In Australia, Aboriginal and Torres Strait Islanders experiences poor well-being and health outcomes in the community. The other issues which affect the community growth are like family violence and child abuse (AIFS, 2020). Family violence needs to be understood as both a cause and effect of social deprivation and intergenerational trauma, inadequate parenting, and drug abuse within wider contexts. It remains a crucial issue of social policy and places a huge burden on societies, especially women and children (Lander, Howsare & Byrne, 2013). This essay discusses the social determinants of health and other factors impacting aboriginal populations and individuals facing problems such as family violence.
Family violence is a common issue amongst Aboriginal people and the Torres Strait Islanders community and this type of violence occur within the families. Aboriginal prefer the word 'family violence' as it covers the wide spectrum of kin and marital relationships that may include abuse (NSW Department of Health, 2011). The family violence in the indigenous population can be viewed as violence in the broader community amongst members of their larger family network including grandparents, aunts, uncles, relatives, whereas the non-Indigenous peoples view family violence as merely what happens within the nuclear family. It applies to 'one-on-one hardship, bullying of aboriginal members and injury, self-harm, and suicide. Many Aboriginal people who are victim of family violence had to conceal and/or reject their feelings of pain and desperation to survive over the years. Throughout the family, this trauma has become internalized, revealing itself in harmful actions such as exploitation of family violence, alcohol and drugs and suicide (AIFS, 2020).
The family violence rates in Aboriginal people are likely to be under-reported due to the nature of different types of primary health response, substantial under-reporting by victims to police and incomplete selection of cultural histories of perpetrators (AIHW, 2016). The Australian Burden of Disease Survey found that in family violence, the partner abuse contributed approximately 1.6 percent in Indigenous Australian’s, compared to the non-Indigenous Australians, it was 5 times more. The age-adjusted hospitalization rate for indigenous women in 2014–15 for non-fatal family abuse assaults was 32-fold the average for non-indigenous women (AIHW, 2018). Low functioning and discipline within the family may have major negative impacts on children. Family violence-affected children may have impaired brain development that affects many aspect of their functioning (Atkinson, 2013). Depression and anxiety, cognitive impairment, delays in development, and low academic performance are the adverse effects of family violence on children. In addition, they may include sexually transmitted infections, drug use, homelessness and deprivation for older children and women (Hovane & Cox, 2011).
Social determinants are the circumstances in which people are born, rise, live, work and age. Indigenous Australians are more likely than non-indigenous Australians to have poor health, a low life expectancy, and suffer through health problems during their lifetime. The key factors affecting Aboriginal's health and well-being in the physical environment include: water treatment and availability, access to accessible and nutritious food and food protection, sufficient housing and maintenance, and reducing overcrowding (Davy, 2016). Environment-related health issues include; infectious diseases, cardiovascular and renal disorders, tumours, and skin infections. Culture, social networks, culture, sexism, socioeconomic deprivation, and the psychological distress combines to affect health behaviour. The desire to maintain cultural identity and distinctive features, close social associations with families and children compounded by cultural expectations have an effect on health behaviour (Davy, 2016).
Aboriginal people have considerably lower rates of Medicare Profits and Drug Benefits usage. Higher rates of access to primary care may explain why Australian Aboriginal and Torres Strait Islanders are twice as likely to use hospital ambulance / casualty services as other Australians (AIHW, 2018). Women exposed to domestic abuse are more likely to have physical effects, adverse results in pregnancy, sexually transmitted diseases and abortions in choice. Such results result in poorer physical and mental wellbeing, decreased hospitalizations, decreased use of outpatient treatment for acute conditions and less preventive care. While multiple medical organizations, government agencies, recommend regularly screening for inquiring about domestic abuse, several doctors do not obey these guidelines for various reasons, including lack of expertise, insufficient training and fear of offending patients. People from poor backgrounds make increased use of physicians and outpatient care at hospitals, but are less likely to use preventive health services. Most homeless people, however, do not attend any health service when required (Usta& Taleb, 2014).
The aboriginal people as compared to the non-Indigenous people, faces more health problems causing their morbidity and mortality. Indigenous people get hospitalised more because of the poor health conditions, poor care at hospitals and overall lower access to health interventions. A patient who have come across family violence might not be comfortable in sharing personal details so as nursing staff one need to build a rapport first (Canutoet al., 2018). The confidence and the cordial gestures of the nurse towards the patient will help to build trust and further anxieties and misunderstandings will be avoided in sharing information. Also, as nursing staff one has to be non-judgmental and be approachable by the patient. The tone of voice should be proper and the body language should be non-threatening. So as a good nursing staff the patient body language has to be read carefully. The level of eye contact being used by the patient, follow the patients lead and adjust the body language accordingly. If required the nurses can also counsel the family with considerations of their cultures and beliefs.
Due to lack of facilities such as education and health care services, which are necessary for survival and good healthcare, the aboriginal community is endangered by its life. The existing social issues faced by individuals and families (e.g., alcohol, drug abuse, and family violence), though in the past linked to stress, in effect generate present stress for many indigenous people. So, there is a need that government starts working towards a better health programs for the aboriginals, so that the issues like family violence can be tackled as these are interrelated.
AIHW. (2016).Family violence prevention programs in Indigenous communities. Retrieved fromhttps://www.aihw.gov.au/getmedia/c0e5bdde-e9c4-4a1f-808e-256191835cde/ctgc-rs37.pdf.aspx?inline=true
AIHW. (2018). Family, domestic and sexual violence in Australia. Retrieved from https://www.aihw.gov.au/getmedia/d1a8d479-a39a-48c1-bbe2-4b27c7a321e0/aihw-fdv-02.pdf.aspx?inline=true
AIHW. (2018). Australia's health 2018: in brief. Retrieved from https://www.aihw.gov.au/reports/australias-health/australias-health-2018-in-brief/contents/all-is-not-equal
Atkinson, J. (2013). Trauma-informed services and trauma-specific care for Indigenous Australian children. Retrieved from https://www.aihw.gov.au/getmedia/e322914f-ac63-44f1-8c2f-4d84938fcd41/ctg-rs21.pdf.aspx?inline=true
Australian Institute of Family Studies. (2020).Child protection and Aboriginal and Torres Strait Islander children. Retrieved from https://aifs.gov.au/cfca/publications/child-protection-and-aboriginal-and-torres-strait-islander-children
Canuto, K., Wittert, G., & Harfield, S. (2018) “I feel more comfortable speaking to a male”: Aboriginal and Torres Strait Islander men’s discourse on utilizing primary health care services. International Journal for Equity in Health17 (185), 1-11. https://doi.org/10.1186/s12939-018-0902-1
Davy D. (2016). Australia's Efforts to Improve Food Security for Aboriginal and Torres Strait Islander Peoples. Health and Human Rights, 18(2), 209–218.
Hovane, V., & Cox, D. (2011). Closing the gap on family violence: driving prevention and intervention through health policy. Sydney: University of New South Wales.
Lander, L., Howsare, J., & Byrne, M. (2013). The impact of substance use disorders on families and children: from theory to practice. Social Work in Public Health, 28(3-4), 194–205. https://doi.org/10.1080/19371918.2013.759005
NSW Department of Health, (2011). Responding to family violence in Aboriginal communities. Retrieved from https://www.health.nsw.gov.au/aboriginal/Publications/pub-family.pdf
Usta, J., & Taleb, R. (2014). Addressing domestic violence in primary care: what the physician needs to know. The Libyan Journal of Medicine, 9, 23527. https://doi.org/10.3402/ljm.v9.23527
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