Indigenous Australian and Diabetes - Essay Example

? Australian Indigenous health: Diabetes Australian Indigenous health: Diabetes Introduction Australia is one of the most developed countries in the world with one of the best Gross Domestic Product (GDP) growth rates and Producer Price Index (PPI). It has one of the best health systems as well. The health system is, however, biased as some people in Australia do not have access to good healthcare, especially the Aborigines, who are the natives of Australia. They live in marginalized areas where there are no hospitals or clinics, do not earn well from employment and do not feed well. As such, Aborigines health is very poor compared to other Australians. Statistics indicate that only about forty percent of Aborigines are in good health compared to more than 80% of other Australians. This affects the mortality rate of these people, which is more than two times the non-indigenous Australians. Poor healthcare to Aborigines and their lifestyles increase chances of getting chronic diseases like diabetes. Diabetes is one of the diseases that has increased Aborigine mortality rate in the recent years. There are few clinics and healthcare centers in regions where aborigines live and their diet is also poor. At the same time, many cannot afford medication. More than 30% of the entire Aborigine population has diabetes. In addition, the government has been doing little to Aborigine health. Less than one percent of the national budget was used on Aborigine health. This is little money and may not have a high impact on the Aborigine health. Health experts and civil rights have lobbied the government to invest more in Aborigine healthcare. This paper will discuss Australian Indigenous Health, specifically diabetes, the current trends, why Aborigines are affected more than Non-Aboriginal Australians, strategies used to mitigate Diabetes and what can be done to improve the current intervention measures and strategies. Epidemiology Diabetes is one of the most common chronic conditions in the world today. The disease is as a result of low production of insulin which is responsible for regulating blood sugar in the body. Diabetes is characterized by high levels of blood sugar and can adversely affect the general health of the patient. The condition makes the body weak making the patient susceptible to opportunistic conditions, which can even lead to death. There are two common types of Diabetes, Type 1 and Type 2. Type 1 diabetes is caused an autoimmune disease of the beta cells of the pancreas. These cells are responsible for the production of insulin, which regulates blood sugar. Type 1 diabetes is most common in young people and accounts for 5 to 10% of the total diabetes patients. Type 2 diabetes is caused by health factors that have suppressing factors on the pancreas. Excess fats make it almost impossible for the beta cells to produce insulin and regulate body sugar. In fact, more than 75% of people having type 2 diabetes are either overweight or obese. Type 2 is common in adults and accounts for 90 to 95% of all diabetic patients (Hawley and Dunstan, 2008). There is no cure for either of the two types of diabetes, but research and experiments are underway to find a cure. Currently, diabetes is management is done to mitigate the risks that are associated these conditions for example (Thomas and Nestel, 2007). Type 1 diabetes patients have to live on insulin shots. They inject insulin on their hands every day according to the physician instructions. Type 2 diabetes patients are advised to exercise to lose weight and cut fats in the body. They can also use pills if the former strategy does not work. Diabetes patients have to eat healthy and exercise often to mitigate the effects of the condition (Speight, 2013). Prevalence of diabetes in Australia is relatively high, currently ranked the fifth country. Diabetes is common among the elderly people. There is a higher prevalence of diabetes to Aborigines in Australia compared to non-Aborigines. According to Australian Institute of Health and Welfare, prevalence in aborigines was three times that of other Australians in the year 2011. The number of diabetes caused deaths in aborigines was at a staggering seven times the number of other Australians. There is a high prevalence to diabetes in Aborigines in remote areas compared to aborigines living in urban centers (Marley, et al, 2012). Factors contributing to high diabetes prevalence in Australian Aborigines There are number of factors that contribute to the high vulnerability and prevalence of diabetes in Australian Aborigines Genetics Genetic composition of the Australian aborigines is relatively different from that of European Australians. Genetic researchers found that Aborigine body and genetic predisposition is that of making them efficient hunters. They have long legs, small bodies, narrow hips and narrow shoulders. This body structure makes them adapted to hunting as their ancestors did. Researchers confirmed that this body structure requires less energy for survival compared to other Australians. Trend has been changing fast, and aborigines can no longer be hunters as they used to be in the past. Nowadays, they have to integrate and blend with the other population and do what they do (Nabhan, 2006). Aborigines no longer hunt and they do not have a lot of energy- cut fats consuming activities presently. Their bodies accumulate fats very fast because they are adapted to low energy consumption. Any excess food in the body is converted to fat and stored as fats. Therefore, Aborigines are very susceptible to weight gain and obesity subsequently. A lot of fat in the body affects the beta cells of the pancreas by suppressing them making it impossible to produce the much- needed insulin. The amount of insulin produced keeps on decreasing leading to diabetes (Colagiuri, et al, 2010). Other researchers and experts have also found out that Australian Aborigines are less sensitive to insulin. People that are less sensitive to insulin need large amounts of the hormone for proper function in regulating blood sugar. When insulin levels start decreasing as aborigines gain weight, there is a high chance that they will get diabetes type two sooner than other Australians. Non Aboriginal Australians are not at risk of getting diabetes even when insulin levels reduce slightly because they are more sensitive (Nolan, Damm, and Prentki 2011). According to Qiao, the Australian Aborigines are likely to develop insulin resistance faster than other Australians. This is a condition in which there is genetic predisposition making the body reject insulin (Qiao, 2012). This means that insulin is either not produced or not utilized when produced. It is thought insulin resistance and insulin insensitivity is caused by a defect in the stimulatory G-protein pathway that is responsible for secretion of insulin. Consequently, body sugar is not regulated leading to increased blood sugar subsequently leading to diabetes mellitus (Lee and Kim, 2007). Lifestyle The lifestyle of the Australian Aborigines is not only very different from other Australians but also extraordinary to some extent. According to the ancestors of the Aborigines, consuming fats is good for their health. It was believed that fats have medicinal value and should be taken often. Most Aborigines still continue with this cultural practice to date. They isolate what they call good fats from animals and take them raw. The lifestyle of Australian Aborigines has changed much. Unlike in the past when they used to walk long distances and hunt, they do not do much nowadays. Fats are likely to accumulate in their bodies, and this could have an effect on the islets of Langerhans that are responsible for the production of insulin (Ghosh, 2012). Aborigines are used to foods with high concentrations of fats. According to McDonald (2006), Aborigines like fatty foods as their ancestors taught them. Food to Aborigines shows a sense of belonging, connection to a family link and to the past. McDonald approached a number of Aborigines in Kimberly region of Northern Australia and asked them about foods. All interviewees stated that were used to fatty foods, which could be categorized into family food, fast foods and diet foots. Family foods are taken together with other members of the family. Family means a lot to these people and taking food together shows a sense of f linkage. Fast foods are usually taken to satisfy hunger and have no social meaning to Aborigines. On the other hand, diet foods are those that are taken without any preparation, for instance, raw fat or bush plants (McDonald, 2006). Nutrition The traditional Aborigine hunter gatherer diet has been replaced with the western type of diet, which is high in sugars and fats. Aborigines living in urban centers usually prefer fast foods, which are usually much cheaper. Their income is relatively low and cannot afford to spend a lot of money on food. Aborigines in the rural areas take food with low dietary fibre, high in fats, saturated fats and sugar as (Dussat, 2009) . In addition, they do not have enough money to afford fruits, which are sources of vitamins and important co-factors. Most urban-based Aborigines have also started using cigarettes and alcohol. Aborigines living in rural areas do not have access to fresh food supplies and fruits. They are usually marginalized compared to those living in urban centers. With their genetic predisposition, Australian aborigines are likely to be obese and overweight with this lifestyle increase vulnerability to diabetes and other chronic diseases and conditions (Best, 2007). Social Factors There are many social factors that have a great impact on health of individuals. Income and education have a high impact on the society than most people think. According to Carson and group, the two factors dictate the place to live and the kind of lifestyle to expect. Those making low incomes live in poverty; overcrowded, poorly planned and health hazard areas. Though the poverty levels in Australia are relatively low, Aborigines are generally poor. They do not have access to good education, and if they do, they rarely finish school. It is almost impossible to find jobs in Australia with low education. Therefore, the Aborigines have to settle for whatever kind of job they get (Collins, 2010). Jobs that Aborigines get are not well-paying for the lucky ones. Others do not even have jobs and have to cater for their own and family needs. As such, they struggle to even make enough to cater for the basic needs. Struggle in every human being leave alone the Australian Aborigines is not a walk in the park. Most Aborigines are psychologically affected by the low-income they earn and the places they inhabit. They feel inferior when they consider how other people within the state are living comfortably. In fact, most aborigines are depressed because of their deplorable social-economic conditions. Depression is said to be a major risk factor for diabetes and other chronic disease symptoms (Abbot, Et Al). Another social factor the Australian Aborigines have to contend with is discrimination. It is interesting to not that the Australian constitution actually allows discrimination against Aborigines (Fisher, 2012). Unlike other Australian minorities, Aborigines are discriminated against through economic and social means. Regions where Aborigines live are under-developed with no good road network, health facilities and schools. They have challenges accessing the very basic amenities like healthcare, education and equality. While the Australian government spends billions of dollars on education and housing for other Australians, Aborigines get close to zero. In fact, Aborigines are discriminated to the point that they cannot speak good English in a country whose native language is English. Aborigines speak broken English, which is commonly recognized as Aboriginal English (Hill, 2007). The Australian government has been promising to do whatever it takes to ensure that discrimination against Aborigines come to an end. In fact, the government made a declaration in regards to this subject matter after a lot of pressure from United Nations and civil rights organizations. However, experts question whether the declaration will change anything as discrimination against Aborigines in Australia has already taken root (Mansen, 2011). This is very limiting to Aborigines, especially when they are communicating with other Australians. As a result, Aborigines suffer even they are not ought to suffer. A good example is when Aborigines have to be taken to court. They cannot express themselves fully and most times they are sentenced to prison. No wonder there are high imprisonment rates among the aborigines compared to other Australians (Pink and Albon, 2008). The rate of racism in Australia is so high that even human rights organizations, and the United Nations have taken down. UN special reporter, James Anaya went for a twelve-day fact finding tour on Aborigine discrimination in Australia in 2009 (Giago 2010). Geographical Location Australian Aborigines are usually located in remote and marginalized regions. The road network and transportation in these regions make access to important healthcare facilities almost impossible. They have to walk long distances just to access healthcare facilities (Maronne, 2007). The real cost of accessing healthcare facilities for Aborigines is not the lack of the facilities but transportation, medication and accommodation money. Most Aborigines are not well-educated and cannot get good jobs. They have little income and affording these services to access healthcare is a big challenge. The best earning Aborigines earn only about 50% of the other Australian income (United Nations Publications, 2009). Many Aborigines do not emphasize health care as well. They are not well-educated and therefore, do not really understand the value of good health. As such, they rarely go to hospitals and healthcare facilities for regular check-ups. Although there are approximately three hundred thousand hospitals out of the eight million in Australia meant for the Australian Aborigines, Aborigines do not go to seek medical attention. Therefore, Aborigines are likely not to get sick because the condition could not be prevented but because the patient did not seek medical assistance. This becomes fatal when conditions like diabetes are involved. Usually, this condition can kill someone if immediate medical attention is not sought. This could explain why there are much diabetes and chronic diseases related deaths among the Australian Aborigines (King, Smith and Gracey, 2009). Implications for nursing practice Nurses have a high impact on management of diabetes and mitigation of diabetes-related symptoms. They are responsible for screening, diagnosing and advising the patients. Nurses advise patients on the type of diet they should take and how they should exercise. Currently, there are few nurses in the Aboriginal dominated regions, especially the very remote regions. Healthcare facilities and hospitals are few in most of the regions. At the same time, most Aborigines do not seek medical attention even those close to healthcare facilities. In that case, the number if nurses in the Aboriginal dominated regions should be increased. Awareness campaigns on the importance of regular screening and tests should be carried out in these regions as well. Nursing based practice should have a positive impact on the number of cases reported and preventing diabetes-related deaths (Department of Health and Ageing, 2010). Current intervention methods Indigenous health is of great concern to the Australian government and Non-Governmental organizations alike. The Australian government has committed to adjust the system to include the Aborigines and other discriminated minorities. The government of Kelvin Rudd is probably one administration that committed to Aboriginal health than any other. Kevin Rudd shocked many people when he openly apologized to the Aborigines for the past injustices during his acceptance speech on December 2007. He also stated that the government was committed to closing the 17 year life expectancy gap between Non-Aboriginal Australians and Aborigines. The Rudd administration formed a Bipartisan cabinet with the opposition in the quest to address the Aboriginal health care problems (Anderson, 2008). This was part of Kevin Rudd’s administration campaign dubbed “close the gap," which was formed as soon as he took office. One unique factor about this campaign was the fact that it was supported by many Aboriginal and Non-Aboriginal organizations and Institutions. This organization started with over twenty institutions and kept on growing. Members of the public supporting this campaign were requested to register through the organization's website. Rudd’s administration gave 1.6 Billion Dollars to be used in the campaign. Additional resources were provided by other members of the campaign totaling to more than five billion dollars (Anderson, 2008). “Close the gap” campaign has been setting goals at the beginning of every year and works towards achieving them. This is important to ensure that this disparity is closed within the next decade (Anderson 2008). The Australian government has also been working with Aboriginal institutions like the National Aboriginal Community Controlled Health Organization (NACCHO) at a national level and a state independent organization like the Victorian Aboriginal Community Controlled Health Organization (VACCHO). The government funds projects that are aimed at providing health care facilities and services to the Aborigines in their communities. There are more than two hundred initiatives currently, which are funded by the government through NACCHO. These organizations are managed by local Aborigines who are elected by the organization's board. NACCHO is very committed to establishing a community health care system to all Aborigines in Australia (Davidson, 2008). The individual state community organizations are structured in such a way that all individuals within the community are involved. The individuals that make the community in a certain region choose the people to represent them on the board of directors; the management committees and other staff work in the organization. Any issues arising from the local community or the national organizations are addressed in a hierarchical system. In this case, issues to the community level are sent to the local office, regional, state and to the national level in that order. Updates from the national level are communicated back to the state, regional, local to community level. The system has been working pretty well and promises to change Aboriginal health if the current pace is maintained (Anderson, et al 2011). McIntyre and Mooney (2008) believe that equality in health care in Australia is achievable. The only thing the government has to do is to be more committed to Aboriginal Healthcare. The Australian government has been trying, and these two authors feel that it can do more. There are many case scenarios in which the government has shown a lot of commitments in other things and has achieved. At the same time, there are many other places where the healthcare system has been made more affordable and accessible to minorities. In fact, Aborigines in Australia are more marginalized health wise compared to countries like Canada and United States (Durey, 2010). It is encouraging that Australian states are taking the initiative to improve Aboriginal health. New South Wales for example has a department that is responsible for Aboriginal healthcare. The departments has been studying the Aboriginal populations within the estate determining their health needs and trying to address them. The idea is to use an evidence based approach to addressing healthcare challenges Aborigines face. Each other state doing the same will improve Aboriginal healthcare decreasing prevalence of conditions such as diabetes (New South Wales Government, 2012). This strategy has worked in some way across Australia. According to the Australian Institute of Health and Welfare, preventive health services are picking up among the Aborigines. Screening, health checks and immunization has increased dramatically among the indigenous people. Thousands were tested. Screened and immunized for the various conditions thanks to the awareness and sensitization campaigns. Though targets have not been reached yet, the pace is good and is expected to continue improving (Australian Institute of Health and Welfare, 2009). Easy supply of food to the Aborigines can greatly improve their health and conditions such as diabetes can be controlled better. Transport networks to regions where Aborigines live are not good at all. Improving the road and transport network will encourage suppliers to serve those regions. Considering that Aborigines are relatively poor, the Australian government can provide subsidized food rations to the Aborigines. There are several non-governmental organizations that are already doing this, and the government can support them to continue with the good course. The Australian government has the resources, network and mechanisms that can deliver better than these organizations (Gracey, 2006). Another thing that can be done is ensuring food security in Aborigine regions. (Socha, 2012). Most places in Australia have good soils in dry parts; horticulture can be used to address food security. The government can provide the necessary resources and expertise for the provision of water, construction materials and storage facilities. These installations can be constructed in every local region. Aborigines near the installation can get access to fresh food, vegetables and fruits at all times. This strategy would be of benefit to the whole country as excess supplies can be exported to other countries, and Australia earns foreign exchange (Pollard, 2013). Aboriginal education needs to be improved. Aboriginals usually suffer because they are not well educated. Their English is poor leading to miscommunication between Aborigines and Non-Aborigines. In fact, this is a big problem in some regions where Aborigines are taught by Non -Aboriginal teachers (Burridge, Whalan, and Vaughan, 2012). The government should consider having the teachers trained the local Aboriginal language, get interpreters or train some members of the local community to be teachers. Another approach that can work is supporting the community-based education system. Funding and provision of necessary resources can be provided to individual Aboriginal communities (Beresford, et al, 2012). Australian healthcare system is one of the best in the world. Aborigines and indigenous Australians are discriminated against limiting their access to health care facilities and services. Many suffer from chronic conditions like diabetes. They earn very little income compared to other Australians making it hard to seek management pills and injections. Addressing challenges faced by indigenous Australians in accessing health services is likely to change Australia for the better. References Abbot, et al. (2010). Barriers and enhancers to dietary behaviour change for Aboriginal people attending a diabetes cooking course. Promotion journal of Australia, 21(1), 33-8. Anderson, I. (2008). Closing the indigenous health gap. Australian Family Physician, 37 (12), 1- 2. Anderson, J., et al. (2011). Strengthening Aboriginal Health through a Place-Based Learning Community. Journal of Aboriginal Health, 7 (1) pp.42-53. Australian Institute of Health and Welfare. (2009). Access to health services for Aboriginal and Torres Strait Islander people. Retrieved from http://www.aihw.gov.au/indigenous-observatory-health-services/ Australian Institute of Health and Welfare. (2012). Australia's Health 2012: The Thirteenth Biennial Health Report of the Australian Institute of Health and Welfare. Canberra: Australian Institute of Health and Welfare. Best, C. (2007). Vic: Health authorities failing fatter Victorians. AAP General News Wire, 1. Beresford, Q.,et al. (2012). Reform and Resistance in Aboriginal Education. Reference and Research books news, 27 (3). Burridge, N., Whalan, F., & Vaughan, P. (2012). Indigenous Education: A Learning Journey for Teachers, Schools and Communities. Research and Refence Books News, 28 (2), p.1. Collins, P. (2010). Progress for Aborigines still too slow, says Rudd. The Irish Times, 1, 10. Davidson, P., et al. (2008). A partnership model in the development and implementation of a collaborative, cardiovascular education program for Aboriginal Health Workers. Australian Health Review, 32 (1), 139-46. Department of Health and Ageing. (2010). Aboriginal and Torres Strait Islander Health Performance Framework: 2010 Report. Retrieved from http://www.health.gov.au/internet/publications/publishing.nsf/Content/health-oatsih-pubs-framereport-toc/$FILE/HPF%20Report%202010august2011.pdf Durey, A. (2012). Reducing racism in Aboriginal health care in Australia: where does cultural education fit? Australian and New Zealand Journal of Public Health, 34 (1). Dussat, F. (2009). Diet, diabetes and relatedness in a central Australian Aboriginal settlement: some qualitative recommendations to facilitate the creation of culturally sensitive health promotion initiatives. Health Promotion Journal of Australia, 20(3), 202-7. Fisher, M. (2012). Australia's constitution permits discrimination against Aborigines. The Ottawa citizen, 1. Ghosh, D. (2012). Functional food and health claims: regulations in Australia and New Zealand. Australian Journal of Dairy Technology, 64 (1), 152-54. Giago, T. (2010). American Indians and Australian Aborigines travel a similar path. McClatchy - Tribune News Service, 1. Colagiuri, P, et al. (2010). The cost of overweight and obesity in Australia. Medical Journal of Australia, 192 (5), 260-264. Gracey, M. (2006). An Aboriginal-driven program to prevent, control and manage nutrition-related “lifestyle” diseases including diabetes. Asia Pacific Journal, 15 (2), 178-188. Hawley, J., & Dunstan, D. (2008). Overweight and obesity in Australia. Medical Journal of Australia, 188 (11), 678-679. Hill, R. (2007). Disadvantaged consumers: An ethical Approach to Consumption by the poor. Journal of Business Ethics, 80, 77-83. King, M., Smith, A., & Gracey, M. (2009). Indigenous health part 2: the underlying causes of the health gap. The Lancet, 374(9683), 76-85. Lee, J, & Kim, M. (2007). The role of GSK3 in glucose homeostasis and the development of insulin resistance. Elsevier, 77 (3). Mansen, M. (2011). Will the declaration make any difference to Australia's treatment of Aborigines? Griffith Law Review, 20(3), 659-672. Marley, J, et al. (2012). Quality indicators of diabetes care: an example of remote-area Aboriginal primary health care over 10 years. Medical Journal of Australia, 197(7), 404-408. Maronne, S. (2007). Understanding barriers to health care: a review of disparities in health care services among indigenous populations. Circumpolar Health, 66 (3), 188-198. McDonald, H. (2006). Eat Kimberly concepts of health and Illness. Australia Aboriginal Studies, 2, 86-97. McIntyre, D., & Mooney, G. (2008). The economies of Health Equity. Cambridge: Cambridge University Press. Nabhan, G. (2006). Why Some Like It Hot: Food, Genes, and Cultural Diversity. Washington D.C: Island press. New South Wales Government. (2012). Aboriginal Health. Retrieved from http://www.health.nsw.gov.au/aboriginal/pages/default.aspx Nolan, Damm, & Prentki. ( 2011). Type 2 diabetes across generations: from pathophysiology to prevention and management. The Lancet, 378(9786), pp.169-81. Pink, B, & Albon, P. (2008). The health and welfare of Australia's Aboriginal and Torres strait islander peoples. Australian institute of health and welfare, 21. Pollard, C. (2013). Selecting Interventions for Food Security in Remote Indigenous Communities. Springer, 1, 97-112. Qiao, Q. (2012). Epidemiology of Type 2 Diabetes. Oak Park: Bentham Science Publishers. Socha, T., et al. (2012). Food Security in a Northern First Nations Community: An Exploratory Study on Food Availability and Accessibility. Journal of Aboriginal Health, 1,1. Speight, J. 2013. Managing diabetes and preventing complications: what makes the difference? Medical Journal of Australia, 198(1), 16-17. Thomas, M, & Nestel, P. (2007). Management of dyslipidaemia in patients with type 2 diabetes in Australian primary care. Medical Journal of Australia, 186 (3), 128-130. Read More