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  • Subject Name : Nursing

Social Gradients in The Health of Indigenous Australians

The disparity in health care is not new to anyone and everybody is aware that the Indigenous population has been associated with a major source of discrimination (Shepherd et al., 2012). The pre-invasion period was dominant by the Indigenous population with better physicals and mental health of the population. The population are divided into small chunks and they follow their traditional practice without any forced action that increases their emotional and spiritual wellbeing. The lifestyle before the invasion was close to the land and they are solely dependent on the land for the livelihood. The social determinants before the colonization were not so prominent and they not affected the lifestyle of the Indigenous community (Shepherd et al. 2012).

There has been a great gap between the actual care that is required to address the specific need of the Indigenous population and type of health care services they are getting. There has been a great disparity in the health care concerning the Indigenous population that increase the vulnerability to acquire lifelong disorders. The disparity also increases the social determinant that has a detrimental effect over the health of the Indigenous community and it increases the risk for infectious disorders. The mental disorder is also evident due to the terrifying effect of the colonization that leads to increased risk for depression and anxiety (Bond & Singh 2020).

One of the aspects that Indigenous population are the pride of is the traditional practice and belief that helps them to be connected to the land. Assimilation Policy of 1961 increase the trauma faced by the Indigenous population by forcing the Indigenous population to adopt the white Australian custom. This increases the discrimination concerning the voting right, housing and education that increase the poor health condition of the Indigenous population. The Assimilation Policy of 1961 also leads to the generation of the stolen generation where mixed-blood children are forcibly isolated from their family that lead to thousands of family in pain and traumatic state (Lino 2017). 

The sports are one of the sections of the society where everybody wants to see the equality and equal distribution of the resources to give equal opportunity to every individual. Australian polices and the law has been biased after the colonization toward the Indigenous population that lead to racism in a different sector. The Indigenous individual involved in the sports also faced racism in the selection, field and ranking that has directly decreased their morale and directly impacted the mental health. The players belong to the Indigenous community were negatively commented over the field which directly increases the distress and deteriorates their performance. The bad performance of the Indigenous player was a matter of joke for the other player but the good performance was the physical gifts from them. The discrimination in the field and decrease opportunity in the care decreases the self-efficacy of the players and leads to increase episode of depression and anxiety (Merga & Booth 2017).

 The racism is directly associated with the physical and mental issue which directly decrease the productivity of the individual. The stress that is developed due to the persistent racism leads to the emotional and behavioural issue that has lifelong complication for the individual and family. The racism leads to the establishment of the irrelevant behaviour that leads to the behavioural change due to poor mental health like avoidance, aggression or substance abuse. Racism also leads to the psychological issue that leads to lifetime complication for the individual. The compromised mental health wellbeing directly deteriorates the physical and emotional wellbeing (Vines et al. 2017). The sports racism not only impact the career or ambition of the individual but it leads to the lifetime issue that individual has to face due to irrelevant behaviour of the other individual. The racism leads to the behavioural issue that leads to the negative thought process of the individual that can include decreased trust, feeling disconnected and decreased hope that leads to suicidal thoughts. The unmet need of the individual due to racism in the resources leads to the dissatisfaction from the life which leads to depressive episode and irritant behaviour of the individual. The racism in the adults leads to the persistent presence of the stressor that leads to the increase chances of the high blood pressure which also increase the further physical health lead complication like a heart attack or brain haemorrhage (Harris et al. 2018).

The colonization has greatly impacted the Indigenous community and their mental health which increase the fear of losing their children. Pregnancy and post-partum duration are the most critical time in the life of the mother and children thus require extra care (Brown et al. 2019). The racism in the health care sector directly increases the disparity in the care thus increase the risk for maternal poor health. The antenatal care is considered to be important to keep a track of the mother health with baby growth pattern so that proper care is provided. The discrimination in the health care sector leads to the poor division of the resources which increase the chances of missed right antenatal care that is necessary for the pregnant women’s. The lack of antenatal care leads to the increase complication for the mother like intrauterine growth retardation, preterm birth of the baby or increase the risk for mortality. The physical health of the mother and baby is compromised due to the discriminative behaviour of the health care setting that directly leads to increase the rate of mortality and morbidity in the gestation period or after the delivery of the baby (Brown et al. 2019).

The mother and newborn health are considered to be priority issue as they are more prone to acquire infection or issue but to the racial behaviour in the health care setting Indigenous population face issue while pregnancy and after the birth of the baby. There are evident sing that racism is directly associated with the cognitive and physical impairment of the newborn due to the increased stress and lack of right resources. The racism increases the chances of the mental health deterioration which lead to the depression and anxiety issue in the mother which directly impact the baby growth (Paradies 2018). The data presented by the Centre for Disease Control and Prevention (2019) discussed that due to the racial disparity around 700 women die during the pregnancy duration or as a result of its complication. The disparity leads to the lack of quality of care, coordinate team, transporting facility and an antenatal specialist to assist the issue of the pregnant women. These factors increase the risk of unaddressed issue of the mother which ultimately lead to poor health or increase the risk for mortality. These disparities are needed to be addressed to improve the poor health of pregnant women and newborn child to improve the equity in the care concerning the Indigenous community.

The primary school period is considered to be an important development phase in the children’s life as they are starting interacting, communicating and socializing. The racism in the primary school setting directly impacts the development of the children which lead to poor cognitive and neurological development that can impact lifetime over the individual. The negative behaviour of peers leads to a sense of negativity in the thoughts which lead the child to be isolated and less expressive. The neurological development is highly affected due to the stressor created by the irrelevant behaviour of the surrounding individual. The compromised neurodevelopment includes issue in language and communication or emotional breakdown which add the issue to the child life. The racism negatively impacts the children and thus children faced racism in the primary school has negative behaviour over the dominant group of the society (Myers & Bhopal 2015). Children are considered to be more vulnerable to be a victim of racism due to their constructive thinking process and less understanding toward things thus they are highly impacted by the irrelevant behaviour of the surrounding individuals. The children faced racism also increase the chances of the neurological issue due to persistent stress which has a detrimental effect over the physical health also like balancing issue, memory difficulty and speech impairment. The racism in the primary school not only affects the children but the family also as they are unable to deal with the negative consequence of their children which has life, long impact over the health of the child (Trent et al. 2019). The racial discrimination in the primary school leads to deteriorated neurodevelopment of the child which lead to negative psychological stress response and unhealthy behaviour. The racial episode sometime led to the aggressive behaviour in the children due to overpowering the discrimination which has a negative impact over the health of the child. The primary school children are in their most crucial phase and the irrelevant behaviour lead to development issue followed by the physical issue due to persistent stress. The racism deteriorates the neurological development of the child increase decrease self-esteem of the children and deteriorates the academic performance. Sometimes children also face racial behaviour from the staff of the school that also has a negative impact over the child which led to reluctance behaviour toward school. Sometime due to racism children in the primary school has to face depression and anxiety issue which lead to the social cut-off and psychological distress (Assari et al. 2017).

These findings helped me to analyse the gap in the care concerning the indigenous population and the impact of racism has directly deteriorated the physical as well as mental health. After the study, I realised that there is a need to improve the care that is more culturally safe and competent to address the issue faced by the diverse population. The first aspect that is important to deliver quality and culturally safe care is following the nursing standards that are important to justify the professional role by respecting the different cultural belief. I will try to improve my clinical practice by following the nursing professional standards. Nursing and Midwifery board (2017) proposed the profession standard for the nurse to improve their understanding concerning the professional role and to deliver the quality with cultural safe care. The professional standards include code of conduct, code of ethics and standard of practice that are important to deliver the quality care to the patient. I will try to improve my cultural competent communication skills that are important to respect and understand the different cultural belief of the population. By using cultural competent skills I can improve the conversation with the culturally diverse population that is important to deliver the cultural safe care. The study presented by Brown et al. (2016) effective communication is important to improve the understanding of the patient related to the care and this improves the quality of the care. The cultural competent care helps to improve the way of communication of the health care professional that respects the cultural diversity of the population.

The person-centred approach is important to deliver the cultural safe care thus I will try to incorporate the person-centred approach in the care. The study presented by Santana et al. (2018) discussed that the person-centred approach is important to increase patient participation in the decision-making process to improve cultural safety. The person-centred approach helps the care to be personalized by considering the different cultural belief of the individual to improve the cultural competency in care. I will also try to incorporate the empathy in the conversation that is important to improve the conversation with the culturally diverse population by feeling the issue and assisting them. Empathy is important to feel the emotion of the patient to understand their perspective which is important to deliver the culture safe care. The article presented by Sinclair et al. (2017) health care provides should have empathy in the conversation to improve the patient expression of the issue that is important of person-centred care. The empathy is important to provide the judgmental free environment to the patient which is important to understand the patient perceptive concerning the care. These aspects in the care will help me to incorporate the cultural aspect in the care which helps me to deliver the cultural safe care which is important to improve the equity care that will help to address the gap in the care concerning the Indigenous population.

References for Australian Indigenous Men, Women and Children

Shepherd, CC, Li, J & Zubrick, SR 2012, ‘Social gradients in the health of Indigenous Australians’, American journal of public health, vol. 102, no. 1, pp. 107–117. DOI: 10.2105/AJPH.2011.300354

Bond, CJ, & Singh, D 2020, ‘More than a refresh required for closing the gap of Indigenous health inequality’, Medical Journal of Australia. pp. 1-2. DOI: 10.5694/mja2.50498 

Lino, D 2017, ‘The Indigenous Franchise and Assimilation’, Australian Historical Studies, vol. 48, no. 3, pp. 363–380. DOI:10.1080/1031461x.2017.1313875 

Merga, MK, & Booth, S 2017, ‘Investigating debates around racism in sport to facilitate perspective transformation in the secondary English classroom’, Journal of Transformative Education, vol. 15, no. 3, pp. 184–202. DOI: 10.1177/1541344617692773 

Vines, AI, Ward, JB, Cordoba, E, & Black, KZ 2017, ‘Perceived racial/ethnic discrimination and mental health: a review and future directions for social epidemiology’, Current Epidemiology Reports, vol. 4, no. 2, pp. 156–165. DOI: 10.1007/s40471-017-0106-z

Harris, RB, Cormack, DM & Stanley, J 2018, ‘Experience of racism and associations with unmet need and healthcare satisfaction: The 2011/12 adult New Zealand health survey’, Australian and New Zealand Journal of Public Health. DOI:10.1111/1753-6405.12835 

Brown, SJ, Gartland, D, Weetra, D, Leane, C, Francis, T, Mitchell, A & Glover, K 2019, ‘Health care experiences and birth outcomes: Results of an Aboriginal birth cohort’, Women and Birth. pp. 404-411 DOI:10.1016/j.wombi.2019.05.015 

Paradies, Y. (2018). Racism and Indigenous Health. DOI: 10.1093/acrefore/9780190632366.013.86.

Centre for Disease Control and Prevention, 2019, ‘Racial/Ethnic Disparities in Pregnancy-Related Deaths — United States, 2007–2016’, https://www.cdc.gov/mmwr/volumes/68/wr/mm6835a3.htm

Myers, M & Bhopal, K 2015. ‘Racism and bullying in rural primary schools: Protecting White identities post Macpherson’, British Journal of Sociology of Education, vol. 38, no. 2, pp. 125–143. DOI:10.1080/01425692.2015.1073099 

Trent, M, Dooley, DG & Dougé, J 2019, ‘The Impact of Racism on Child and Adolescent Health’, Pediatrics, vol. 144, no. 2, pp.1-14. DOI:10.1542/peds.2019-1765 

Assari, S, Moazen-Zadeh, E, Caldwell, CH & Zimmerman, MA 2017, ‘Racial discrimination during adolescence predicts mental health deterioration in adulthood: gender differences among blacks’, Frontiers in Public Health, vol. 5. DOI:10.3389/fpubh.2017.00104 

Brown, EA, Bekker, HL, Davison, SN, Koffman, J, & Schell, JO 2016, ‘Supportive care: Communication strategies to improve cultural competence in shared decision making’, Clinical Journal of the American Society of Nephrology: CJASN, vol. 11, no. 10, pp. 1902–1908. DOI: 10.2215/CJN.13661215

Santana, MJ, Manalili, K, Jolley, RJ, Zelinsky, S, Quan, H & Lu, M 2018, ‘How to practice person-centred care: A conceptual framework’, Health expectations: An International Journal of Public Participation in Health Care and Health Policy, vol. 21, no. 2, pp. 429–440. DOI: 10.1111/hex.12640

Sinclair, S, Beamer, K, Hack, TF, McClement, S, Raffin Bouchal, S, Chochinov, HM & Hagen, NA 2017, ‘Sympathy, empathy, and compassion: A grounded theory study of palliative care patients' understandings, experiences, and preferences’, Palliative medicine, vol. 31, no. 5, pp. 437–447. DOI: 10.1177/0269216316663499

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