Health Workforce

The indigenous population in Australia has been closely associated with healthcare inequities and poor healthcare outcomes due to limited access, quality and representation (Jongen et al., 2019). This inequity results in the development of disparity in overall healthcare outcomes of the Indigenous and the non-indigenous populations of Australia. The poor outcomes in healthcare-associated parameters with low life expectancy and a higher incidence of diseases are also associated with the poor representation of the Indigenous health professionals in the care systems (Lai et al., 2018). The poor representation is associated with existing stigma, prejudice, and also with limited education opportunities. This essay will explore the factors associated with the poor representation of indigenous Australians in the healthcare workforce of the country and will discuss its impacts on the health outcomes of the population. This paper will also highlight the actions taken so far, in the last three decades to limit this gap. Further, a brief analysis of the existing barriers to recruitment and retention of the individuals in the workforce of healthcare from the Aboriginal Torres Strait and Islander population will also be discussed in this paper.

The gap in access, availability, and quality of the healthcare caress between the Aboriginal Torres Strait and Islander population and the mainlanders is in common knowledge (Australian Institute of Health and Welfare, 2015). Even with the highly efficient healthcare system of Australia that promises one of the highest life expectancies across the globe, there exists a gap of 7-8 years between the life expectancy among the Indigenous and the non-Indigenous groups of people (Australian Institute of Health and Welfare, 2015). Further, the incidence of diseases is higher in the Aboriginal Torres Strait and Islander population and with limited access to the care facilities. This disparity is also associated with the underrepresentation of the Aboriginal Torres Strait and Islander population in the healthcare system. The group has the highest infant mortality rate, increased drug abuse and high incidence of alcoholism. The population is more likely to develop diabetes and heart disease in between the age of 32-44 that the non-indigenous population (World Health Organization, 2020). According to the government of Australia, Indigenous workforce represents 1.6% of the total health-related workforce in the country and has increased up to 11.6%, with 1,009 indigenous workers per million population in Australia in 2006 to 1,347 per million in 2016 (Wright et al., 2019). The Indigenous population remains underrepresented in the Australian healthcare workforce with limited participation from the Aboriginal Torres Strait and Islander population. The rise in Indigenous population workers and the population rise of the Aboriginal Torres Strait and Islander population has not been parallel (Australian Institute of Health and Welfare, 2015). In terms of the population estimates, there were 221 Indigenous workers per million in 2006 that have reduced to 207 workers in 2016. Moreover, the growth in the number of workers is not holistic and largely restricted only to states of Queensland that witnessed a growth of 4.2% and New South Wales with growth if 6.6% (Wright et al., 2019). The limited representation of Aboriginal Torres Strait and Islander population in healthcare workforce is systematic and present at all levels. For instance, only 1.1 of all the nurses and midwives in the Australian healthcare system were from the indigenous origin and only 0.5% of medical practitioners were from Aboriginal Torres Strait and Islander population (Lai et al., 2018). Therefore, this presents a critical concern regarding the lack of adequate representation and the of the Aboriginal Torres Strait and Islander population in healthcare workforce with impacts on their overall health and healthcare disparity.

Implications of inclusion of Aboriginal Torres Strait and Islander population in the healthcare workforce is massive as there is increasing evidence of how the inclusion of the Aboriginal Torres Strait and Islander population in workforce promotes cultural competence, limits communication gaps, promotes culturally appropriate care, promotes cultural education and promotes better healthcare outcomes for the community (Secombe et al., 2019). The rising gap between the Indigenous and the non-Indigenous groups of people remains a major public health concern for the Government of Australia. Lack of adequate workforce outs direct implications on the care provided to the Aboriginal Torres Strait and Islander population in terms of cultural competence, linguistic and communication barriers, and the quality of care ensured (Jennings et al., 2018). Further, it has also been identified that the existing gap is closely associated with the poor management of chronic diseases that require long term care and facilitation. Lack of adequate Indigenous workforce, therefore, directly affects the overall health of the Aboriginal Torres Strait and Islander population in Australia (George et al., 2019). It has been found that chronic diseases impact the Aboriginal Torres Strait and Islander population at a disproportionately high rate than the Non-Indigenous groups of Australia and accounts for the to thirds of the mortality gap between the Aboriginal Torres Strait and Islander population and the Non-Indigenous groups (Jongen et al., 2019). It has been indicated that the Aboriginal Torres Strait and Islander population is more likely to suffer from asthma, hearing loss, heart conditions, diabetes, etc. at a significantly higher rate (Australia. Department of Health and Aboriginal and Torres Strait Islander Health Workforce Working Group, 2017). The greatest discrepancy is associated with the cardiac and renal diseases. An individual from Aboriginal Torres Strait and Islander population is three times more likely to suffer from diabetes than a non-Indigenous individual (Conway et al., 2017). These implications can be understood with the fact that due to lack of adequate representation of Aboriginal Torres Strait and Islander population in healthcare workforce, linguistic, cultural, and social barriers limit the reach of healthcare access and policies to the Aboriginal Torres Strait and Islander population and thus renders them to be less effectively applied to limit the existing gaps (George et al., 2019).

Several policies and programs have been developed by the Government of Australia that focuses on enhancing the participation of the Aboriginal Torres Strait and Islander population in the healthcare forces. The National Aboriginal Torres Strait and Islander workforce strategic framework 2016-2023 has been designed by the Government of Australia to function of six priority areas to support the health workforce (Australian, 2018). These priority areas include improvement in recruitment of the Aboriginal Torres Strait and Islander population in the healthcare workforce, improvement in workforce skill and capacity, supporting the healthcare sector for culturally safe places and environment for working. The policy aims to improve the graduation and employment rates for the Aboriginal Torres Strait and Islander population, and improving the health and workforce planning and policy development (Cheer et al., 2020). A significant policy that has aimed to woe to promote participation and recruitment of the Aboriginal Torres Strait and Islander population is the “closing the gap” by the Commonwealth of Australia that aims to improve the overall healthcare and provide enhanced job opportunities in sectors to the Aboriginal Torres Strait and Islander population (Topp et al., 2018). However, many public healthcare centres fail to apply these priorities resulting in poor representation of the Aboriginal Torres Strait and Islander population in the healthcare workforce. In 2012, the Government of Australia also initiated national registration for the healthcare professionals from the Aboriginal Torres Strait and Islander population but failed to provide adequate coverage to the population and the workers (Cheer et al., 2020). The limited application of the policies in the public healthcare institutions can be regarded as one of the major concerns associated with the poor representation of the Aboriginal Torres Strait and Islander population in the healthcare workforce of the country (de Witt et al., 2018). Therefore, it becomes crucial to identify the facilitators and barriers that are associated with the recruitment and retention of the Aboriginal Torres Strait and Islander population in healthcare workforce of Australia.

Factors that affect the engagement of the Aboriginal Torres Strait and Islander population in the inclusion in the healthcare workforce include education and training, employment opportunities, racism and stigma, prejudice, family and community responsibilities, stress, isolation, and limited information (de Witt et al., 2018). Considerable research denotes that the workers from Aboriginal Torres Strait and Islander population require cooperation and support from the fellow workers for retainment and employability in the care settings. The Aboriginal Torres Strait and Islander population who work in the healthcare system are often seen as “cultural brokers” that can facilitate improved quality care for the Aboriginal Torres Strait and Islander population by ensuring cultural and social safety when the care is being provided (Australia. Department of Health and Aboriginal and Torres Strait Islander Health Workforce Working Group, 2017). The inputs from the indigenous population can be significant as it can help in the development of the existing care systems, policies and the system reforms for improved care facilitation. The enables associated with the recruitment and retention of the Aboriginal Torres Strait and Islander population include the organizational level factors like coworker support and peer mentorship, present of a culturally safe workplace, and access to clinical and cultural supervision (Lai et al., 2018). It has also been identified that the availability of professional development opportunities and job security with adequate remuneration also play a critical role. In conjunction, personal, and individual factors like motivation to make a difference in Aboriginal Torres Strait and Islander population health also play a critical role (Lai et al., 2018).

Several barriers are also associated with the recruitment and retention of the Aboriginal Torres Strait and Islander population in the healthcare workforce. These barriers can be on structure level and include racism and prejudice in the working setting that reflects lack of respect and stigma and negatively influences the retention rates of the Aboriginal Torres Strait and Islander population in healthcare workforce (Cheer et al., 2020). System-level barriers, like a limitation in the organizational functioning and poor salaried structures, also affect the recruitment and retention of Aboriginal Torres Strait and Islander population in the Australian healthcare workforce. Additionally, limited career pathways are also expressed as a barrier by the Aboriginal Torres Strait and Islander population individuals that impacts the retention (Lai et al., 2018). Barriers associated with the recruitment and retention of the Aboriginal Torres Strait and Islander population in the Australian healthcare workforce can also be analyzed in light of organizational level factors that include heavy workloads and lack of adequate support from the supervisors resulting in poor mentoring (Topp et al., 2018). Lack of professional development opportunities is also seen as a major barrier associated with the retention of the healthcare workers from the Aboriginal Torres Strait and Islander population. Individual-level factors like proximity to the community also play a critical role and determine the engagement of the healthcare professional in terms of retention and service as a healthcare professional (Conway et al., 2017). To limit the barriers and close the existing gap in the healthcare workforce representation of the Aboriginal Torres Strait and Islander population, it is suggested that the healthcare systems of Australia focus on improvement in recognition of the Aboriginal Torres Strait and Islander population professionals in the care facility and apply the suitable policies (Jennings et al., 2018). Cultural safety and mutual respect should be ensured in the workplace to encourage the participation of the Aboriginal Torres Strait and Islander population and their engagement should be enhanced to promote retention and recruitment (George et al., 2019).

This essay provides a succinct discussion on the lack of adequate representation of the Aboriginal Torres Strait and Islander population of Australian in the Australian workforce. This essay acknowledges the lack of representation and identifies its impact on the health of the Aboriginal Torres Strait and Islander population. This essay also identifies the actions taken by the government of Australia to limit the disparity in terms of healthcare professional representation in Australia from the Aboriginal Torres Strait and Islander population. The barriers and the enables that are associated with retention and recruitment of the Aboriginal Torres Strait and Islander population in the Australian healthcare workforce have been identified and suggestions to improve the existing limitations have been recommended.

References for Indigenous Population in Australian Healthcare System

Australia. Department of Health and Aboriginal and Torres Strait Islander Health Workforce Working Group. (2017). National Aboriginal and Torres Strait Islander health workforce strategic framework 2016-2023. https://www.voced.edu.au/content/ngv:77535

Australian Institute of Health and Welfare (2015). The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples. https://www.aihw.gov.au/reports/indigenous-health-welfare/indigenous-health-welfare-2015/contents/indigenous-population-key-points.

Australian, M. (2018). Re-framing the Indigenous kidney health workforce. BMC Nephrology, 18, 310. https://staging.mja.com.au/system/files/issues/211_01/mja250210.pdf

Cheer, K., Lui, F. W., Shibasaki, S., Harvey, A., Grainger, D., & Tsey, K. (2020). The case for a Torres Strait Islander‐driven, long‐term research agenda for environment, health and wellbeing. Australian and New Zealand Journal of Public Health, 44(3), 177-179. https://search.proquest.com/docview/2408562000?accountid=6724.

Conway, J., Tsourtos, G., & Lawn, S. (2017). The barriers and facilitators that indigenous health workers experience in their workplace and communities in providing self-management support: A multiple case study. BMC Health Services Research, 17(1), 319. https://doi.org/10.1186/s12913-017-2265-5

de Witt, A., Cunningham, F. C., Bailie, R., Percival, N., Adams, J., & Valery, P. C. (2018). “It's just presence,” the contributions of Aboriginal and Torres Strait Islander Health professionals in cancer care in Queensland. Frontiers in Public Health, 6, 344. https://doi.org/ /10.3389/fpubh.2018.00344/full

George, E., Mackean, T., Baum, F., & Fisher, M. (2019). Social determinants of Indigenous health and Indigenous rights in policy: A scoping review and analysis of problem representation. International Indigenous Policy Journal, 10(2). https://doi.org/10.18584/iipj.2019.10.2.4

Jennings, W., Bond, C., & Hill, P. S. (2018). The power of talk and power in talk: A systematic review of Indigenous narratives of culturally safe healthcare communication. Australian Journal of Primary Health, 24(2), 109-115. https://doi.org/10.1071/PY17082

Jongen, C., McCalman, J., Campbell, S., & Fagan, R. (2019). Working well: Strategies to strengthen the workforce of the Indigenous primary healthcare sector. BMC Health Services Research, 19(1), 1-12. https://doi.org /10.1186/s12913-019-4750-5

Lai, G. C., Taylor, E. V., Haigh, M. M., & Thompson, S. C. (2018). Factors affecting the retention of indigenous Australians in the health workforce: A systematic review. International Journal of Environmental Research and Public Health, 15(5), 914. https://doi.org/10.3390/ijerph15050914

Secombe, P. J., Brown, A., Bailey, M. J., & Pilcher, D. (2019). Equity for Indigenous Australians in intensive care. Medical Journal of Australia, 211(7), 297-299. https://www.mja.com.au/system/files/issues/211_07/mja250339.pdf

Topp, S. M., Edelman, A., & Taylor, S. (2018). “We are everything to everyone”: A systematic review of factors influencing the accountability relationships of Aboriginal and Torres Strait Islander health workers (AHWs) in the Australian health system. International Journal for Equity in Health, 17(1), 67. https://doi,org/10.1186/s12939-018-0779-z

World Health Organization (2020). Australia’s disturbing health disparities set Aboriginals apart. https://www.who.int/bulletin/volumes/86/4/08-020408/en/

Wright, A., Briscoe, K., & Lovett, R. (2019). A national profile of aboriginal and Torres Strait islander health workers, 2006–2016. Australian and New Zealand Journal of Public Health, 43(1), 24-26. https://doi.org/10.1111/1753-6405.12864

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