the Council of Australian Governments (COAG), and expected to fulfill the Australian Health Care Agreements (AHCA) -AHCAs were under debate due to disagreement over how much federal funding should be provided to assist states with public hospitals -Restructure in the system was hoped to improve quality, clarity, effectiveness, and accountability -New agreements require reports on performance in exchange for increased funding -Hoped to solve problems of preventable diseases, gap in life expectancy between indigenous and non-indigenous people, and wait times -NHHRC released a June 2009 final report on health care—proposed that the Commonwealth Government assume full responsibility for funding of primary health care Nicola Roxon – Minister for Health and Ageing who reports directly to the Prime Minister Ten Key Elements of a future Australian health system: 1. Accessible, affordable care that is timely, appropriate to culture 2. Informative 3. Focused on preventative care 4. Continuous care for those with ongoing conditions 5. Safe, high quality care that always improves 6. Better management of health information 7. Flexibility in responding to needs of community 8. Excellent working environments 9. Quality education and training 10. Cost-effective and fiscally sustainable system National Health Care Strategy draft featured 4 priorities: 1. Improving access and reducing inequity 2. Better management of chronic conditions 3. Increasing the focus on prevention 4. Improving quality, safety, performance, and accountability -Preventative Health Task-force: required to provide evidence and advice on framework for Preventative Health Partnerships, a three year work program, a National Preventative Health Strategy, advice on other matters from the Ministry of Health and Ageing – also focuses on drug, alcohol, and tobacco related health as a focus -Overall goals of the health reform: end obesity problem, minimize daily smoking below 9%, reduce prevalence of harmful drinking, close the life expectancy gap between natives and non-natives Week 3 – Aboriginal Health Policy -Data survey is presented—collected from 72 interview from the indigenous population in the North Territories, and their health providers -Known issue: culturally sensitive health care is not often available -This study affirms importance of having Aboriginal health workers -Health services need to relate to indigenous beliefs and practices -Health care models that succeed put aboriginal families in the center, in control -Research asked: What system exists? What works? What is needed still? -Interviews included patients, carer, Aboriginal Health Workers, health care workers, and interpreters -”balanda” -word referring to non-indigenous people, from “Hollander” -Aboriginal people have an honest fear of white people, of language barrier in medical care -They are frightened by medical technology and Western medicine -They believe that white medical professionals and Western medicine doesn't care about them -They see Western medicine as failing to respect their own culture of healing, where a medical expert must be recognized as part of tradition (called ownership of knowledge) -Aboriginal medical workers speak the native language and understand their own people better, and thus are preferred -It is important to recognize body language of patients, which non-aboriginal workers fail to do -overall, cross-cultural understanding and being a mediator between 2 cultures is key -Empowerment of aboriginal people as health workers is necessary for improvement -There is concern with cultural issues such as leaving work for funerals—workers may not come back for a week and demand flexibility in their leave time -Aboriginals want more regular workers, not some that come and go quickly from one job to another -There is a need for networking and encouraging aboriginal people to attend clinics, because many never even have set foot in one -Aboriginals working in a clinical role can alienate them from the community, because they are supposed to serve in a support role more importantly for the sick and dying Week 4 – Mental Health Policy -A study was conducted in Canada that observed the perspectives of children living with a parent with a mental illness -Many parents, when treated in a hospital or clinic, are expected to quickly return to normal life and continuing parents their children -Most mothers with mental illness have at least one child living with them; fathers have not been well studied -Symbolic interactionism is studied here, a term that means the connection between shared meanings (symbols) and interaction between parents and children -Parents studied were being treated for schizophrenia, bipolar disorder, or depression -Two basic social psychological processes (BSPPs) were conducted: (1) finding the rhythm, where children found a way to manage with day to day life with their parent, and (2) maintaining the frame, where children created a safe distance in their relationships to their parent -Children were found to have higher emotional currents during times of instability of the parents' illnesses -Some children felt anger and confusion, and thus had difficulty find the rhythm and maintaining the frame -Children tried to fit in by meeting the external social expectations—which they see as challenging to them and their family -Exacerbations of the mental illness led to difficulty for children finding the rhythm, and thus created difficulty in allowing the child to connect with the parents -Stages associated with finding the rhythm: (1) monitoring (children observe the parent for unusual patterns of behavior, either struggling to make sense due to ignorance of the issue or understanding due to knowledge); (2) adjusting (children act in a way that does not draw out symptoms of their parents illness and maintains connection) -Stages associated with maintaining the frame: (1) Preserving myself (children develop lives of their own while keeping a connection); (2) Getting away (children physically or mentally leave the scene to focus on other things); (3) Living my life (children take control and pursue their own interests, trying to be less responsible for the parent); (4) Selective sharing (Children share intimate information with trusted people—friends, parents themselves, teachers, relatives, counselors); (5) Flying solo (children with limited parental resources solve problems on their own, feel responsible for themselves); (6) Opting Out (children stop investing more energy in their relationship with the parent, and try to move on to independence) -Children would often gauge the cost and benefits of maintaining the frame -The first method of this was comparing the past to the present, to see if their life and family life was better or worse than before as far as happiness and stability -The next method was comparing past illness with present status of the parent, where they became optimistic or pessimistic depending if the parent was improving or deteriorating -Next was comparing self to others, where children find positive and negative differences between them and their peers—perhaps they struggle more with friendships, or feel unique and more able -Next was comparing parents and family to others, where children gauged material wealth, support, stability, and fun versus other children and families -Children experienced strong emotional currents, depending on highs and lows of the parents with an illness -Children were feeling best when the parent was positive, but worst when they had to deal with emotions alone -It is recommended that nurses work to emphasize the positive ways children develop to maintain a relationship with their parents, and that family members all be educated and given information about what resources they may access -Shorter hospitalizations and community care leaves families with few resources, and holistic services for children and their families would help improve relationships Week 5 – Aged Care and Health Policy -”social death” – essentially where a person is hopelessly ill, and considered lost although still biologically alive -In this situation, health providers fail to give the same treatment and interaction they would give a normal patient -discussion follows of biological vs. social death—how societies hold ceremonies of grieving after the actual death of a person, usually in Western society where we recognize death as immediate while other cultures may see it as gradual -Which comes first? Social death or biological? In some societies someone is socially dead when it is known they are dying, they may be even buried alive or left to die -There are three major groups of people today who may be considered socially dead -1. Lengthy Fatal Illness – people often die in hospitals or clinics today, and at a slow rate while under medical care, leading to anticipatory grief among relatives who begin to move on before the biological death -2. Very old people – natural or appropriate death, where people today are living to be much older than before, and are placed in a different part of society for the latter part of their life. Relatives may anticipate a very old person's death for many years, and treat them as socially dead -3. Loss of Personhood – patients in a vegetative state with no awareness of their condition may be treated as socially dead. This is not always true, depending on the attention that relatives give to this person despite their condition. Care for these people can be largely custodial, and when death occurs biologically it is uneventful and not as powerful as social death—a patient's ability to recognize others is the line drawn for loss of personhood -Dementia can fall into all three categories, where it happens over a slow amount of time, or at an old age, and can lead to the loss of personhood—essentially a slow death in life, as in Alzheimers -Interviews were conducted in a study of elderly people experiencing dementia, to see if relatives had begun seeing them as socially dead -Questions measured the current state of social relationships with the patient, based on emotion, humor, arguments, and other interaction -Four categories of responses were found, among relatives and carers: 1. Respondents believing/behaving as if the sufferer were socially dead (~1/3) 2. Respondents who believed but didn't behave like the sufferer was socially dead (~1/5) 3. Respondents neither believing nor behaving as if the sufferer is socially dead (~1/3) 4. Respondents not believing but behaving as if sufferer is socially dead (4 of 95) -Overall, very few cases showed any extremely detached treatment of sufferers, as people either used emotional interaction as a reason to keep behaving or believing, or else continued compassionate treatment out of force of habit. If the respondents were in category #1, they often saw no signs that the sufferer had value left in life and that they were aware of their surroundings Week 6 – Disability Policy -study was conducted on patients with cerebral palsy and Complex Communications Needs (CCN) -effective communication between nurses and patients is critical to quality of patient care -ineffective communication, on purpose or accident, can have negative health effects -nurses need more training on communication with developmental disability/CCN patients -Nurses often have great difficulty communicating with patients who can't speak and the patients rely mostly on family members for help -People with cerebral palsy are more likely to develop physical problems, and lack speech, and thus may be frequent hospital visitors who experience discomfort and difficulty in getting care -All ten surveyed people with cerebral palsy indicated they had some difficulty communicating with nurses, but could understand what nurses said to them -patients tried many methods of communication with little result -All reported that without speech and alternate communication methods, they would have no communication with nurses and none of them received support from the hospital in making communication easier -Communication barriers: 1. no method to communicate 2. no opportunity to communicate 3. nurses did not understand communication attempts 4. nurses did not respond -Consequences of poor communication included difficulty in explaining methods for comfort positioning, in participating in self-diagnosis, and in gaining access to necessary assistance -patients found they were paid less attention to, were ignored, and were misunderstood -The two main problems overall were nurses not being familiar with communication support needs and lacking access of familiarity with alternative communication methods -It is suggested that nurses receive more training in this area, and also take more time to simply listen and attempt to communicate -Nurses need to be more aware of the traits of cerebral palsy and CNN, as well as familiar with alternative communication, and finally must be trained to be proactive in encouraging more proficient ways to communicate as well as be called to attention by patients Week 7 -Terms: Social Determinants of Health (SDH), Emergency Department (ED) -In investigating frequent visits to ED, study tries to find how SDH affects frequency -Power factors mediating health: employment policy, income/taxation policy, occupation, social class, education, universal health care/market model, housing policy, ethnic or gender discrimination -Power factors can influence intermediary determinants, including: health access (transport, social support), social position, biological/behavioral factors, psychosocial factors, environment or employment risks, socioeconomic level, and housing stress -More frequent visitors may have these characteristics: Private dwelling No internet Employed as labourer People aged over 15 years with no post-school qualification People with an annual income between $13,000- $20,799 Renting from the Federal government or community organisation Unemployed One parent families Paying less than $120 rent per week Aged under 70 years with long term health condition or disability needing assistance Of Aboriginal or Torres Strait Islander origin Private dwelling requiring one or more bedrooms Aged over 15 years and has been separated or divorced Employed as a machine operator or driver Over 15 years and did not go to school Employed in low skill community work or personal service work Does not speak English -Stats were measured using SEIFA (Social Economic Index For Areas) and IRSD (Index of Relative Socioeconomic Disadvantage) by zip code -For people in the lowest SEIFA, they often had farther distances to hospitals, had lack of services offered, lack of knowledge about services, and children with specific needs -There was also a pattern of long wait times, no after hours services, and some people don't go to a general practitioner—instead straight to a hospital depending on urgency and hour of day -overall problem of the triage order, of lack of services, of distances to hospitals, of service hours, and of structure of services Week 8: Systematic Literature Reviews -Four types of literature reviews: Annotated bibliography, Literature reviews/narrative review, systematic literature reviews, Meta analysis -Annotated bibliographies feature a brief outline of each article under the source information, gives reader an overview of the sources -Literature reviews give an outline of the field of research, summarizing relevant articles in one synthesized piece of writing rather than in a list—it gives an account of the field, a background of the research, a framework for analysis, and a review of debate -Systematic literature reviews were invented in the field of medicine and provide the reader with all the evidence on a topic to date and is based on empirical research—it includes evidence based medicine (EBM), evidence based education (EBH), and evidence based health care (EBHC) -Archie Cochran’s book Effectiveness and Efficiency in 1972 helped develop the EBM field and was based on treatment of prisoners of war by the British government in WW2—it argued for better effectiveness of treatments and better efficiency in healthcare costs -the Dartmouth Atlas of Health by John Wennberg, an American, also contributed by showing that surgery was a supply driven system, based on inequality of service provisions, physician practice styles and huge variation in medical knowledge—not based on evidence -A third influence is acceleration of technology that has allowed speedy and readily available knowledge of the thousands of publications of medical research that is now available -Finally, there is an increasing consumer education and knowledge about health care- accelerated by the Internet. For this reason the Australian government has made EBM or the Cochran data base to all Australians -Thanks to Cochran, there now exists what is called Randomised Controlled Trials—gold standard of reliability and validity in researc -RCTs called for more peer review and evaluation of clinical trials and are quantitative, comparative, controlled experiments in which investigators study two or more interventions in a series of individuals who receive them in random order -Five levels of evidence: Level 1 (based on systematic review and randomized controlled trials), Level 2 (based on smaller controlled trials to show statistically insignificant or no trends), Level 3 (based on non-randomized, controlled or cohort studies, case series, case controlled studies or cross-sectional studies), Level 4 (based on the opinion of authorities of expert committees), Level 5 (opinion of individuals who have written and review guidelines based on experience, knowledge, and discussion) -Finally, a meta analysis is where the results of a number of studies are brought together and collated—in EBM a meta analysis is where there theory matches across a number of studies Week 9 – Physical Activity and Obesity Policy -This case examines arguments for subsidy of artificially sweetened beverages (ASBs) or diet drinks, called a slim subsidy -is an alternative to the fat tax, on foods that may lead to obesity such as sugar sweetened beverages (SSBs) -Subsidy of ASBs is regressive, not progressive like tax on SSBs -ASB subsidy will make it cheaper to get low energy drinks, without unnecessarily raising expenses on sometimes needed SSBs -There is debate on whether food should be taxed differently from other goods or the same—some argue its not an issue, while others see low food taxes as having a positive benefit for poor families that spend more of their income on food -Few economists support distinction on good and bad foods when being taxed -Australian taxes processed foods but not fresh foods -All foods arguably are good in moderation, bad in excess, so the tax may be unfounded -Argument is that SSBs often account for most obesity in adolescents, and a thin subsidy could lead to lower caloric intake and thus weight loss in this group -Research suggests that (1) taxes on SSBs may be regressive and (2) taxes or subsidies need to be aggressive to work -In the US people of lower socioeconomic status spend more on SSBs and calories overall -The study recommends that policy makers look at one of two options: (1) a subsidy on ASBs or (2) both a fat tax on SSBs and a thin subsidy on ASBs, so the tax funds the subsidy -A second unrelated article examines how children perceive boundaries for where to play, and examines the difference between rural and urban children ages 8-10 -It studied a rural school on Kangaroo Island as well as a school in Adelaide -Children took photographs of where they played, who they played with, and what they played -Urban children revolve around gardens, parks, playgrounds, and organized activities -Rural children play in large open spaces and nature -Urban children listed dangers as factories and other structures -Rural children listed dangers as wild animals and water -Urban children were more quick to accept boundaries laid out for them, while rural children would roam larger spaces while still depending on adult transportation as a check -The conclusion is that children actively shape and construct their own boundaries -Another conclusion is that context must be considered in sociological studies, as the environments can be different -Community policies to expand, build, or preserve spaces for youth to play cannot be determined by an across the board policy, but must instead use local recommendations that fit local needs Week 10: Drug Policy -Research suggests strongly that increasing alcohol prices reduces consumption and alcohol related problems -Australia's excise tax on ready to drink (RTD) alcoholic spirits is an example of such an effort to reduce consumption—called the “alcopops tax” -Stats show that after taxes have come into effect, overall sales of packaged alcohol as well as youth consumption has dropped -It is suggested that this leads to a public health benefit, though it is not known in exactly which area or demographic -Another author suggests that cannabis is the drug of choice for young people -The burden of managing cannabis abuse falls on the family, often the mother -This study sought to gain insight into effects of adolescent drug use on family life, and specifically on mothers -Findings show that an adolescent drug problem is extremely disruptive on family life -Among adolescents that developed a pattern of drug abuse, all were boys -Mothers notice the problem when boys are 15-16, and that it develops in a school related environment -Participants responded to awareness by becoming more vigilant of their son's activities -Participants felt they had to be home and supervising children more often -Child behavior becomes menacing, aggressive, irritable, belligerent, and unpredictable -Participants experienced verbal and physical abused as well as threats from the child's associates -It was noticed that boys lost interest in things, their grades dropped, and motivation dropped -Children became upset when they realized that low performance led to diminishing options for achieving goals and education -Mothers described children “stealing and dealing” commonly, and having police contact often -The mothers were terrified by the thought of their child going to prison, more than anything -Observing criminal patterns as well as depression and anxiety problems led mothers to reprioritize their goals for their children and make a different but loving relationship -Overall this shows the difficulties mothers face when their child has a drug problem, but also how they maintain their compassion and determination to be a good mother -Not all support solutions are available to all families, though forms of counseling, therapy, and advice do exist -It is suggested that women's health practices include questions about mothers' relationships with their children -This would lead to a more accurate picture of stress and anxiety that many women face -Overall, school nurses are in a position to help with children, and women's health nurses with mothers, in reducing the negative impact of drug-use lifestyles on family life Week 11: Sexual Health Policy -This article discusses how language indicates what is socially normal and acceptable -Modern views show that gender and sexuality are two different things -gender is based on the body, which has a sex -sexuality is fluid and based on culture and other contingencies -The study investigates how Australian men indicate expectations for male behavior through language and humor -Humor is used in this case to be a successful heterosexual male and mark boundaries from homosexuality -There is a use of “othering”, where groups denigrate another gender, race, or group to make humor -The study found many different approaches, instances, and methods of humor: Humor in media to communicate norms of masculinity—use of jokes that establish real and failed masculinity, the latter being akin to homosexuality Humor in the creation of schoolyard masculinity—boys use sexual humor to show adherence to group norms, such as masculinity or mocking of education, more academic students, and also for flirting Policing behaviors from acceptable male behavior and bodies—sexual humor is used to humiliate and ridicule those who stand apart from the group in their behavior or appearance, or even backgrounds Your reaction determines your fate—a boy's reaction determined if he would rise in the pecking order, and whether or not the teasing would continue or intensify; the joke was ideally deflected back at the instigator or onto a socially weak male Policing space, behavior and thought—humor is used to keep gay men at a distance and to ensure that straight men laugh at jokes and do not find themselves aligned with gay men Know thy friends—men in groups alone will express increased masculinity and harsher humor that is homophobic and sexist The antithesis of laughing: crying—laughing is expected, but crying leads to derision by other males and would make someone a subject of jokes Just a joke or orchestrated cruelty?--it is difficult to measure what is acceptable, as humor can use varied intensity, frequency, and targeting that is considered more offensive by some than others, also it may offend the target but no one else -Overall the study finds that homophobia can shape a variety of behaviors in all men -There is concern that the pressure of being hyper-masculine can pose health risks, physically and mentally -Men can be pushed into health-compromising behaviors in order to prove masculinity, avoid jokes -Second article on sex education and whether it has a result on lowering pregnancy -Teenage pregnancy brings economic and social disadvantage -One study found that girls are less likely to be pregnant nor sexually active if given intensive education about overall youth development—sports, careers, sex education, and more -school based education is the most effective way to reach children before they are sexually active -Since the advent of HIV in the 1980s, much more focus has been put on STD control -these programs aim to (1) minimize pregnancy and (2) minimize STD transmission -Abstinence-only programs fail to delay becoming sexually active and may give higher risk of not using birth control -Pregnancy still is highest in communities that have poor access to education and support -the authors believe there is no clear solution to the high pregnancy problem in highly developed countries -The study suggests that young people need to learn to: make sound sex and relationship decisions use negotiation and refusal skills against sex recognition risky situations that may become violent know where and how to find support and help know how to conduct safe, protected sex -There has no been a national acceptance of a sex education framework, which has been beneficial -What is still required is universal sex education for all young people Week 12: Interprofessional Policy -Occupational therapists plan therapy interventions in order to help Australian schoolchildren achieve their full educational potential -Therapists at Flinders see children ages 5 to 18 for a variety of reasons, including handwriting, paper based games, and sports occupations -These therapists then write a report for both the parents and the school, reports that make recommendations for individual developmental needs -The following study was conducted to assess how teachers rated the usefulness of the reports written by occupational therapists, who weren't sure of their reports' reception -Four themes emerged from the responses of the teachers, who were all at different schools in South Australia -(1) Reports were “Understandable but not always useful” - could be improve with more cooperation and collaboration between therapists, teachers, and students beforehand -(2) “Its important, we can't do it all” - Teachers felt that the reports helped fill in a knowledge gap about meeting students' needs and addressing behavioral problems -(3) “We never actually speak” - The teachers' perspectives would be useful to the therapist in writing the report, because therapists don't have knowledge of a classroom setting -(4) “It's probably impossible but... in an ideal world” - suggestions included having the therapist deliver the report in person, having a follow up for teachers after receiving the report, having occupational therapy follow up for parents, and actually having occupational therapists employed at the school -The study recommends that teachers and therapists learn more about one another's profession, as well as seek closer collaboration in these interventions and reports -Second article is on shifting care from the hospital to the home -Developed countries are facing growing health care costs due to a growing ageing population -There is a shift toward Rehabilitation in the Home (RITH) to cut costs for ageing people -2 types of RITH: bed substitution (replaces hospital rehabilitation) and ambulatory (aims to complement inpatient care) -The authors argue that care responsibility is shifting with RITH from paid to unpaid carers -These unpaid carers go unrecognized and have little say in care-planning policy decisions -24 of these carers were interviewed to answer the question: how is the role of the carer constructed in RITH programs? -Carers were question around the following five themes: -(1) Assumption of care – many reported that they came to be the primary carer somewhat involuntarily, as patients were allowed to be checked out of hospitals without ensuring they had care -(2) Work of caring – carers were expected to help with domestic activities of the patient and ensure the patient's safety—they described doing just this, for as much as 24 hours a day -(3) Confusion and lack of consultation about discharge – carers were somewhat cynical about discharge being in the client's best interests, thought it may have been rushed, and did not feel that they were consulted about RITH as the carer -(4) Lack of reimbursement and recognition – carers often did not know about what pay and benefits they could receive, and were upset that their efforts were not recognized for compensation -(5) Support to carers – carers expressed appreciation for family, community, and professional support but also were confused or frustrated about lack of information and consultation on getting medical support at times -both carers and medical staff perceived that RITH meant a high level of work and responsibility -both also saw a problem with information and consultation between one another -Overall, RITH is a new environment that involves both medical professionals and the home-based individuals -Home-based carers are central in the working position but peripheral for decision making -Recommendations (1) These carers are disenfranchised and need to be given reciprocal rights in a written agreement outlining expectations, and information about services available and (2) carers need to be formally incorporated into case management processes and (3) future research should look into cost-effectiveness for RITH and assess the overall costs to the carer Read More