Tackling Health Inequity of the Aboriginal People in Australia - Report Example

1. Introduction Among Australians, there is no equal sharing of good health. There exist significant differences in terms of health within and between different groups in Australia. Such differences are experienced in the rates of diseases and deaths, life expectancy, health behaviours and risk factors as well as utilisation of health services. These health inequities are related to Aboriginality, occupation, education, status of employment, income, ethnicity and gender. The indigenous people such as Aboriginals in Australia are exposed to significant inequity in health in relation to the entire community. For instance, the expectancy for Aboriginals is lower in comparison to non-indigenous people and it is accompanied with high death rates, disability and various illnesses which include diabetes, injuries and accidents, respiratory and cardiovascular diseases. These inequities in health are also related to socioeconomic gradient where poor health and shorter lifespan is associated to lower socio-economic groups. In addition, poor health in Aboriginals is related to poverty where those that are poor experience a variety of deprivations such as marginalisation, denial of choice and opportunities, material deprivation, exclusion, and powerlessness (Draper, Turrell & Oldenburg 2004). 1.1 Health gap In Australia, there is an incredible gap of 18 years that exist between the indigenous Australians and the average Australian. However, there has been significant improvement in particular addressing the death rates of indigenous Australians. It has been found that the gap between other Australian infants and the indigenous infants has been narrowing (AIHW 2011). On the other hand, AIHW also states that alcohol consumption, tobacco use, inadequate physical activity and poor nutrition among others that lead to communicable diseases are some of the health inequities that are significant among indigenous Australians they still need more focus. Woodward & Kawachi (2000) argue that, with the health inequities evidenced in indigenous people especially the aboriginals in Australia, there arise many reasons for control or reduction of these inequities. The inequities in health are unjust and are not biological but the factors that determine health inequities are largely out of individual control and can be said to be potentially avoidable. These inequities can be avoided and are also amendable to change, for instance, shifts in socioeconomic conditions can lead to short term change in population’s health both negatively and positively. The inequities in health affect the health and wellbeing of everyone. The burdens of the problems in health such as mental illness, infectious disease, violence, alcohol and drug abuse in aboriginals poses diverse social and health impacts to all sectors in the society. There are also major economic impacts of health inequities. Excess mortality and morbidity are directly attributed to economic burdens through increased social and health cost as well as a reduction in economic productivity. With time, relative inequities in health will continue to increase. For instance, overall improvements in the status of population health may lead to deterioration or lack of improvement in health for specific groups such as Aboriginal populations. Thus, programs for reduction of health inequities need to be promoted as they seem to be cost effective considering the effects of health inequities (Wilkinson 2005). From the information above, health is seen to be dependent on the people’s lives and their choice of living. Marmot (2004) states that health inequities arise from societal inequities. Small societal differences lead to small inequities of health while large differences in the society results to large health inequities. The differences in provision or access to health care matter as well as the differences in lifestyle. But the key social inequality determinants in health usually lies in the conditions as well as the circumstances in which various groups of people work, live, grow, work and age. The circumstances are controlled and shaped by distribution of power, money and resources at local and national levels. Social determinants of health have great responsibility in health inequities where avoidable and unfair differences in health status are experienced among different groups within Australia especially indigenous groups. The key determinants of social health include social status and incomes, social participation and support networks, health literacy, education, healthy living conditions, lifestyle factors, culture and discrimination, individual behaviours, early factors of life and genetics (CSDoH 2007). Comprehensive primary health care (CPHC) involves the a combination of clinical care, prevention programs, promotion of health, rehabilitation, measures on public health and advocacy on matters related to health. It involves services beyond the treatment of individual with a focus on population. CPHC programs are aimed at improving performances in the systems of health laying focus on the services on comprehensive primary care. This leads to maximization of health gains for aboriginal community (Commonwealth of Australia 2001). Empowerment involves processes and outcomes meant for generating changes at multiple levels such as community or individual and strengthening of collective action in order to influence social situations in a positive way. Empowerment must be associated by certain qualities such as power in making decisions, believing in the ability of an individual in order to make a difference, access to resources and information, anger management, embracing of change and growth among others. Primary health care, cultural safety and empowerment have a symbiotic relationship as they require reciprocal respect, trust, participatory decision making, collaboration and a shift in power base (Bartlett & Boffa 2001). 1.2 Choice of inequity as an understanding of SDoH Social determinants of health consist of conditions in daily lives which are responsible for major inequities of health within the country. That is, the way income, power, goods and services are distributed locally or nationally and the visible circumstances of the lives of people and how they access education, healthcare, conditions of work, their communities, homes and their chances in leading a life that is flourishing. This shows that social determinants represent a complex and broad arrangement of political, social, environmental, economic and cultural factors which have a strong impact on inequity and health status. For instance, aborigines in Australia have the likelihood of lower levels of economic and social resources. As a result this will lead to lower levels of income and high rates of unemployment. This in turn results to engagement of activities which include alcohol and drug abuse that will bring deleterious effects into their health and illnesses such as obesity. In this case, these people cannot be in a condition to control their lives. This means that the Aboriginal people do not have the chance to choose the lives that they value which results to ill health due to lack of education, employment, better working conditions, income for a healthy living (food, sanitation and housing) and sustainable communities among others (Draper, Turrell & Oldenburg 2004). This article prevents vision 2030 designed for closing the gap on health inequity between the indigenous and non-indigenous Australians. It then applies the CPHC approach in explaining the vision 2030’s process in closing the gap as well as the relation between CPHC and empowerment as applied in implementation of vision 2030. 2. Vision 2030 The review done on health performance indicators in Australia showed that the Australians in rural as well as remote residences have little access to health care services such as age care, disability care, and coronary care service despite of rising need for such types of services. In addition, inadequate improvement of rural community infrastructure, limited availability of quality food, unfavourable economies of scale responsible for social and health services have been experienced in indigenous Australians (Pritchard & McManus 2000). Achievements by 2030 The crucial advances that have been made in health services have been able to recognise the inequalities that had been persistent across every domain which include health status, wellbeing, education and social conditions. The identified inequalities have been eliminated in order to give the Aboriginal people a chance to effectively and efficiently access quality health care and better salaries and working conditions (Pholi, Black & Richards 2009). The specific target achieved; The gap of life expectancy that had been in existence between these aboriginal people and non-indigenous people in Australia has been reduced. Gaps in the mortality rates for aboriginal children that are under five years has been closed The access to the early childhood education for all four year old aboriginal children in remote communities has been improved The gap in writing, reading and the achievement of numeracy for aboriginal children has been reduced The gap that existed for aboriginal students in year 12 or for attainment rates that are equivalent has been reduced The gap in the outcomes of employments between aboriginals and non-indigenous Australians has been reduced (Madden and Pulver 2009). The identified barriers that had been obstructing the aboriginal people to access health services have also been reduced: Economic barriers: a lot of aboriginal people that had been experiencing long economic disadvantage can now afford doctor and co-payments of PBS and invisible costs such as having a phone in their homes for making enquiries, appointments or travel costs. Geographical or physical barriers: all the communities in remote and rural areas can now acquire local access to specialists, general practitioners, hospitals and pharmacies. For the aboriginal communities on the fringe of concentrations of major urban have are enjoying ready access to practices which bulk-bill and a variety of health services and specialists. Primary health centres in remote areas that are responsible for provision of services to aboriginal people can be easily accessed and they provide an improved, high quality care. Administrative barriers: the aboriginal people are in a condition to procure or carry current healthcare and Medicare cards in case they may be undergoing some economic struggles. Cultural barriers: aboriginal people can now confidently enter any non-aboriginal service (Andrews, Long & Wilson 2002). 3. Use of a model of comprehensive primary health care (CPHC) CPHC approach is employed in achievement of the vision 2030. The approach ensures that there is incorporation of mind, body, spirit, environment, custom, land and socio-economic status. In a construct of an aboriginal culture, this approach include an essential and an integrated care which is based on practical, socially acceptable and scientifically sound procedures and technology that was made accessible to these communities. These factors are made as close as possible to where these communities’ lives by ensuring that they fully participate in the spirit of self-determination and self-reliance (Pholi, Black & Richards 2009). It is worth noting that this approach required intimate knowledge about the aboriginal community and the health problems they were facing. In addition, the community itself provided the most appropriate and effective way of addressing the community’s main health problems. This includes preventive, curative, promotion and rehabilitative services (Powell-Davies 2008). The CHPC that was developed by the services above is comprehensive as it encompasses Medicare provision, with its chronic illnesses management, and its clinical services in treating diseases and it included various services. These services include pharmaceuticals, environmental health, preventive medicine, counselling education and promotion on health, postnatal and antenatal care, rehabilitative services, maternal and child care, various programs and necessary health care features that came from emotional social and physical factors (NACCHO 2009). Thus, using a comprehensive approach, health care practitioners are able to change the economic, environmental, political determinants of illnesses which lead to creation of better health in aboriginal people communities. It is worth noting that a variety of social determinants of health is incorporating circumstances that are inter-related in matters of poverty, income and wealth distribution, powerlessness, psycho-social deprivation, discrimination such as racism and sexism, factors that were related to race, gender, age and ethnicity, literacy, socio-ecological environments and utilisation of health care. The approach act as a system response and philosophy meant for reducing the inequities in health. With a CPHC approach, it was possible to address the wide range of environmental and social factors that lead to ill health in addition to those factors that create and sustain good health. This approach led to improving of health outcomes and quality of life of aboriginal people. In connection to this achievement, it is recommended that there will always be a growing awareness for all to work in a more effective way in order to deal with social health determinants and also to put into consideration that lack of a comprehensive approach will lead to continual increase in health inequities (Bartlett & Boffa 2005). 3. 1 CPHC Approach The focus of the 2030 vision is to improvement of provision of comprehensive, secure primary health services of care in the entire state in order to ensure early detection, better prevention and management of conditions such as chronic conditions that posed significant burden of aboriginal people’s ill health. The investments on primary health care of aboriginal are increasing and everyone is empowered towards closing the gap that existed for a long time. Health systems, non-governmental partners and the government worked together to ensure that the new investment benefits are maximised and the existing service are equipped enough in order to serve aboriginal community (Rosewarne & Boffa 2004). Mobilisation of services is very essential for availability of an appropriate follow up for addressing the detected health issues that result from improved access to checks on health. Using the approach, high rates of preventable morbidity, chronic disease, mortality, preventable hospital admissions and low preventative services uptake shows that service arrangements that were existing at that time are not meeting the needs yet. The aboriginal people from non-remote areas had the likelihood to report the reason why they did not seek health care, costs related to seeking of treatment as compared to the one in remote areas. In addition, aboriginal people in remote areas cite lack of transportation options, lack of services in the areas and long travel distance as the main reason for neglecting treatment (NACCHO 2005). The approach has come up with an integrated planning process for aboriginal health to; Increase the CPHC services availability by giving priority the closing of the gaps between communities as well as providing service options Taking the corrective responsibility to ensure the availability of car for all aborigines in the community from multidisciplinary teams which involved medical practitioners, practice nurses, aboriginal health workers, staff on health and others to ensure maximisation of provision of core services at local level, arranging service visits for remote locations and specialised needs; these services include availability of occupational therapy, physiotherapy, dental and audiology services for the aboriginals people with higher needs. Defining clear pathways meant for maximising opportunities for care to home for more acute and specialised care putting into consideration on who was providing services, how, where, and when. Building capacity for holistic and integrated service responses that were more comprehensive for those with complex conditions, designing protocols and implementing them; the complex conditions included mental health, alcohol and drug. The approach also ensured that the system provided good patient care support by monitoring the progress of provision of care and achievement outcomes. Use of CPHC approach ensured that the unplanned approaches to issues of health and conditions were eliminated Strategies were implemented to ensure that the services were safe culturally and barriers were removed. These barriers include those related to transport, racism and discrimination, appointment times, opening hours and flexible approaches. It also ensured prioritisation on access for aboriginal community. The approach also ensured provision of programs for promotion of health for aboriginal communities and families. For instance, providing community approaches to initiatives on physical activities and healthy eating that are integrated with individual support in order to manage and prevent chronic diseases (Labonte et al. 2008). The CPHC approach greatly contributes to the efforts of addressing inequalities in aboriginal people. This approach provide the ability to understand the difference existing on aboriginal people that are experiencing social and health disadvantage (McDonald 2007). 3.3 CPHC approach and power/empowerment The major focus of CPHC is health which is attained through equity and empowerment of the community. Thus, one of the principles of CPHC is to commit to empower the community. Empowerment involves processes and outcomes meant for generating changes at multiple levels such as community or individual and strengthening of collective action in order to influence social situations in a positive way. Empowerment must be associated by certain qualities such as power in making decisions, believing in the ability of an individual in order to make a difference, access to resources and information, anger management, embracing of change and growth among others (Wass 1995). Achievement of the vision 2030 that is directed to health equity using CPHV approach depends on every worker and aboriginal community empowerment. The medical practitioners, nurses and other providers of health need to empower the affected aboriginal people. This will lead to development of trust between the two which makes it easier for the workers to provide better services while the affected people have the morale to collaborate in treatment and rehabilitation. In the process of addressing the factors that lead to ill health by use of COHC approach, a better coordination between the practitioner and the aboriginal people will lead to faster and effective way of improving the health outcomes and the quality of life of this community. With empowerment, there will always be a commitment for everyone to work together in a more effective way in order to deal with social health determinants. Primary health care, cultural safety and empowerment have a symbiotic relationship as they require reciprocal respect, trust, participatory decision making, collaboration and a shift in power base (Baum et al. 1999). Conclusion It is evident that indigenous people such as the aboriginal people in Australia are significantly poorer as compared to the non-indigenous people. This negatively impacts on the aboriginal people’s health leading to issues such as poverty, illnesses, and disability among others. Social determinants of health have great responsibility in health inequities where avoidable and unfair differences in health status are experienced among different groups within Australia especially indigenous groups. The aborigines do not have the chance to choose the lives that they value which results to ill health due to lack of education, employment, better working conditions, income for a healthy living and sustainable communities among others. Health services are very essential in achievement of health inequality. The aboriginal people’s health is a matter of determining the features of these people’s life and it includes control over aboriginal’s physical environment, of self esteem of the community, of dignity and of justice. The CPHC approach ensures that there is incorporation of mind, body, spirit, environment, custom, land and socio-economic status. In a construct of an aboriginal culture, this approach include an essential as well as an integrated care which is based on practical, socially acceptable and scientifically sound procedures and technology that is made accessible to these communities. The CPHC approach greatly contributes to the efforts of addressing inequalities in aboriginal people. Vision 2030 has enhanced the reduction of the gap that exists between the indigenous Australians and non-indigenous Australians. Thus, it is a strong potential in reducing or eliminating health inequities in Australia by 2003. References AIHW 2011, Australia's Health. Canberra: Australian Institute of Health and Welfare. Andrews B, Simmons P, Long I, and Wilson R. 2002, Identifying and overcoming the barriers to Aboriginal access to general practitioner services in rural New South Wales. Aust J Rural Health 10: 196-201. Bartlett, B. & Boffa, J 2001, Aboriginal Community Controlled Comprehensive Primary Health Care: The Central Australian Aboriginal Congress, Australian Journal of Primary Health 7(3) 74 - 82 Bartlett B, & Boffa J.2005, The impact of Aboriginal community controlled health service advocacy on Aboriginal health policy. Aust J Prim Health, Vol. 11, no. 2, 53 -61. Baum F, Murray C, Verity F, Pettifer S, Shuttleworth C, Warin M 1999. South Australian Community Health Centres: Towards a Comprehensive Primary Health Care Practice. Case study presented at World Health Organisation: “Towards Unity For Health” Conference, Thailand. Commission on Social Determinants of Health (CSDoH) 2007, Social Determinants of Indigenous Health: The International Experience and its Policy Implications’, International Symposium on the Social Determinants of Indigenous Health Adelaide. Commonwealth of Australia 2001, Better Health Care: Studies in the Successful Delivery of Primary Health Care Services for Aboriginal and Torres Strait Islander Australians. Accessed on 29 may 2012, http://www.health.gov.au/internet/main/publishing.nsf/Content/health-oatsih-pubs-bhcs.htm Draper G, Turrell G & Oldenburg B 2004. Health Inequalities in Australia; Mortality. Health Inequalities Monitoring Series No. 1 AIHW Cat. No PHE 55. Canberra: Queensland university of Technology and the Australian Institute of Health and Welfare. Labonte R, Sanders D, Baum F, Schaay N, Packer C, Laplante D et al.2008, Implementation, effectiveness and political context of comprehensive primary health care: preliminary findings of a global literature review. Aust J Prim Health, 14(3):58-67. Marmot M 2004 The status syndrome. New York: Henry Holt. Madden R.C, and Jackson Pulver L.R. 2009. Aboriginal and Torres Strait Islander population: More than reported. Aust Actuarial J 15(2): 181-208. McDonald J.J 2007, Primary Health care or primary medical care: in reality. Aust J Prim Health 13(2):18-23. National Aboriginal Community Controlled Health Organisation (NACCHO) 2009, Submission to the Taskforce developing the National Primary Health Care Strategy, Accessed on 29 may 2012, . National Aboriginal Community Controlled Health Organisation (NACCHO) 2005, National guide to a preventive health assessment in Aboriginal and Torres Strait Islander peoples, RACGP, Melbourne Powell-Davies G, Williams A.M, Larsen K, Perkins D, Roland M, Harris M 2008 Co-ordinating primary health care: an analysis of the outcomes of a systematic review. Med J Aust, Vol. 188(8), p. 65-S68. Pholi, K., Black, D. & Richards C 2009, Is ‘Close the Gap’ a useful approach to improving the health and wellbeing of Indigenous Australians? Australian Review of Public Affairs, vol. 9, p. 1-14. Pritchard B, McManus P, eds. 2000, Land of discontent: the dynamics of change in rural and regional Australia. Sydney: University of New South Wales Press Rosewarne C, Boffa J 2004, An analysis of the Primary Health Care Access Program in the Northern Territory: A major Aboriginal health policy reform. Aust J Prim Health, Vol 10(3) 89 -100. Wass, A 1995. Promoting Health: the primary health care approach. Sydney: WB Saunders, Bailliere Tindall, Harcourt Brace and Company Woodward A and Kawachi I 2000, Why reduce health inequalities? J. Epidemiol. Community Health, vol. 54, pp. 923-929. Wilkinson R 2005 The Impact of Inequality: How to Make Sick Societies Healthier. New York: The New Press. Read More