Health Inequilty - Case Study Example

Health Inequality Student’s Name Course: Tutor’s Name: Date: Introduction In Australia, it is common knowledge that Aboriginal communities have suffered historical injustices that need to be remedied. Such injustices span all social, economic, and political spheres and recently, there has been a form of awakening among the Australian social fabric on the need to apologise and ‘close the gap’ that has been created between Aboriginal communities and their non-Indigenous counterparts. Being at the ‘closing the gap’ campaign has been the Australian Government, which started by acknowledging that previous policies had contributed to the perpetuation of wrongdoing against the Indigenous communities. The acknowledgement by the government was closely followed by identification of the key areas that needed government attention; if at all the Indigenous community would play catch-up in all fronts with the rest of Australia. The key areas that need attention include healthcare, education, and the economic sector. This paper will discuss the healthcare neglect that had ravaged the Aboriginal communities thus leading to health inequalities. Further, the paper will discuss the measures that government intends to take in order to remedy the situation. The paper will also recommend other measures that government can take in order to improve the health situation of the Aboriginal communities even further. Causes of health inequalities among Aboriginal communities living in the Northern Territory The term health inequality refers to a social concept characterised by unjust and avoidable differences in health (Whitehead, 1990). In Australia’s context, health inequalities have been witnessed for centuries on end and are largely contributed to by historical issues such as poverty and social inequity that exists between the Indigenous communities and their non-Indigenous counterparts (Harris & Simpsons, 2003). The Northern Territory (NT) is a special case because it not only registers health differentials between it and the rest of Australia, but it also registers disproportionate divisions of poor health between the Indigenous and non-Indigenous communities (Australian Bureau of Statistics (ABS), 1997). The most graphic testament of the poor health in NT was captured by ABS (1997), when it was revealed that Indigenous Australians born in the NT in the 1990s had a life expectancy that was 20 years lower than other people in the larger Australia. It was also revealed that 58 percent of deaths occurred among Indigenous communities living in the NT before the age of 55 years. Only 17 percent of non-Indigenous NT residents occurred before the age of 55 years (ABS, 1997). Some diseases which are more common in Indigenous communities and not in the non-Indigenous population include heart and coronary diseases (Wendy et al., 2005; Zhiqiang & Wendy, 2005); low birth weight (Wendy & Jenifer, 2010); high suicide and accident rates (Yuejen & Karen, 2006), and Chronic kidney failure (Spencer et al., 1998) among others. As Mackenbach (2002), Acheson (1998), Graham (2000), and Lynch and Kaplan (2000) note, health inequality determinants are for the most part found outside the healthcare system. Specifically, such determinants relate to the inequities that exist in the economic, social, cultural and political distribution of opportunities and resources. The Indigenous communities in Australia have for the greatest part of history suffered cultural segregation, meaning that they have not been able to participate equitably in the social, economic and political activities in the country (Australian Institute of Health, 1988; Jackson & Ward, 1999; Ring & Firman, 1998). Consequently, their living and working conditions have suffered immensely, leading to low socioeconomic status. Over the years, it has been established that one’s socioeconomic status affects their wellbeing. In fact, the higher one is on the socioeconomic ladder, the healthier they are likely to be (Australian Institute of Health and Welfare, 2004; Draper, Turrell & Oldenburg, 2004). Some authors like Evans et al. (1994), and Marmot et al. (1997), have gone as far as stating unequivocally that low socioeconomic status is the most significant risk factor related to health. Their view is supported by countless other authors, who include Tsey and Every (2000); Reading (2009); Morone and Jacobs (2005); and Wilkinson (2005). In Devitt, Hall and Tsey’s (2001) submission for example, it is stated that “people of low socioeconomic status have higher levels of ill health because, generally speaking, they lack the finance, knowledge and skills to acquire the essential prerequisites of good health - such as suitable housing, education, nutritional diets ...” (Devitt et al., 2001, p. 2). If this assertion by Devitt et al. was indeed true, the health inequalities that exist between Indigenous communities in the NT and their counterparts elsewhere in Australia can be traced to historical injustices such as land dispossession as claimed by Territory Health Services (THS) (1996). According to THS (1996) when the Aboriginal communities were dispossessed of their land and moved from their original homelands, they lost their economic base and social entity that was attained from living in close-knit economic groups. The manner in which the Indigenous communities living in NT were dispossessed has also contributed significantly into the health inequalities witnessed among them. According to THS (1996), the dispossession exercise was often characterised by violence and brutality. When settlers came into Australia, Devitt et al. (2001) note that the Indigenous communities “became either a convenient workforce within the economic system that the settlers hastened to establish, or unwanted nuisances to be ignored, regulated, moved on or, at times, exterminated” (p. 5). In essence, when the settlers moved into the Northern Territory, the Indigenous communities lost ownership of the lands, and even where they continued to reside in the same land, they lost their control over the same. Colonisation is especially regarded as a process that left Indigenous communities powerless and in response, most lost the sense of control that they had on their personal and community life (Anderson, 2002; Dodson, 1994; Tsey & Avery, 2000). The combined effects of dispossession and losing control over their lands had long-lasting effects on the well-being of Indigenous communities in NT. According to Anderson (2002), Flick and Nelson (1994), Saggers and Gray (1998), and Ritchie and Reading (2004) for example, the disempowerment led to psychosocial or spiritual malaise among individuals in the communities, which eventually surfaced in conditions such as alcohol and drug dependence, high suicide incidents and high accident rates. Flick and Nelson (1994) further observe that the malaise that overwhelms Indigenous communities based on historical injustices meted on them further lead to high stress and anxiety levels, eventually shaping the health of individuals, families and entire communities for generations to come. Woodward (1974) had earlier stated that the ill-health among Indigenous communities was a manifestation of their alienation from the land which was at the centre of their spirituality. The spiritual attachment that Indigenous people have with their ancestral land was further underscored by the Central Land Council (2011). Amid the dispossession that occurred during the colonial era, the situation was worsened by the low socioeconomic status that predisposed them to increased health risk factors such as poor nutrition, smoking, alcoholism, poor living conditions and other physiological factors (Singh & de Looper, 2002). The historical injustices’ contribution to health inequalities in the NT is further worsened by the fact that the Australian Government has been slow in admitting that the situation can be remedied through government policy (Oldenburg, McGuffog & Turell, 2000; Ring, 1998). Evans et al. (1994), and the Social Justice Report (2005) supports the observation by Ring (1998) by stating that, historically, the Australian government had paid a blind eye on evidence produced by researchers indicating that historical injustices were to blame for the persistent health inequalities. Recently however, the government has instituted measures which are meant to close the health inequality gap that exists between Indigenous Australians in the NT and their non-Indigenous counterparts. The Measures The Australian Government through the Northern Territory Emergency Response (NTER) review board identified seven key measures that were, according to the government, necessary for the improvement of the well being of Indigenous communities living in the NT. The measures include: I) ‘welfare reform and employment’; II) ‘law and order’; III) ‘enhancing education’; IV) ‘supporting families’ ; V) ‘improving child and family health’; VI) ‘housing and land reform’; and VII) ‘coordination’. This paper will discuss two of the identified measures namely: ‘enhancing education’ and ‘housing and land reform’. The “Enhancing Education” Measure In a bid to enhance literacy among the 73 Indigenous communities living in the Northern Territory, the Australian Government (2008) through the NTER identified the need to construct additional classrooms, accelerate literacy programs in the NT, establish school nutrition programs, start volunteer programs for teachers, and enhance the quality of packages given to teachers. Notably, the identified sub-measures did not have any statutory backing in Australian law. The resolve by the Australian government was informed by a report by Anderson and Wild (2007), which revealed that the NT had “miserable school attendance rates”, and that there was an apparent “complacency” regarding the situation (p. 18). Rather, the government provided for them administratively. Evidence that enhancing education is used to enhance health outcome of the Aboriginal people The reasoning behind enhancing education as a means of closing the gap in health inequality between Indigenous and non-Indigenous Australia is founded on the belief that proper education will equip the children with the skills and knowledge needed to enter the job market (NTER Evaluation Report, 2011). By keeping the children in school, the government further believes that it will reduce the wave of violence, substance abuse, anxiety and depression, which often results in poor health (Commonwealth of Australia, 2010). The most profound evidence that the government is using education enhancement to reduce health inequality is contained in its investment in the NT’s education sector. The school infrastructure has expanded significantly to cater for increased enrolment, early learning is fostered through government initiatives, and there are support programs targeting parents (Commonwealth of Australia, 2010; NTER Evaluation Report, 2011). A review carried out by the Commonwealth of Australia (2011) on NTER revealed that since the initiatives were established in 2007, the government has been working on attracting and retaining skilled teachers to the NTER communities. Strengths and weaknesses of ‘enhancing education’ The main strength of enhancing education as a way of reducing health inequalities among the Indigenous population is contained in the fact that all sub-measures appear to have government backing. The resolve by the government to enhance education is seen in the budgetary allocations in the sector. On the counter side however, the challenge of posting qualified teachers to rural areas has been identified by Lock (2008) as a major weakness. This is nothing new because McClure et al. (2003), Fitzgerald (2004) and Fitzgerald (2006) had earlier observed that teachers find the housing and working conditions in rural Australia unfavourable. Additionally, the nutritional program, which was intended to enhance school attendance by the Indigenous students, was a flop (DEEWR, 2009). Notably, the nutritional program alone did not provide enough motivation for the children to attend school, or for parents to send their children to school. Specifically, the requirement that the parents pay for the meals was a short-coming to children whose parents were unable to pay as they could be locked out of the program. Another weakness of the ‘enhancing education’ measure is contained in the fact that the government did not consider how to lift the language barrier that exists in Indigenous communities. According to the Productivity Commission (2003), 70 percent of Indigenous children learn English as a second, third, or even fourth language. The Australian Government (2009); Thorne (2003); Comino et al. (2010); Gibney et al. (2005); and Morris et al. (2005) all note that a significant number of children have an impaired hearing capacity, while others simply do not regard education as necessary since their parents do not sensitize them on the same. Usually, the non-educated parents do not attach much significance to sending their children to school. The outcomes of the ‘enhancing education’ measure are even more heartbreaking. In a 2010 survey by the NT Department of Education and Training, it was revealed that primary school attendance had dropped to 60.3 percent in 2010, from 64.6 percent in 2006. Additionally, Students in the NT did not meet the country’s minimum standards in numeracy, reading and writing. The only positive indication came from Year 3 students, who showed an increase in reading skills since 2008. These statistics are then an indication that the NTER’s approach to enhancing education is not as successful as was initially envisaged. This is an indication that the government and all stakeholders involved need to go back to the drawing board. The ‘Housing and land reform’ measure Having established that dispossession and displacement of Indigenous communities from their lands in the colonial era was at the heart of health inequalities plaguing such communities, the ‘housing and land reform’ measure was ostensibly set to resolve the historical injustices. Australian National Audit Office (2010) specifically states that the measure was meant to be a development enabler, whose desired effect was the attainment of lasting, positive and equitable socioeconomic changes. Evidence of implementation and use in reducing health inequality By 2011, the Australian government was holding 5-year leases for 64 communities in the NT. Subsequently, the government will pay rents to the traditional landowners (FaHCSIA, 2011). Improvement of the Indigenous people’s economic wellbeing is expected since they can eat well, take their children to school and even afford decent accommodation. During the 5-year lease period, the government has an obligation to institute infrastructure development in the lands, and develop housing, which it will take over as the main landlord. Strengths and weakness Among the outstanding strengths of the ‘housing and land reform’ measure is that it will allow government participation in the development of target areas, without displacing or relocating communities. This will probably earn the government support from the local communities, since the Indigenous communities will develop a sense of ownership over government processes. Among the most outstanding weaknesses of the ‘housing and land reform’ measure, on the other hand, is the fact that the government has not identified how it is going to deal with the high occupancy rates registered among Indigenous families. In a 2008 survey, it was revealed that 66 percent of Indigenous people in the NT aged above 15 years were living in overcrowded houses (ABS, 2008). The Human Rights Law Centre (2011) notes that some traditional landowners had not received land rate payments from the government by 2011, and this may arouse suspicion among locals regarding the government’s trustworthiness. Conclusion and recommendations It is reasonable to conclude that the ‘enhancing education’ measure should be more detailed. Notably, the Australian Government should seek to comprehensively address all factors that could hinder the enhancement of education among children born in the Indigenous communities (Charles Darwin University, 2010; Ladwig & Sarra, 2009). The government should on the other hand show more commitment towards the ‘housing and land reform’ measure. It is not just enough to issue 5-year lease titles; rather, the government needs to pay rates to traditional land owners as initially indicated in NTER. Such issues aside, the government needs to consider including a ‘cultural security’ measure in the NTER. Under such a measure, the government could establish policies and strategies for maintaining and protecting the cultural identity of the Indigenous communities. Additionally, the government could work on ways and means of strengthening leadership among the Indigenous communities. According to Anderson et al. (2006), the greatest hindrance to the attainment of results in government-engineered initiatives is the fact that such initiatives are viewed by the Indigenous people as being imposed on them. As such, the locals do not develop a sense of ownership. 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Yuejen, Z. & Karen, D. (2006). Causes of inequality in life expectancy between Indigenous and non-Indigenous people in the Northern Territory, 1981&nda. Medical Journal of Australia, 184(10):490-494. Zhiqiang, W. & Wendy, E. H. (2005). Is the Framingham coronary heart disease absolute risk function applicable to Aboriginal people? Medical Journal of Australia, 182 (2): 66-69. Read More