Indigenous Health Disparities in Reproductive Health - Case Study Example

Name Lecturer Task Date Indigenous health disparities in Sexual/ reproductive health Introduction There exist vast disparities between the health of Australia’s indigenous Aboriginals and/or Torres Strait Islanders and the rest of the population. This gap is characterized by a significant worse health status in the indigenous group and sexual health remains a major public health issue for indigenous males and females. Sexuality health has various aspects and influences such as human development, relationships, interpersonal skills, sexual expression and identity, and society and culture. The disparities seen in the aboriginals are attributable to the gaps in socio-economic status such as education levels, income levels and employment status. Other factors that could influence the disparities in sexual health include health behaviour factors, medical conditions, historical factors and environmental factors. Sexually transmitted infections (STIs) are among the major component of sexual health issues among this group. There are male and female specific conditions that affect this group that require nursing care that is able to meet the cultural and behavioral patterns that influence their sexual health(ABS, 2010B & AIHW, 2011). The community nurse together with other health workers has a key role in helping to breach the gap that exist in this group regarding sexual health and overall health. This is by their nursing process, offering culturally sensitive clinical care, health promotion and monitoring of outcomes during provision of care. This requires understanding sexuality and sexual health, the cultural beliefs, perceptions and health seeking behavior as well as the variables that and determine them. Despite the fact that this population represents about 2.5% of the total population (ABS, 2010b), STIs are higher among the aboriginals who have poor health seeking behaviour that allows them to present late often with complications to health facilities especially given that majority of STIs have mild symptoms or are asymptomatic. Some STIs with higher prevalence among the indigenous include Chlamydia, gonorrhea, syphilis, HIV and Herpes virus. Other disparities among the Indigenous population exist, for instance females have a higher number of Chlamydia and gonorrhea diagnoses than Indigenous males which raise issues of other variables that could account for this. The disparities in sexual health, determinants and role of community nurse According to Kirby institute study 2011, though there has been a decline, notifications of STIs were noted to be higher among this group upto four times that of non indigenous group who had 1,257 per 100,000, compared with 340 per 100,000 respectively. At the same time, Chlamydia infections were higher just as gonorrhea which formed more than 1/3 of diagnoses (AIHW &ABS 2008). Syphilis notifications were 12% among Aboriginal this group which still reflects the burden of STI in this group just as genital herpes that has estimated prevalence of 18%, compared with about 12% estimated for the non-Indigenous population. However, the HIV rates were found to be similar for the Aboriginals and the non-Indigenous populations. Other problems in sexual health include erectile dysfunction in males, reproductive health issues for females such as family planning and teenage pregnancies. For instance, Aboriginal women in 2008 were found to have more children and younger ages than non-Indigenous women. 20% of teenagers from Indigenous descent had babies compared with 4% of non-Indigenous women, (Burns J et al, 2010 & ABS 2009). Several cultural beliefs and perceptions influence the pattern of sexual health inequalities that are seen even in presence of primary care services. Stigmatization of sexual problems is common among the aboriginals. For instance, males more often than not remain silent about sexual health problems and at best speak among themselves without seeking health care and mostly wait till the worst happens so as to involve their significant others such as wives, (Michael J A et al, 2007). In this case, complications are inevitable and majority of simple manageable problems and infections may become irreversible. Misconceptions about confidentiality exist. Sexual problems demand confidentiality on the part of care providers and aboriginals present with difficulties in expressing their problems for fear of lack of confidentiality by health professionals. This distorted perception perpetuates the stigma attached to sexual problems and hinders the seeking of health care or misrepresentation of facts (AIHW, 2011). Among the males, the aboriginals have been found to prefer male health care providers who they consider are appropriate to handle their matters. There is a female predominance in the health sector which does not provide a culturally appropriate environment for males to express their sexual problems. Contact tracing helps to curtail STIs which cannot be controlled if such problems are not solved. Those living in remote areas or a non-English-speaking background have language barriers especially men that limit their access to health care (WHO, 2008). The health seeking behaviour among the aboriginals is poor and favors the progression of disease conditions due to inability to seek services early. Feeling of shame and low self-esteem contribute to the delayed seeking of health care and communication difficulties that sees the problems in sexual health among the aboriginals (Lumby & Farrelly, 2009). Reduced access to primary care and specialist services to aboriginals also exists in many rural, regional and remote areas and hence does not appropriately meet their sexual health needs (Thomson N et al, 2010)). There are no appropriate range and quality of primary health care services that are suitable for various age groups. Targeting youth, elderly and women among other groups in delivery of health services would change the attitude of the people and subsequently improve the utilization of health services. Indigenous population has various social determinants that affect sexual health. Limited financial resources contributes to the significant disparities since low income leads to poor education and literacy and inability to use health information causing poor health seeking behaviour and risky health behaviour such as inability to embrace preventive measures of STIs and teenage pregnancies (Hayman N., 2010). Poorer income also limits the accessibility to health care service since they cannot afford the medical services and medications. The level of education is also an important social determinant. Indigenous population has lower school attendance than non indigenous population. More of indigenous males attend school in this group than females across all age groups, (Steering Committee for the Review of Government Service Provision, 2009). The Indigenous females also had lower school completion rates than males. This could partly explain the higher rates of STIs among females than male s due to effect of education on health seeking behaviour. Education helps in understanding sexual health matters and seeking of health care. Poor health behaviors are associated with the lower levels of education prevalent among the aboriginals. Employment levels correlate with income which is influenced directly by level of education. Thus the indigenous group is less employed especially the females since employment rate depends on education level and hence translates to lower economic status which influences access to health services. Geographical location of indigenous population living in remote areas with no public transport, presents difficulties in accessing health services because of transport and distance. In these areas with primary health care services, appointments to these people are not always available on time and were mostly marked with waiting times were too long (ABS 2008). Remote areas also have poor linkages and poor communication limiting coordination of primary health care services as well as restrict their availability. Health service providers are required to display best practice in promoting sexual health and quality outcomes in other primary health care sectors among the indigenous communities (Grew R, 2008). For a community health nurse, there are several roles to be played in line with ethical codes of conduct. Respecting, incorporating and providing culturally acceptable services, is an important role of a nurse in ensuring the gap in healthcare is breached among this group of population. This does not only improves access but also enhances patient-client relationships as well as trust that enhance clinical care [Nguyen 2008]. Understanding the conceptions of personal health regarding social, emotional and spiritual wellbeing, as well as insight into the historical and cultural factors of these people is an important aspect for a nurse to offer effective clinical care. This breaks an important barrier to accessing health services among the aboriginals. Promoting health awareness is another important aspect of nursing care. This will promote access to primary care services by enhancing understanding of when to seek health care or advice (DiGiacomo M et al, 2011). It also encourages health-seeking behaviour as early as possible to avoid complications and for them to experience quality lives (Fahridin & Britt, 2009). This can be provided through outreach services, liaison and community education in partnership with indigenous health workforce. Involving these people in decision making process concerning their health issues is also an important role of nurses to improve health outcomes and breach the existing gaps in health care. This ranges from involving the communities to decide the nature and range of services to be offered till they attain full community involvement in primary care services. This will not only improve the identification existing and emerging health problems but also brings health benefits be creating a strong identity and self-determination among them. This will promote the support of community health programs in sexual health and health promotion (Grew R, 2008). To ensure sustainable and lasting measures to breach the discrepancies, monitoring of outcomes and appropriate follow up cannot be underestimated as an essential part of good clinical care. This is particularly important in indigenous patients who may have multiple and complex sexual needs and conditions in a background of poor of access to health care. This will see a long term improvement in clinical outcomes and entire health care delivery (Phillips, et. al., 2010). Conclusion It is clear from this discussion that Indigenous population has a statistically significant gap in regards to sexual health and entire health status compared with the non indigenous population. This is clearly demonstrated by the burden of STIs, teenage pregnancies, male disorders (such as erectile dysfunction) and other sexuality problems. Various socio-economic variables such as financial factors, education levels, cultural beliefs and perceptions as well as health seeking behaviour are responsible for the observed discrepancies. Other barriers to seeking help for reproductive matters include living in remote areas, feeling shame and stigma regarding sexual matters and lack of knowledge about reproductive conditions. This poor health position is also influenced by accessibility and mode of delivery of health services by the health care providers. The health personnel and specifically nurses have a key role in helping to solve the observed gaps. This include providing culturally acceptable services, promoting health awareness, involving this community in decision making concerning health matters and monitoring outcome during patient care. All these would help breach the gap in health and see a lasting solution to the issues that disproportionately face the indigenous communities. References Australian Bureau of Statistics (ABS). (2010b). The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples. (ABS Catalogue no. 4704.0) Canberra: Australian Bureau of Statistics. 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