Inequality to Aboriginal People in Health and Medical Systems - Essay Example

Running Head: HEALTH INEQUALITIES Health Inequalities [Name of the Writer] [Name of the Institution] Health Inequalities Introduction Inequality to Aboriginal people in health and medical systems has precisely been examined in this essay. Firstly, Aboriginal people have been enduring very inadequate health and medical services. Although many indigenous people have died because of poor health conditions, Australian society has not acted enough at all in the past. But now those citizens who have been questioning about social inequalities in health care to be considered seriously, seem to be a little satisfied now seeing the signs of political breakthrough in health care facilities. Currently Australian Government seem to be adamant to do something about this issue. (Kanitsaki, 2007) This issue has been included in the new health care strategies by the Australian Government 2 The Scottish Office Department of Health, Working together for a healthier Scotland. Cm 3854, The Stationery Office, Edinburgh (1998). are currently available for public consultation. Central to the issue of how such an aim is to be achieved is the setting of targets for reducing inequalities and the selection of indicators to monitor progress towards those targets. Nevertheless, the government has already placed a formal responsibility on health authorities to set local targets to reduce identified inequalities within their boundaries, and to be held to account for making progress towards these targets. This is the first time in Australian history that such requirements have been established. The government has also signalled its intention to introduce legislation to make local authorities responsible for promoting the social and economic well-being of the communities they serve and for working in partnership with health authorities in undertaking this process. These developments are already concentrating the minds of those responsible for translating public-health strategy into practice at both national and local levels in Australia. But this is not merely an Australian preoccupation. Across Europe, the same concerns about health-divides, which in some cases are widening, have pushed the issue higher up the political agenda.” Member states of the European Region of the WHO are in the process of renewing commitments to the Health For All strategy, and are currently debating the setting of equity targets. Several countries have begun intensive assessments of the extent of health inequalities in their populations and some have gone further. For example, Sweden has set up a Parliamentary Commission on Public Health, which is drawing up an equity-oriented national strategy, with subgroups now working on devising targets. There needs to be an emphasis on health education and promotion to prevent Aboriginal people from becoming sick in the first place. (Ring, I.T. and Elston, 1999) Nursing education also needs to include Aboriginal cultural awareness programs and an understanding of the past and its link to current health problems. The health gap between Australia's indigenous and non-indigenous populations is widening. The lack of progress in improving the health of the Aboriginal and Torres Strait Islander population is one of the 'biggest public health failures'. (Ring, I.T. and Elston, 1999) There has been little or no improvement in the health of Indigenous Australians at a time when populations of developed or developing worlds have experienced enormous improvements. According to Mooney et al, (Mooney, G.H., Wiseman, V.L. and Jan, 1998) The Australian indigenous people can expect to live about 17 years less than other Australians, and their mortality rate is three times higher. Australia is now one of the most culturally diverse nations in the world with diversities in ethnicity, race, religion, languages, gender, class and culturally diverse lifeways. (Omeri,2005)Aboriginal Australians represent less than 2% of the total Australian population with an estimated 76% living in large cities and rural towns and 24% distributed through remote rural communities. ( Stanley, F. and Wilkes,1999) The lack of access to health resources for remote or isolated Aboriginal communities contributes to bleaker statistics, including higher death rates from preventable or manageable diseases. Those living in remote areas have 10-20 times higher death rate from specific diseases including diabetes, cervical cancer, parasitic and respiratory diseases. Despite these appalling statistics, the health care system appears to be running a band-aid approach. Linda Bunn, a senior Aboriginal health worker, explains that Aboriginal people are 'lost souls floating around on an alien planet, some are completely alienated from their own traditional culture and yet so entirely out of place in a western world -- they are completely dispossessed'.( D'Alessio, 2003) An Aboriginal person is more likely to have experienced a range of disadvantages including: Low level of income or socioeconomic status Racial abuse Institutional-based discrimination from the justice, education and welfare sectors Deep-seated poor self esteem Personal history of traumatic disruption to family life when young Current experiences of bereavement and grief for family members(Papalia, D. and Olds,2005) Deficits in health care The view of many health professionals about health and illness in the Western medical system fails to acknowledge that it has little meaning for many Aboriginal people. Their medical practices and institutions are shaped by Western theories of illness and subsequent treatment. (Mardiros,2003) Nurses as health professionals are still emerging with degrees and diplomas which reflect medical ethnocentrism. This is partly due to lack of social and cultural perspectives in educational curricula and nursing faculties' entrenchment in the biomedical model of health care. (Angell,2005) Ethnocentrism has been actively absorbed into theory and practice in the discipline of nursing and has become integrated into its institutional practices. In multicultural and multiracial Australian society, nursing as a discipline can be examined against an ethnocentric, as well as gendered, classed and historical background. (Kanitsaki,2005) Deficits in health care delivery should not be interpreted as a criticism of non-Aboriginal nurses. They are part of society at large lacking a much deeper awareness of Aboriginal issues. It also reflects a deficit in current registered nurse programs which include very small amounts of cultural awareness studies. (Bush, A. and van Hoist Pellekaan,2003) Holistic nursing Nurses have committed themselves to the care of the total person and therefore must integrate an understanding of cross-cultural issues into their nursing practice. (Griffin,2003) Holistic nursing models need to encompass health, education, economic, community/social and cultural issues. Madeleine Leininger proposed that cultural assessment skills used by nurses in the United Kingdom incorporated 'cultural congruence' and 'culturally tailored' approaches to ensure culturally relevant and contextually meaningful care for diverse clients. Culturally appropriate and congruent nursing care plans with relevant content and practice will be possible once the nurse discovers clients difference in values, beliefs, and practices relating to health and illness. (Omeri,2005) Education and promotion A greater priority placed on public health services and health prevention would contribute to improved Aboriginal health. Instead of focusing on sick Aboriginal people, Australian health service should emphasise more on services designed to prevent sickness in the first place. Nurses are in a position to be informed, influence radical change and empower health care users. The challenge to work in partnership with the Aboriginal community can create a sense of hope and control which are important determinants of health status.( Pratt, 2003) Nurses can avoid misconceptions and stereotypes if they develop insight and recognise social and political experiences of Aboriginal people.( Spratling,2003) Nurses can use their power as primary health care professionals to celebrate people working together in partnership and ultimately break down barriers. Health education and promotion are part of requirements on which good health can be built. However, there are social and economic factors described as 'health prerequisites' including food, shelter, clean water and finance. Without these even the most appropriate health care system will fail.( Pike, S. and Forster, D.2003) In understanding and reflecting on past and present relationships with Aboriginal people, nursing gains wisdom and insights which illuminate the way of the future and prepare nurses to meet the health challenges that await.( Grogan,2003) Transcultural care The field of Transcultural Nursing was developed by Madeleine Leininger with culture as a major component of care. Care is described as the essence of nursing, essential to healing and curing and is culturally based. Even though Leininger has constructed her theory within the Western paradigm of nursing she offers a theory that poses serious challenges to nursing and its ethnocentric stance in a multicultural and multiracial world. Leininger states that there remains a critical need for Transcultural Nursing in graduate and undergraduate programs.( Tomey, A.M. and Alligood,1998) However, although Transcultural Nursing asserts that key facts can be learned about a culture to enable adequate service provision, how deeply can a person appreciate a culture that they do not belong to?( Polaschek,1998) The education, training and employment of Aboriginal people in Australian health care delivery would be beneficial in providing a better understanding and appreciation of experiences from an indigenous viewpoint. Fran White commented in 1990, that an increase in the amount of Aboriginal registered nurses has the potential to improve the health of Aboriginal Australians (Hayes, B. and Monaghan,2003) People from the same culture are more likely able to provide a culturally safe atmosphere. (Williams,1999) Recognition and respect of Aboriginal cultural values is an essential step for nurses to gain an understanding of the social complexities of Aboriginal society. (Grogan,2003) Respect for another's culture is an important component and consideration for the provision of competent nursing care. Aboriginal culture is a powerful adaptive and therapeutic force, it informs and makes sense out of the present, it provides continuity to the past, it bonds people and communities, and provides identity.( Reser,2001) Cultural safety Cultural Safety is a concept developed by Maori nurses, from an indigenous minority point of view. When defining Cultural Safety, unsafe nursing is referred to as 'any actions which diminish, de mean or dis empower the cultural identity and wellbeing of an individual'. Safe nursing practice involves 'actions which recognise, respect and nurture the unique cultural identity of the Tangata Whenua (Maori) and safely meet their needs, expectations and rights'. Cultural Safety focuses on attitudes which individual nurses bring to their practice, and attempts are made to change their social conditioning used in their nursing approach. Williams argues that there should be regular and compulsory examination of preconceived ideas and stereotypes to overcome racist attitudes and discrimination practices? (Papps, E. and Ramsden,2005) Cultural Safety recognises that the nurse may be the first person a health consumer meets and may engender feelings of reluctance to return. The patient may not take full advantage of 'primary health care' and avoid service until expensive and dramatic secondary or tertiary intervention is necessary. Cultural Safety asserts clients should be treated regardful of their differences and things that make them unique. It ensures health service users are empowered, as it is the patient who decides whether safe or unsafe care has been given. The notion of shifting the power from the nurse in a dominant Anglo-Celtic European health care system to the person who seeks care is a crucial step towards the empowerment of the Aboriginal people of Australia. A greater sense of control is achievable with a wider acceptance and recognition of a valued role for Aboriginal people in Britain society.( Ring, I. and Firman,1998) Cultural Safety is a concept which offers significant advantages from Aboriginal British’s perspective and acknowledges their experience of alienation in a colonised Australia. Conclusion An Aboriginal person living in Australia has less opportunity to live a full and healthy life in comparison to their non-Aboriginal counterparts. Their experience in the past, including policies and attitudes reflect a poor health status in Australia today. The Anglo-European dominance in the health care system and nursing institutions must be realised as a barrier which impedes health access for Aboriginal people. Nurses' contribution to the processes of change in health care provision and the empowerment of Aboriginal people is fundamental to an improvement in the Aboriginal health status. The nurse can focus on education and promotion of health while understanding and respecting the worldview of another culture. Both Transcultural Nursing and Cultural Safety support the view that understanding of culture is both necessary and vital for congruent and safe nursing practice. Nursing in Australia needs to acknowledge the experiences and unique culture of Aboriginal Australian citizens to play a role in improving their health outcomes. References Angell, D. Clients needs and related client services in multicultural Australia, in Transcultural nursing in multicultural Australia, Royal College of Nursing, 2005. Bush, A. and van Hoist Pellekaan, S. Footprints, a trail to survival, in Gray, G. and Pratt, R. (eds), Issues in Australian nursing 4, Churchill Livingstone, 2003. D'Alessio, V. Ethnic minorities: Running a Band-Aid, Nursing Standard, 19:18, 2003, pp.22-23. Griffin, S. A crossroad of care, in Gray, G. and Pratt, R. (eds), Issues in nursing, Churchill Livingstone, 2003. Grogan, G. Transcultural nursing in indigenous Australia, in Transcultural nursing in multicultural Australia, Royal College of Nursing, Australia, 2003. Grogan, G. Transcultural nursing in indigenous Australia, in Transcultural nursing in multicultural Nations, Royal College of Nursing, 2003. Hayes, B. and Monaghan, J. Redressing the imbalance: Facilitating the entry of Aboriginal and Torres Strait Islander people into nursing, in Gray, G. Pratt, R. (ed), Issues in Nursing, Churchill Livingstone, 2003. Kanitsaki, O. Rethinking cultural sensitivity, Nursing inquiry, 2007, pp.11-12. Mardiros, M. Promoting Aboriginal self-determination in health through nursing research, in Gray, G, and Pratt, R. (ed), Issues in nursing 4, Churchill Livingstone, 2003. Mooney, G.H., Wiseman, V.L. and Jan, S. How much should we be spending on indigenous health services for Aboriginal and Torres Strait Islander people? Medical Journal, 1998, pp.508-509. Omeri, A. Transcultural nursing: fact or fiction in multicultural Australia, in Transcultural nursing in multicultural Australia, Royal College of Nursing, Australia, 2005. Omeri, A. Transcultural nursing: fact or fiction in multicultural Australia, in Transcultural nursing in multicultural Australia, Royal College of Nursing,2005. Papalia, D. and Olds, S. Issues and theories of human development, in Gething, L., (ed), Lifespan Development, 2005, McGraw Hill, Roseville, NSW. Papps, E. and Ramsden, I. Cultural safety in nursing, international Journal for Quality in Health Care, 2005, pp.491-497. Pike, S. and Forster, D. (eds) An individual and community focus for health promotion, Churchill Livingstone, Melbourne, 2003. Polaschek, N.R. Cultural safety: a new concept in nursing people from different ethnicities, Journal of Advanced Nursing,1998, pp.452-457. Pratt, R. Black and white together. Breaking down the harriers, in Gray, G. and Pratt, R. (eds) Issues in nursing 4, Churchill Livingstone, 2003. Reser, J.P. Aboriginal mental health: conflicting cultural perspectives, in The health of Aboriginals, Harcourt Brace Jovanovich Publishers, 2001. Ring, I. and Firman, D. Reducing indigenous mortality in Australia: Lessons from other countries, Medical Journal, 1998, pp.528-533. Ring, I.T. and Elston, J. Health, history and reconciliation, Journal of Public Health, 1999, pp.228-231. Spratling, M. Aboriginal community health nursing: Reflections, responses and rewards, in Gray, G. and Pratt, R. (eds), Issues in Australian Nursing 4, Churchill Livingstone, Melbourne, 2003. Stanley, F. and Wilkes, T. Aboriginal health, The Lancet, Online, 351:9115, 1998, p.1573(3), Tomey, A.M. and Alligood, M.R. Nursing theorists and their work, 4th edn, Mosby's, 1998. Williams, R. Cultural safety -- what does it mean for our work practice?, Journal of Public Health, January 1999, pp.213-214. Read More