Healthy Country, Healthy People by Christopher - Article Example

ARTICLE REVIEW Name Institution Professor City and State Date: The following essay is a literature review of an article by (Christopher et al 2009) Healthy Country, healthy people: the relationship between Indigenous Health status and “caring for country”. The review will have a succinct portrayal of the purpose and content of the article and an analysis of the strength and weakness in the article. Description of how the article contributes to the general knowledge of the topic will also found in the essay. The article of healthy country, healthy people: the relationship between indigenous health status and caring for the country is a report written by Christopher in the year 2009. Summary The article of Healthy Country, healthy people: The relationship between Indigenous Health status and “caring for the country.” This is a report based on a research carried out to investigate the association between activities carried out by indigenous people, which they strongly belief, they promote quality health and the health results which are relevant to indigenous mortality and morbidity that is excess. The article report comprises of different parts that show how the research was carried out. An abstract exists, which shows the contents that are present in the report. In the abstract, the objective of the report is stated, the design, setting and participant in the research is also shown, the main outcomes of the research are briefly named results are presented and finally the conclusion of the report is briefly stated. The introduction talks about the indigenous people known to own the northern part of Australia, in addition to 85% of, the coastline. We are told through (The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples 2005) that their life expectancy is below normal Australian average. This is said to be attributed to the disease burden associated with malnutrition, inactivity, socio economic disadvantages and social disorders. Furthermore, 40% of the excess mortality of the indigenous people is because of cardiovascular disease and type 2 diabetes. (Australian Government National Institute of Governance, 2006) argue that although there is evidence suggesting that centralizing the indigenous service and population into township will lead to worse health, the article says that the pressure to do so is increasing. With depopulation of the remote area, ecological degradation has taken place due to less indigenous management of land. Weeds, wildfires, are damaging unchecked landscape and animals as the owners have located to other places. The article also provides the acknowledgement of the Indigenous health by the national strategic framework (National Aboriginal and Torres Strait Islander Health Council, 2004). For the Aboriginal people and Torres Strait Islander people, their health is not only the freedom of a person from sickness but also the support requirement of relationships between families, society, land, spirit and sea that is interdependent and healthy. According to the framework, the indigenous health of people must focus upon cultural, spiritual, social and emotional wellbeing, as well as their physical health. Additional literature review (National Aboriginal and Torres Strait Islander Health Council, 2004) shows that traditional owners of land have the objective of maintaining the links with their ancestral estates. They have also evolved in their program management of natural resource through innovation undertaken by both contemporary and customary ecological services, to take care of the country. Because of their activities, there are environment health gains, positive influence of health behaviors and social health determinants. The Final report of society discussions on the NHMRC road map October 2002: Canberra says that despite the fact that there is no systematic investigation that done on this area the demands of the indigenous shift their focus in health research to know what it is exactly that works. This is because the cultural and social determinants, resilience and health together with the awareness of effective interventions may arise outside the health sector. In the research, the participants were the indigenous people who ranged from the ages of 15 to 54 years. The method of selection was through an outreach program of the remote area of Arnhem Land community, which was for preventative health checks. Volunteers were recruited from different places such as homeland, workplaces, township residence and public places like outside community stores. Burgess et al. (2008) shows that measures were done through a collaboration of the remote Arnhem Land Township and the network homelands surroundings. They identified six main activities used in caring for the country. These were burning of annual grasses, protecting sacred areas, time on country, gathering of food and medical resources, ceremonies and artwork productions. Burgess et al. (2008, p. 26) says that participation of the activities was quantified by means of a questionnaire that was administered by interview on a format based on a four-point ordinal response. Since the questionnaires were validated systematically and rigorously in population, the accurate composite scale weighted was derived. Participant’s weight was recorded; height and circumference of waist was measured. From the measurement, their body mass index was derived. An automated sphygmomanometer was used to measure the blood pressure of the individuals. Blood was sampled as well as the collection of morning urine and serum samples collected were taken to an accredited laboratory. After evaluation of the medical records, type 2 diabetes was identified in the participants through their blood glucose level. The risk of a 10 year Coronary Heart disease was calculated in among participants aged 30 to 54 by the use of the Framingham equations. The risk of cardiovascular disease among the participants was estimated by using New Zealand Guidelines Groups together with participants medical history review (NZGG, 2003). A modified five-item version of the Kessler Psychological Distress Scale (K5) was used in measuring psychological distress. The method of collecting self- reporting data is said to be through the questionnaires that were interviewer administered. Christopher Burgess also tells us that in order to avoid the confounding of the association between caring for the country and health incomes, they controlled for residence in their analysis. The Charles Darwin University was responsible for approving the ethics of the study. In the statistical analysis section, we are informed that the participants were divided by where they resided, that is, homeland and township. They began analysis by the calculation of the correlation analysis of the person and product movement. They also investigated relationships that were multivariate among health behaviors and caring for the country by use of the analysis of regression in ordinal logistic and the backward stepwise logistics. Social demographic variables such as income, age, residence, education and sex together with health behaviors, which did not include consumption of bush food, the division of the weighted composite caring for country score scale by the inter-quartile range were included in the investigations. We are informed that predictors, which were of no significant were removed while re evaluating regression models. The association between caring for the country and the outcomes of the clinic were tested by the regression of the backward stepwise multivariate through the use of logistic regression in the case of binary outcomes; continuous outcomes used linear regression and logistic regression of ordinal were used for the cardiovascular disease risk. Significant clinical health behaviors like smoking, exercise, and alcohol consumption were included. In the analysis five women who were participants were excluded from the abdominal obesity model and BMI the reason being they were pregnant. There were three evaluation criteria for the outcome model of the clinic. The first was the clinical plausibility; second being the standardized residuals satisfactory diagnostic plot against the values for continuous variables that are fitted while the third was the Hosmer–Lemeshow goodness-of-fit statistic, which was satisfactory for binary outcomes. We are informed that all the statistics analysis was done using Stata software, version 9.2 (StataCorp, College Station, Tex, USA). From the result that was obtained, the residents of homeland were associated with a marginally significant income that is higher, less takeaway food consumption, lower attainment of education, more bush food consumption, frequent exercise and participation in caring for the country that was grater. From the coefficient relations we are showed that there is a significant association between a group’s health behaviors and socio demographic characteristics with clinical outcomes. For example, the greater the age of an individual the greater its correlation is with clinical outcomes. After adjusting residence place, socio demographic factors and health behaviors, there was an increase in inter-quartile range of the caring-for-country weighted composite score scale. This was because of there was a significant association with more consumption of bush food, more exercise that was done frequently and better health on clinical outcomes that is less abdominal obesity, lower BMI, less diabetes, lower HbA1c level, lower blood pressure, lower CVD risk, higher HDL cholesterol level, normal ACR and lower psychological distress. Here, the results revealed, caring for the country was not associated at all with smoking, consumption of more frequent takeaway or store food or alcohol consumption. The article report concludes that there was a substantial and significant association of caring for the country. The indigenous people as an activity that promotes health and clinical health outcomes relevant to mortality and morbidity that is excess in Arnhem Land community assert this. There were three implications that were provided from the findings; first from the results, there was the provision of preliminary empirical support for the demands of the indigenous people, which were longstanding for the investment of the government in activities that help the indigenous people in managing the country. The strategy elaborated will likely deliver ecological health benefits, possible human health gains through social, cultural and physical mechanisms, and a sustainable economic development. Secondly, the results of the findings suggested that there should be careful reconsideration of indigenous policies known to bring conflict and discourage the connection with the country as well as simultaneously promoting the indigenous management of natural resources. Garnett S et al. (2009, pp. 53-66) indicates that homelands adopt health promotion activities that are important in delivering both ecological and human health benefits. Thirdly, there are demonstrations of potential importance of the collaboration of engagement of the indigenous people activities in promoting good health through the identification of interventions that were appropriate in the tackling of intractable disadvantage in Australia’s remote places. After evaluating the article, the strength and weaknesses that are present can be identified. The weakness of the article is contributed by the study limitations. The study was unable to identify the direction of the association between the health outcomes and caring for the country even after the study identified possible pathways that were plausible from the literature of Burgess et al (2005, pp. 117-122). The findings of the study, therefore, are merited in order to elucidate the association’s causal direction. This does not provide a clear approach of how and exactly the directions of the associations. The volunteers who participated in the preventive health checks did not fully represent population morbidity terms. This was reflected in the study as there was a lower than expected prevalence that was cohort of the type 2 diabetes. In addition, the age structure of the sample people did not differ significantly from the census of the other researches carried out. This would results in almost the same results that were obtained. There is inaccuracy of the study. This is shown through the measure taken which were crude and relied mostly on the self-report. The assessment of nutrition is known to be nutritionally inaccurate. This may have led to misinformation where the results obtained showed that caring for country measure was robust and, in addition, it was validated by the use of test–retest validity, rigorous statistical analysis and respondent completion, which is proxy. Other weakness was the non-validation of the cardiovascular measure among the population. Although the researchers used The Framingham equations to estimate absolute risk of CHD in people, the technique is effective in only estimating the risk in people who are 30 years and older. This is known to underestimate the potential and identified risk. The New Zealand Guidelines Group’s CVD risk chart, which was used, underestimated the risks, as it requires all women and men who are the ages of 44 and younger to be allocated the similar and same age-specific risks. Although the results obtained were conservative estimates of risks, it does not provide the real risks that are associated. This may result in wrong information being given out. Finally, the article generalizes the findings that were obtained as other indigenous information and contexts were uncertain. This is because the researchers found diversity in the languages, culture expressions of the people and land tenure hence it was difficult to communicate. This meant that the article did not fully exhaust their field of study and hence more research and exploration was needed to be carried out in that sector. The article does not display only weakness but also other sectors exhibit strength. An area where this is found is the discussion part where the study used systematic validated and developed measures of the participation of the indigenous people. Here it has exhibited various significant and substantial associations of excess Indigenous mortality and morbidity with health outcomes that are relevant. The article also shows consistent findings of other reports on the better health outcomes for residents in homelands. In addition, it explains caring for a country for the associations from a view of point of the indigenous people. Caring for the country is defined as the participation of people in interrelated activities on traditional or aboriginal lands and seas with the purpose of promoting spiritual, ecological and human health. It is known to be a community driven movement that aims at long-term cultural, social, physical and an economic development that is stable in mostly the remote and rural locations. The movement also contributes simultaneously to the conservation of cultural and globally valued environmental assets. The strength of the study is indicated in the identification of a potential mechanism. This shows how improved health outcomes come about after they are associated with homelands residence. The article again exhibits statistically significant associations that exist between positive health outcomes and the participation in caring for country despite the fact that the sample was small. In addition, the findings that were none significant showed trends that were consistent with the researcher’s expectation. The research also contributes to the support of the preliminary empirical epidemiology, which shows that Indigenous assertion in caring for the country will bring health benefits through social, behavioral and cultural pathways. Lastly, the study has used rich literature review from different sources that contribute to the quality work, which is produced. For example, detailed results from the measurement are given, and the corresponding authors are identified. Reference List Brough, M., 2006. Archived speeches. Blueprint for action in Indigenous affairs. Indigenous Affairs Governance Series. Canberra: Australian Government National Institute of Governance. Burgess, C et al. 2008. Development and preliminary validation of the ‘Caring for Country’ questionnaire: measurement of an Indigenous Australian health determinant. International Journal Equity Health, 7(1), p. 26. Garnett T. et al., 2009. Healthy Country, healthy people: policy implications of links between Indigenous human health and environmental condition in tropical Australia. Australia Journal of Public Admin, 68(1), pp. 53-66. National Aboriginal and Torres Strait Islander Health Council, 2004. National strategic framework for Aboriginal and Torres Strait Islander health: context. Canberra: NATSIHC. New Zealand Guidelines Group, 2003. The assessment and management of cardiovascular risk. Evidence-based best practice guideline. Wellington: NZGG. Read More