Institutional Racism and Its Role in Inequitable Access to Healthcare - Literature review Example

Discussion Paper Student’s Name Professor’s Name Course Title Date Discussion paper Introduction The World Health Organization (WHO) advocates for universal health coverage in both developing and developed nations (WHO, 2015). Many industrialized nations as well as middle-income countries across the globe provide their citizens with access to health services. The main objective of universal health coverage is to ensure equitable access to health care (WHO, 2015). While some countries like Canada finance the universal access systems through tax revenues, other countries like Germany finance the universal access systems through private insurance schemes. Thus, the method of financing the universal access system varies from one country to another (WHO, 2015). According to World Health Organization (2014), Access to equitable health care is a basic human right. However, rural communities in many countries, including Australia continue to struggle due to lack of access to health care services. A qualitative interview, which was carried out in 2011, on twenty former Australian health ministers revealed that inequality between Australian indigenous and non-indigenous exists. According to them, inequality undermines the country’s universal health care system. This is because it leaves the non-indigenous population marginalized (Baum et.al, 2013). Inequitable access to health care in Australia is attributable to various factors, including inadequate financial resources, gender, disability, low level of education, institutional racism and a relatively small population spread across a vast geographic landmass. Institutional racism is the main factor as far as disparities in access to health care in Australia is concerned. For the purpose of this paper, racism and its role in inequitable access to health care will be discussed. In addition, the paper will discuss the role of healthcare professionals in addressing this factor to promote access to health care services. Institutional Racism and its Role in Inequitable Access to Healthcare in Australia According to Awofeso (2011), institutional racism is a major obstacle to equitable health care in Australia. Institutional racism could be defined as any form of discrimination that occurs within institutional settings, including health care institutions, learning institutions, corporations among others (White, Livesey & Hayes, 2012). In other words, institutional racism includes different ways in which racist beliefs have found ways in the operations of institutions, and thus, tend to single out the minority groups. The health care disadvantage among the Torres Strait Islanders and Australian Aboriginals is well recognized. Sooner than later, the human cost of poor health could be devastating, as more Aboriginals and Torres Strait Islanders continue to be racially abused. These populations have low life expectancy compared to the rest of the Australian population. In addition, a large array of chronic illnesses, including obesity and diabetes are much more prevalent among the indigenous Australians. According to the Australian Bureau of Statistics (2014), the health conditions of aboriginals as well as the Torres Strait Islanders are worse compared to the rest of the Australian population. A Challenging racism project report, which was carried out in 2011 showed that 27.9 % of non-aboriginals demonstrate racist towards the aboriginals and Torres Strait Islanders (Awofeso, 2011). According to the report, a large proportion of Australians revealed that they would not like to be related to indigenous people in any way (Awofeso, 2011). A survey, which was carried out by NATSISS in 2008 revealed that, around 30% of Aboriginals above the age of 16 living in urban areas, experience challenges when accessing health care due to institutional racism (ABS, 2008). On the contrary, only 2% of the general Australian populations have difficulty accessing health care (Australian Bureau of Statistics, 2014). White, Livesey & Hayes (2012), in their studies, indicates that the current health care system does not provide the same level of health care to Torres Strait Islanders and Aboriginals as compared to the rest of the population. According to them, there are inappropriate stereotypes made against the Torres Strait Islanders and Aboriginals, and this result to ill-will among the nursing staff. White, Livesey & Hayes (2012) further reveals that the institutional racism in Australia is deeply embedded in the behaviours of the minorities, and thus, a driver of their ill health. There is a growing body of evidence that the healthcare professionals across Australia have been slow to provide primary health care to the Torres Strait Islanders and Aboriginals (Australian Bureau of Statistics, 2014). As indicated earlier, chronic diseases like diabetes, circulatory disease and cancer are more prevalent among indigenous and Torres Strait Islanders people. These chronic and complex health conditions require regular monitoring. However, Aboriginals and Torres Strait Islanders people cannot afford regular monitoring and treatment, as more than half of these populations have low levels of income. Additionally, Aboriginals and Torres Strait Islanders people do not have access to private health insurance. Between 2004 and 2015, for example, only 16% of Aboriginals had access to private health insurance cover (Australian Government Department of Health, 2015). The general understanding in many industrialized societies is that all infants should receive equal access to health care in order to enhance their growth and development. However, this is not the case in Australia, as only a small percentage of aboriginals receive health facilities. A research, which was carried out in 2010 to determine the health service utilization in NSW showed that only 45% of the Aboriginals have access to home visits within the first fourteen days of birth. This is, however, below the universally recommended rate of 65% (Australian Health Review, 2012). In many OECD nations like Australia, equality in healthcare is the main aim of healthcare systems. However, the Australians Aboriginals and Torres Strait Islanders, who are socio-economically disadvantaged, are discriminated as far as ambulatory health care is concerned. Past research shows that the Aboriginals and Strait Islanders do not receive multidisciplinary care (Australian Health Review, 2012). Although there are many health services across Australian urban areas, they are not easily accessible by the indigenous and Torres Strait Islanders people (White, Livesey & Hayes, 2012). A research, which was conducted by the Australian Bureau of Statistics (ABS), demonstrated low utilization of health facilities by these populations (Australian Bureau of Statistics, 2014). For many indigenous Australians and Torres Strait Islanders, being in a hospital environment invokes memories of ill-treatment and racism. The aboriginals used to seeing their loved ones visit hospitals, but never coming home. Thus, they do not trust the current health care system. Many aboriginals believe that they will never leave a health care institution alive. According to them, agreeing to visit a hospital implies that their life is gone. Many members of the Australian Aboriginals refrain from seeing a white health care professional. They only visit a white health care professional only when their health condition has severely worsened. In addition, many Aboriginals and Torres Strait Islanders people lack information on how to purchase drugs (Ware, 2013). According to the Australian Bureau of Statistics (2014), only 20% of indigenous Australians and Torres Strait Islanders have access to a medical practitioner on a daily basis. Further, most indigenous Australians and Torres Strait Islanders’ communities live more than 110 Km from the nearest healthcare institution. Despite the fact that different community services throughout Australia provide primary health care to indigenous and Torres Strait Islanders, less than 40 % of these community services have medical coverage (Australian Bureau of Statistics, 2014). Health centers are mainly concentrated in the cities (400 full time nursing staff per 100,000 people). On the contrary, the concentration of health specialists is relatively lower in rural areas with only 200 full-time nurses per 100,000 people (Australian Bureau of Statistics, 2014). Due to their socioeconomic conditions, the Aboriginals and Torres Strait Islanders people lack transport to attend the health centers across urban areas. Aboriginals and Torres Strait Islanders people have complex health care needs, and therefore, they are forced to travel long distance to access alternative health services (White, Livesey & Hayes, 2012). The Role of Healthcare Professionals in Addressing This Factor to Promote Access to Healthcare Services Tackling institutional racism in Australia is a challenging task. The first step of tackling this insidious problem is for healthcare professionals to understand the impact institutional racism has on the health of Australian indigenous and Torres Strait Islanders people. Understanding the impact of institutional racism on the health of minorities allows healthcare professionals to work together with the minorities to close the gap. Thus, healthcare professionals should roll out anti-racism campaigns in order to protect the health status of the minorities. In other words, the health care professionals must challenge the status quo, which has disadvantaged Aboriginals and Torres Strait Islanders people for the past decades. There is no doubt that effective communication is the key to achieving high standards of quality health care. Past research on doctor-patient communication reveals that effective communication plays a critical role in improving health outcomes (Parnell, 2014). Thus, communication between the healthcare professionals and aboriginal Australians should be highly emphasized. Undeniably, racism hinders effective communication between the aboriginals and healthcare professionals. To deal with this challenge, there must be a two way communication where each person gives information which is properly understood by the recipient. Communication is usually thought to be either verbal or written. However, it is important to note that the body language forms an integral part of communication. There must be sync between verbal communication and body language. Otherwise, the recipient might misinterpret the message. The health care professional must strive to inform the Aboriginal as well as Torres Strait Islanders in their own language. Effective communication plays a critical role in enabling the patients understand potential benefits or harms of the treatment offered. The health care professionals should be provided with medical dictionaries in order to enhance their communication with the Aboriginal and Torres Strait Islander patients. While many healthcare professionals across Australia wishes to enhance service delivery to Aboriginals and Torres Strait Islanders people, the reality is that there is a major strain on Australian health facilities. Therefore, the resources allocated to improving service delivery to Aboriginals and Torres Strait Islanders are inadequate. Nonetheless, this explanation of poor service delivery needs questioning if equitable access to health care to minorities is to be achieved. Therefore, there is need for designing a comprehensive plan of action aimed at grappling with inequitable access to health care. The nursing staff should aim at providing health care that respects and responds to the needs of the minorities. Healthcare professionals across Australia must aim at providing Aboriginals and Torres Strait Islander people with a holistic health model (Elder, Evans & Nizette, 2011). The health care practitioners must combine their expertise in counseling, teaching and clinical skills to enhance service delivery. In addition, they should partner with the Aboriginals and Torres Strait Islanders in managing their health problems. The health care professionals should exercise due care and skill while carrying out their health duties. Recent research has indicated that the health care professionals heavily apply western-based prisms (loyalty, friendship and respect) when screening and treating indigenous communities. Thus, they do not understand the attitudes, behaviors, values, underlying assumptions, and beliefs that exist among the indigenous populations. Providing equitable health care requires awareness of cultural differences. In today’s complex world, what is normal in one community could be shocking or insulting in another community (Parvis, 2013). Therefore, the health care professionals must be conscious of the differences and similarities between various cultural groups. As stated earlier, Aboriginals have varied approaches to illnesses, healing and health issues in general. For that reason, respecting the culture of indigenous and Torres Strait Islanders is the key to enhancing their quality of health care. Indigenous Australians are known to have a more holistic approach to health. This is different from the Western approach that mainly focuses on the biological aspects. Therefore, having culturally aware health care professionals will play a critical role in addressing this factor to promote access to health care services. Misunderstandings and lack of trust are some of the reasons that make Aboriginals and Torres Strait Islanders people fail to use the health services (White, Livesey & Hayes, 2012). The health care professionals must strive to build trust in order to make health services accessible to all the Australian populations. They should empower them to make correct decisions regarding the provision of health services. In addition, they should consult them in order to know the reasons why they do not utilize the health services. The findings could be used to enhance accessibility of health services. The health care professionals should work hand in hand with the local elders in order to build trust and respect with the aboriginals and Torres Strait Islanders people. In this regard, they should consult the elders frequently in order to enhance access to health services. Kinship is a common aspect among the Australian Aboriginals, and thus, the health care professionals should consult the family members prior to the treatment process (Baum et.al, 2013). In the past, health care practitioners used their skills to find the illness, as well as the treatment. Therefore, various aspects including the patient’s preferences, values and financial capabilities were disregarded. Today, a major shift in diagnosis and treatment has occurred. With the multiple issues that have emerged in the health care sector, it makes it necessary for the Aboriginals and Torres Strait Islanders people to be consulted in regards to their health so that they are not only healed medically but emotionally, as well. The health care professionals should design flexible schedules in order to enhance accessibility of health services among the Aboriginals and Torres Strait Islander communities. Also, health care practitioners should advice the patients to take up health insurance in order to improve private health services. Conclusion This paper has clearly demonstrated that, in Australia, there exist health inequalities between the indigenous and non-indigenous populations. Institutional racism plays a greater role in enhancing inequitable access to health care in Australia. Institutional racism causes psychological distress among the Torres Strait Islanders and Aboriginals. In addition, it leads to poor quality of life. Access to good health care is critical to improving the health status of Australian Aboriginals and Torres Strait Islanders. In recent years, the Australian federal government has laid down policies that are aimed at improving the health of Torres Strait Islanders and the Indigenous Australians. Recently, that has been an increase in financing and this has improved access to health care. Infant mortality for the indigenous Australians and Torres Strait Islanders has declined significantly as a result. In addition, their life expectancy has improved by 1.6 years. Nonetheless, the current Australian health care system is faced with myriad challenges which hinder equitable service provision. Among the main challenges facing the Australian health care system include inadequate health care financing, health care illiteracy among the minorities, a growing number of people living with chronic illnesses, inadequate labor supply, inappropriate use of technology, discrimination in the provision of nursing care, an ageing population and hence an increase in heath care needs among many others. In the 21st century, ill-health status among communities is not expected. According Braveman & Gruskin (2003), the aim universal health coverage is to ensure that all communities obtain a broad set of medical interventions without experiencing financial challenges when accessing them. This calls for a well-organized health system, a method of financing health systems and a skilled and motivated workforce (World Health Organization, 2014). The health practitioners should work side by side with different arms of the Australian government for the benefit of the indigenous communities. Moreover, the government should ensure adequate health care financing as a way of enhancing accessibility to services. Reference List ABS.2008. National Aboriginal and Torres Strait Islander Social Survey. Retrieved from http://www.abs.gov.au/ausstats/abs@.nsf/mf/4714.0/ Australian Bureau of Statistics. 2014. Australian Aboriginal and Torres Strait Islander Health Survey. Retrieved from http://www.abs.gov.au/ausstats/abs@.nsf/mf/4727.0.55.003 Australian Government Department of Health. 2015. Indigenous Health: 2014-15 Budget Outcomes. Retrieved from https://www.health.gov.au/Indigenous Australian Health Review. 2012. Universal for whom? Evaluating an urban Aboriginal population’s access to a mainstream universal health home visiting program. Australian Health Review, 27-33. Awofeso, N. 2011. Racism: a major impediment to optimal Indigenous health and health care in Australia. Australian Indigenous Health Bulletin 11(3). 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