Topic:”Close the Gap”is a program initiative committed to closing the health and life expectancy between Australian Aboriginal and Torres Strait Islander people and non-Indigenous Australians by 2030. While measurable improvements take time, there have been some demonstrated improvements in reducing smoking rates, improvements in maternal and child health outcomes and behaviours that lead to chronic diseases.
The Australian Aboriginal and Torres Strait Islander have been experiencing disproportionate levels of education achievement, social disadvantage and employment. This has been associated with poor health outcomes as compared to the other Australians, often with lower life expectancy rates than the other Australian communities. To get a clear picture of the Aboriginal health status, it is imperative to consider the Aboriginals historical context. In the past few decades, the healths of Aboriginal people have shifted from being significantly better to worse as compared to the non-Aboriginal people. Research attributes this to the socio economic disadvantage which is a direct consequence of the past practices of exclusion, oppression and dispossession (Zubrick, Holland, Kelly, Calma, Walker, 2014).
In this regard, this essay will critically analyze the current health status of the Aboriginal people in order to identify the improvement, failures and health demands in this population. This will be done by evaluating the various policies introduced by the government with the aim of identifying why the policies have been adequate or inadequate. The essay will focus on “Closing the Gap policy” to explore its relevance in health promotion strategies. The benefits of these strategic approaches will be explored. In addition, the role of nurses in meeting the current and future health demands of Aboriginal population will be explored. The information will be obtained from the sources that are up-to-date including the government reports and all relevant scientific studies.
Critical analysis of current health status of the Australian Aboriginal and Torres Strait Islander
According to information from 2011 census, it is estimated that the total population of Aboriginal and Torres Strait people is 729,048. In 2015, approximately 33% of the populations are major city dwellers and almost half of the population live remotes areas. The population is much younger as compared to the non indigenous population; only 3.5% of the indigenous people are above 65 years as compared to 14% of the non-indigenous (Australian Indigenous HealthInfoNet, 2016).
Fig. 1. Population pyramid: Aboriginal and Strait Islander vs. non indigenous population
By 2014, approximately 17,779 new births registered were Aboriginal and Torres Strait Islander. This indicates that there were about 6 in every 100 births. Approximately 17% of the new births were from teenagers as compared to 2.5% of the non indigenous population. In addition, the babies were likely to be of low weight (below 2500 g) as compared to the non-indigenous population. The low birth weights are associated with increased risk of developing health related problems. The infant mortality rates are 3 times folds that of the national average (Holland, 2016).
The indigenous people are two time likely to be hospitalized as compared to the non-indigenous people. The main causes of hospitalization in young adults below 15 years are respiratory disorders, ENT and injuries. The main causes of hospital admissions in adults are digestive system disorders, injuries from accidents and cardiovascular disorders. Women have higher pregnancy related issues and the reproductive system disorders as compared to the non-aboriginal population. The indigenous populations have shorter life expectancy of about 18-19 years less as compared to the non-indigenous population. The most common causes of mortality include cardiovascular diseases, which are estimated to be two folds that of the non-indigenous population. Diabetes is the most common endocrine health issue, which is approximately six times higher as compared to that of the non indigenous people(Watkins et al. 2014). About 30% of the indigenous people suffer from diabetes. Other causes of mortality include injuries, lung cancer, liver cancer and cervical cancer. This is a clear indication that although indigenous health policy has been the key Agenda on Australian public policies and politics, there are still huge health disparities (gap) between the indigenous health and the non-indigenous health (Australian Indigenous HealthInfoNet, 2016).
The issue of health inequality has been a great concern for Australia. Although the overall health status of Australia has improved, the health status of the indigenous Australians continues to score below those of non-indigenous populations. Although a lot has been done to address the health disparities, the statistics illustrate that the policies established to address the health disparities have been ineffective (Australian Institute of Health and Welfare, 2010, p.29). Information with historical context of the Indigenous Health is scare. However, it is well illustrated that the health status of indigenous population has been poor from the time the European settlers arrived. The indigenous people had no contact with the outside world before colonization; thus, there were minimal incidences of infectious diseases. The arrival of European settlers led to the introduction of new illnesses such as reproductive diseases due to consensual contact of the colonizers (Australian Human Rights Commission, 2011).
In addition, the indigenous health was also largely impacted by the change in diet. For instance, before colonization, the indigenous food consisted of vegetables and animal proteins. They were also physically active as they obtained their food from hunting and gathering. Colonization led to changes in these lifestyles, which led to increase of heart diseases, diabetes and obesity observed among the indigenous people today. Poor mental health is associated with socio-economic disadvantage which leads to substance abuse. The lack of commitment in addressing the mental health has resulted into increased suicidal rates among the indigenous community. In addition, the populations have low access to medical care. This is due to language barriers where voice can be misinterpreted. From my experience, what one would consider as polite is sometimes conceited by other people. Other issues identified includes inadequate health facilities in rural areas and high cost of services such as travelling costs and treatment costs (Steering Committee for the Review of Government Service Provision, 2014).
Anthropological studies indicate that indigenous people have spiritual connection to their lands. Land to the indigenous people connects them to their ancestors. It was their sense of belonging. The colonizers did not understand this world perspective, and when the more they grabbed the land, the more the indigenous people mental health status deteriorated. Their psychological health issues increased when they were forcefully evacuated from their lands into reserves and settlements. This created disturbances from family, which exacerbated their mental health due to low self esteem and low sense of belonging (Gee et al., 2014).
Evidently, the concept of health among the indigenous population is very complicated by the diverse world perspectives of the indigenous and the non-indigenous populations. The lack of understanding between these two populations has led in a series of health policies with the aim of eradicating health inequality among the Aboriginal and Torres Strait population. The first health policy implemented to address the health disparity was established in 1968. There were a total of 35 reforms that were done between the period and 2006. In general, each of amendments was done by various bodies and institutions which had been created to address the disparities issues that had been inadequately expressed previously. However, the main responsibility was allocated to government, which assigned the various programs to the local authorities. The changes in government led to constant changes in the way the health issues were perceived and addressed (Australian Indigenous HealthInfoNet, 2010).
From my analysis on the policies that have been established to adequately address the issue of health disparities among the indigenous population, I found that comparative analysis was used to identify strategies that have been successful in other countries; which would be implemented in Australia. This kind of analysis is very sufficient in some cases, but when it comes to the Indigenous population, such strategies would hardly align to the indigenous populations and culture because our world perspective is complex and unique. Although the health issues incidences are similar to those in other parts of the world, world perspectives impact the indigenous people health and well being very considerably (Gee et al., 2014).
This ideology is well exemplified by the closure of Aboriginal and Torres Strait Islander Commission (ATSIC) in 2004. This led to greater health disparities as the government could not understand the intricacies of indigenous Australian culture as well as the implications of the actions on the indigenous people’s health. Of all the programs that have been implemented to address the health inequalities in Australia, Closing the Gap policy has seems to be the most promising. The policy focuses the concept of health in a different approach, one which perfectly suits the needs of the Indigenous people. The policy is cultural competent and aims to reduce the health inequality gap by 2030, half the children mortality rates by 2018, improve access to education by 2013 and half the unemployment gap by 2018 (Department of the Prime Minister and Cabinet, 2016).
Health promotion strategies: Strategic approaches used to address the challenges
The concept of Closing the Gap policy is an effective approach that is being applied by the government to promote the indigenous well being and health. The governments have acknowledged that to close the gap in health inequalities, it must recognize the rich cultural practices of the Aboriginal and Torres Strait Islander community. This strong cultural identity is very important in promoting the indigenous health as well as their emotional wellbeing. The council of Australian Governments (COAG) has established sustained commitment from all arms of the government, which has led to initiatives that are directed towards seven building blocks including, early childhood, education, establishing effective economic participation, healthy homes, safe communities and in establishing leadership and governance. This is an effective strategy because it is the destruction of the Aboriginal and Australian culture that has led to the despair and confusion which are associated with the irreconcilable cultures (Australian Institute of Health and Welfare, 2013).
For instance, the early child initiatives, the government has established activities that engage with culture, and ones which are essential in the development of resilient Aboriginal and Torres Strait Islander. The Australian Indigenous Psychologists Association (AIPA) increased connection to family, culture and land results to spiritual protection to psychological distress and ill health. This is associated with the wellbeing factors such as kinship networks increases self identity, and self esteem. This is associated with improved academic performance due to reduced school absenteeism due to health issues. The initiatives also aims at improving education and schooling reduces dropout rates, results in better reading and communication skills in both their language and English communication. Research associates low literacy with negative impacts due to language barriers (Parker and Milroy, 2014).
Evidently, the aboriginal people have strong connection with their culture. Research indicates that when these indigenous people participate in cultural activities, it improves their physical and mental health. The National Mental Health Policy 2008 states that such activities improve their cultural identity which connected to lower mortality and morbidity to the population. In this policy, there are initiatives that have been established to allow the indigenous community to participate in activities which promote preservation of their culture (Holland, 2016). This includes activities such as visual arts production, performing in theatre and music. The socio-cultural wellbeing’s have been identified as the building blocks of the overall health of Aboriginal and Torres Strait communities. This is supported by a qualitative study which found out that participation in cultural ceremonies such as the Kanyirninpa reduces suicide and effectively prevents self harm in communities living in the southeast region. This is because such programs are associated with numerous benefits for participants such as capacity building, social capital as well as empowerment through provision of activities that prides in their cultural identity (Department of the Prime Minister and Cabinet, 2016).
In order to help in closing the gap, nurses should understand the statistics regarding the health status on the Aboriginal and Torres Strait community. These includes the birth rates, the death rates, domestic violence and disease incidences. These are the main sources of mental illness, and statics represents the number of lives that have been destroyed by pain and suffering. Societal issues such as drug abuse, poor living conditions and poor socioeconomic status are the leading causes of such diseases. Understanding these statistics will help the nurses establish care plans are cultural competent and safe (Watkins et al. 2014).
The study analysis indicates relative limited progress against the Closing the Gap 2030 policy. Although there is some good report that have led to fundamental improvements in Aboriginal and Torres Strait health outcomes, the government still have a long way in order to effectively address the issue of inequality among the indigenous people. Although an ambitious task, closing health equality by 2030 is an achievable task. Fortunately, it is also the government priority. Over 200,000 Australians supports the policy, which indicates that it is clear that there is high public demand that government must continue to establish partnership with the indigenous people in order to build a close gap platform that will meet this challenge. I believe we can and should be the people to finally close the gap.
Australian Institute of Health and Welfare. (2013). Indigenous statistics: quality and availability. Retrieved from http://www.aihw.gov.au/indigenous-statistics-quality-availability/
Australian Indigenous HealthInfoNet .(2016). Summary of Aboriginal and Torres Strait Islander health, 2015.
Australian Human Rights Commission. (2011). Close the Gap: Indigenous Health Campaign, Australian Human Rights Commission
Australian Indigenous HealthInfoNet.(2010).Major developments innational Indigenous health policy since 1967.
Department of the Prime Minister and Cabinet. (2016). Closing the gap Prime Minister’s report 2016. Canberra: Department of the Prime Minister and Cabinet
Gee, G., Dudgeon, P., Schultz, C., Hart, A., Kelly, K .(2014). Aboriginal and Torres Strait Islander social and emotional wellbeing. In: Dudgeon P, Milroy H, Walker R, eds. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice. 2nd ed. Canberra: Department of The Prime Minister and Cabinet: 55-68
Holland, C. (2016). Close the Gap: progress and priorities report 2016. Canberra: Close the Gap Campaign Steering Committee
Parker, R., and Milroy, H. (2014). Mental illness in Aboriginal and Torres Strait Islander peoples. In: Dudgeon P, Milroy H, Walker R, eds. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice. 2nd ed. Canberra: Department of The Prime Minister and Cabinet: 113-124
Steering Committee for the Review of Government Service Provision. (2014). Overcoming Indigenous disadvantage: key indicators 2014: Table 11A.1.2.6 Alcohol induced deaths (rate per 100 000), age standardized, by sex, NSW, Queensland, WA, SA and the NT, 2008−2012. Canberra: Productivity Commission
Watkins, R.E., Elliott, E.J., Wilkins, A., Mutch, R.C., Fitzpatrick, J.P., Payne, J.M., O’Leary, C.M., Jones, H.M., Latimer, J., Hayes, L., Halliday, J., D’Antoine, H., Miers, S., Russell, E., Burns, L., McKenzie, A., Peadon, E., Carter, M., Bower, C. (2013). Recommendations from a consensus development workshop on the diagnosis of fetal alcohol spectrum disorders in Australia. BMC Pediatrics; 13: 156
Zubrick, S.R., Holland, C., Kelly, K., Calma, T., Walker, R. (2014). The evolving policy context in mental health and wellbeing. In: Dudgeon P, Milroy H, Walker R, eds. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice. 2nd edition ed. Canberra: Department of The Prime Minister and Cabinet: 69-90 (chapter 5)