Nursing: Indigenous Community Group - Case Study Example

Nursing: COMMUNITY HEALTH AND DIVERSITY Indigenous Community Group (Australia of the Indigenous Community in Australia: The Aboriginal and Torres Island people make up the Indigenous population of Australia. They are found all over in Australia ranging from the large cities to the towns in the countryside and on to very remote areas. Their descent can be traced to numerous distinct groups. They do not have a common language and instead communicate through a host of different languages. The features that are most common among all of the Indigenous population are their poor economic condition and the social disadvantage they suffer from (Themes-Indigenous). In June 2006 the population of Indigenous community in Australia, consisting of the Aboriginals and Torres Strait Islanders was estimated at 517,200 making up 2.5% of the Australian population. The main regions where the Indigenous population are found are in New South Wales, which accounts for 148,200 or 29% of the total Indigenous population and Queensland, which accounts for 146,400 or 28% of the Indigenous population. The region where they constitute a higher proportion of the population is the Northern Territory, where they make 32% of the whole population (The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples, 2008)). In the five years between the 2001 census and the 2006 census there has been a slight improvement in the socio-economic conditions of the Indigenous population. Life expectancy up to the age of 12 years saw an increase to 23% from 20%. The unemployment rate among the Indigenous people, which was 20% in 2001, had dropped to 16% in 2006. In spite of these slight improvements, they fare badly in comparison to the non-Indigenous population. The median weekly equivalized gross income among the Indigenous population was $362, which makes up only 56% of the corresponding income of the non-Indigenous population at %642. Unemployment rate among the Indigenous population is 16%, which is more than three times the unemployment rates of 5% among the non-Indigenous population. Only 34% of the Indigenous population own homes, which is less than half the home ownership rates of the non-Indigenous population at 69% (The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples, 2008). According to Altman, Biddle & Hunter, 2006, the best measure for health status is life expectancy, for life expectancy can be a taken as one of the strongest indicators of over all socioeconomic circumstances, particular when there are wide cultural differences as exists between the Indigenous and non-Indigenous populations in Australia. From this measure the health status of the indigenous people is one area of serious concern. The life expectancy of the Aborigines and Torres Strait Islanders is nearly twenty years less than that of the non-Indigenous population in Australia. In comparison the life expectancy Indigenous populations in the United States of America, Canada and New Zealand is only seven years less than the life expectancy of the non-Indigenous population, highlighting the marked difference on the negative side of the Indigenous population in Australia. There is much higher rate of incidence of chronic diseases in the Indigenous population in Australia, than found in the non-Indigenous people and more alarming is the occurrence of these chronic diseases at a much younger age in the Indigenous people in comparison to the average age of occurrence in the non-Indigenous population. Several factors have been attributed for the poor well-being of the Indigenous people in Australia. These factors are dispossession, poor levels of education, poor socio-economic status, unhealthy life styles, prejudice and discrimination, poor environmental conditions and the lack of involvement of the Indigenous people in the policy and decision making processes (Smart Health: Reforming community health services in Queensland). The poor state of affairs with the Indigenous people traces back to the colonial times and the subsequent treatment meted out to them even after the colonial days. Though the Commonwealth Government laid out benefits in several sectors and even in health for the socio-economic backward communities, these benefits were racially rationed at the implementation level and the Indigenous population was excluded from these benefits. (Anderson et al, 2006). Health differentials are not jus a part of the developing world, but a part of the developed world too and the Indigenous population of Australia stand out as an example of this. According to Kenneth, Bridget and Theo, 2007, evidence from studies suggest that the Indigenous population of Australia suffer far greater health differentials than is found in the Indigenous populations of other developed countries. 2. Respiratory Disease in the Indigenous Population: Respiratory disease is among the common chronic illnesses seen in the Indigenous population in Australia (O’Connor, 2006). Respiratory disease has been found to be a major cause of morbidity and mortality among the Indigenous people of Australia. Evaluation of the ten year period 1983 to1993 age standardized hospital admission rates in Australia show that that these admission rates were 4.5 times greater for Aboriginal men and 8.8 times greater for Aboriginal women than the non-Indigenous population of Australia. Among the Indigenous people diseases of the respiratory system are responsible for 12.2% of the hospitalization of men and 8.7% in women. Standardized mortality ratio in 1991 for respiratory diseases was 5.2 in the case of the Indigenous men and 6.0 in the case of the indigenous women. Lower levels of lung function and a history of asthma was common in many of the children and adults of the Indigenous population. The lower lung growth along with cigarette smoking, poor nutrition, overcrowded residences and poor environmental conditions are factors that contribute to the inequality in respiratory health between the Indigenous and non-Indigenous populations in Australia (Musk et al, 2008). More recent statistics on respiratory diseases show that there has been no marked improvement in respiratory health of the Indigenous people in comparison to the non-Indigenous population in Australia. The 2004-2005 NATSIHS data shows that the proportion of the Indigenous population who had some form of respiratory disease and reported it was 27%, which only shows a drop of 2% from the data of 2001. Asthma was the most frequently reported respiratory disease in the Indigenous people at 15%. After making the necessary allowances for age differences between the Indigenous population and the non-indigenous populations in this data it showed that Indigenous people were twice as likely to suffer from some form of respiratory disease and 1.5 times from asthma, than the non-Indigenous populations (The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples, 2008). The onset of respiratory diseases in the Indigenous population is markedly more frequent early in life in comparison to the non-Indigenous population (Moore et al, 2007). The Western Australia Data Linkage System (WADLS), which contains a systematic record of health data with clear demarcations of the Indigenous and non-Indigenous populations allows for a clear understanding of this early onset of respiratory diseases in the Indigenous population of Australia. This data clearly shows that acute lower respiratory tract infections are responsible for 21% of all the hospital admissions in children for infections before the age of two years. It also demonstrates that there is a marked difference in these hospital admissions on the higher side for the non-Indigenous population of Australia in comparison to the non-Indigenous population. The most plausible reason for this is the inequality in availability of health services to the Indigenous population and health services utilization by the non-Indigenous population (Moore et al, 2007). Tonkinson, 2007, using the Mardu Aboriginal people of the Australian Western Desert area as an example, shows the gulf that exists between the aspirations and way of life of the people and the policies of the Australian government, as a reason for the under utilization of the facilities offered to the Indigenous population. These facts make up the rationale for the choice of respiratory disease in the Indigenous population as the target for intervention. Factors that contribute to poor respiratory health in the Indigenous population have been identified by Musk et al, 2008, as poor nutrition, overcrowded residences, poor environmental conditions and the life style factor of smoking. Poor health related behaviours contribute to a large way in the poor health status of the Indigenous people (Burke, et al, 2007). A major factor that exacerbates respiratory diseases in the Indigenous population is the high prevalence of smoking. In 2005-2005 nearly half the Indigenous in Australia smoked on an average, one or more cigarettes per day, showing that the prevalence of smoking in the Indigenous population had not come down since 1995 in spite of efforts taken to reduce smoking in the population. Men and women of the Indigenous population demonstrate higher prevalence of smoking in all age groups in comparison to the non-Indigenous population (National Aboriginal and Torres Strait Islander Health Survey, 2004-05). 3. Nursing Intervention to Improve the Health of the Indigenous Population: The Jakarta Declaration on Leading Health Promotion into the 21st Century provides a framework for planning nursing interventions to improve the health of the Indigenous people through its five priorities of promoting social responsibility; increasing investments for health development; consolidating and empowering partnership for health; increasing community capacity and empower individuals and secure infrastructure for health promotion (Jakarta Declaration). The first intervention strategy is to promote the awareness of the factors that are responsible for the poor respiratory health in the communities of the Indigenous population of the Australia. The essence of the poor health of the Indigenous population lies in the backward socio-economic status and interventions to improve their health need to target this feature of their existence (Cooke et al, 2007). Hence and added factor in the intervention is the understanding that needs to be created on the impact of socio-economic factors on respiratory health. Increasing the contact and communication with Indigenous people is the strategy that will be employed. Keeping the education on respiratory health to realistic terms is expected to help the intervention to be a success, while the language barriers and the distances involved in contacting some of the communities are expected to act as a deterrent to the success of the intervention (Sawyer & Shah, 2004). Social and health workers already working with targeted communities will be the source of additional assistance. The criteria that would be employed to verify the success of the strategy would be the reduced gap in respiratory health status between the Indigenous population and the non-Indigenous population. The second intervention strategy will be to make available additional financial investments by the authorities for the targeted improvement in respiratory health. The strategy used for this will be to convince the coordinators of the existing health improvement programs for the Indigenous populations to invest in this community intervention. Convincing the authorities for this investment in this community intervention strategy is expected to be a stumbling block to be overcome, for which the decision makers of the community will be roped in for assistance towards the strategy (Sawyer & Shah, 2004). Criteria for the assessment of the success of the strategy will be the availability of finances for the intervention strategy. Within the first two interventions involvement and cooperation of the social work organizations and the government is expected to be achieved and the next intervention will be to ensure cooperation of the community, the families within the communities and the individuals in the family. To ensure this intervention the strategy will be to make the members as far as possible knowledgeable of the cultural gap and the resistance to whiteness that abounds in the Indigenous people and also try and incorporate as many of the social workers from the Indigenous community as part of the intervention team (Martin-McDonald & McCarthy, 2007). The anticipated stumbling block is the built in resistance to policies and measures viewed as in the scheme of things of the white population (Martin-McDonald & McCarthy, 2007), The criteria of success will be measured by the percentage of families and individuals within the community willing to be part of the intervention strategy. The fourth intervention will be empowering the individual to maintain good respiratory health and thereby improving the health of the community as a whole. The strategy used here will include the gaining of cooperation of the elders of the community to spread the means to respiratory health among each individual. According to O’Connor, 2006, health practices in the communities of the Indigenous people are inculcated by the elders through the stories they tell the younger generations. Assessment of the success the intervention will be based on the quantum of support received from the elders in each community. The final intervention will be to ensure that continuous support for improving the respiratory health of the Indigenous communities through the creation of adequate infrastructure. Health of the Indigenous population is a national requirement and not just a requirement of the government. Hence this strategy will involve getting the support and cooperation of non-governmental agencies (NGOs) working for the uplifting of the Indigenous population for the required infrastructure. The assessment of the success will be based on the support received by the NGOs. Literary References Altman, C.J., Biddle, N. & Hunter, H.B. (2006). A HISTORICAL PERSPECTIVE ON INDIGENOUS SOCIOECONOMIC OUTCOMES IN AUSTRALIA 1971-2001. Australian Economic History Review, 45(3), 273-295. Anderson, I., Crengle, S., Kamaka, L.M., Chen, T., Palafox, N. & Jackson-Pulver, L. (2006). Indigenous Health in Australia, New Zealand and the Pacific. Lancet, 367, 1775-1785. Burke, V., Zhao, Y., Lee, A.H., Hunter, E., Spargo, R.M., Gracey, M., Smith, R.M., Beilin, L.J. & Puddey, I.B. (2007). Health-related behaviours as predictors of mortality and morbidity in Australian Aborigines. Preventive Medicine, 44, 135-142. Cooke, M., Mitrou, F., Lawrence, D., Guimond, E. & Beavon, D. Indigenous well-being in four countries: An application of the UNDPS Human Development Index to Indigenous Peoples in Australia, Canada, New Zealand, and the United States. BMC International Health and Human Rights, 7(9), Retrieved May 11, 2008, from, BioMed Central Web Site: http://www.biomedcentral.com/1472-698X/7/9 Jakarta Declaration. 2007. Retrieved May 11, 2008, from Queensland Government Web Site: http://www.health.qld.gov.au/chipp/what_is/jakarta.asp Kenneth, H., Bridget, B. & Theo, V. (2007). Excess Indigenous mortality: are Indigenous Australians more severely disadvantaged than other Indigenous populations? International Journal of epidemiology, 36(3), 580-589. Martin-McDonald, K. & McCarthy, A. (2007). ‘Marking’ the white terrain in indigenous health research: literature review. Journal of Advance Nursing, 61(2), 126-133. Moore, H., Burgner, D., Carville, K., Jacoby, P., Richmond, P. & Lehmann, D. (2007). Diverging trends of lower respiratory infections in non-Aboriginals and Aboriginal children. Journal of Paediatrics and Child Health, 43, 451-457. Musk, A.W., James, L.A., Palmer, J.L., Ryan, G.E., Lake, F., Golledge, L.C. & De Klerk, H.N. (2008). Respiratory infections and lung function in an Australian Aboriginal community. Respirology, 13, 257-262. National Aboriginal and Torres Strait Islander Health Survey, 2004-05. 2006. Retrieved May 11, 2008, from, Australia Bureau of Statistics Web Site: http://www.abs.gov.au/AUSSTATS/abs@.nsf/ProductsbyCatalogue/C36E019CD56EDE1FCA256C76007A9D36?OpenDocument O’Connor, G. (2006). Chronic Disease Among the Indigenous Population of Central Australia. Prevention of Chronic Disease. Retrieved May 11, 2008, from, CDC http://www.cdc.gov/pcd/issues/2006/apr/05_0205.htm Sawyer, M.S. & Shah, S. (2004). Improving asthma outcomes in harder to reach populations: challenges for clinical and community interventions. PAEDIATRIC RESPIRATORY REVIEWS, 5, 207-213. Smart Health: Reforming community health services in Queensland. 2007. Retrieved May 11, 2008, from, Community Health Services Reform Project. Queensland Health. Queensland Government Web Site: http://www.health.qld.gov.au/chsrp/docs/chsrp_lit_rev.pdf The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples. (2008). Retrieved May 11, 2008, from, Australia Bureau of Statistics Web Site: http://www.abs.gov.au/AUSSTATS/abs@.nsf/39433889d406eeb9ca2570610019e9a5/8EAED54CF195A511CA25743900149D41?opendocument Themes-Indigenous. 2008. Retrieved May 11, 2008, from. Australia Bureau of Statistics Web Site: http://www.abs.gov.au/Websitedbs/c311215.nsf/20564c23f3183fdaca25672100813ef1/0179c2b24398e077ca2570a8000945d2!OpenDocument Tonkinson, R. (2007). Aboriginal ‘Difference’ and ‘Autonomy’ Then and Now: Four Decades of Change in a Western Desert Society. Anthropological Forum, 17(1), 41-60. Read More