The Indigenous communities of Australia include the Aboriginals and Torres Strait Islanders communities of Australia. The health outcomes of the people of these communities are inferior to those of other non-Indigenous communities in Australia (Waterworth et al., 2015). On average, the Indigenous males and females respectively live 10.6 and 9.5 years lesser than that of the non-Indigenous females and males (Waterworth et al., 2015). The poor outcomes of health in Aboriginals and Torres Strait Islanders have been utterly attributed to their historical and socio-economic experiences resulting from the political processes that have been taking place in Australia since the early 1800s (Grant et al., 2018). This literature review aims to outline the influence of social, historical, and political processes on the outcomes of health in Australian Indigenous people based on a comprehensive review of recent publications on the related themes.
The historical experiences of Aboriginal and Torres Strait Islander communities have had detrimental effects on their health. Waterworth et al. (2015) performed a study using interviews with 29 Australians supporting the Indigenous groups and demonstrated the factors, which have influenced the health behaviour of Aboriginals and Torres Strait Islanders, including both historical and socio-economic factors. They further elicited that the historical experiences of prejudiced and discriminatory behaviours have led to the development of mistrust and resentfulness in Indigenous communities against the non-Indigenous communities and the government authorities, which is a key factor responsible for the lacking communication leading to the two groups. The lack of communication alleviates the positive impact of non-Indigenous resources on Indigenous Australians’ health (Waterworth et al., 2015). The historical factors still affecting the health outcomes in Indigenous Australians include their past incidences such as stolen generations, issuance of exemption certificates, social and institutional exclusion, exploitation for labour and many more.
From 1788 until today, their territories are frequently taken over by the frontier powers without going into any prior arrangements. Resistance wars were battled between 1788 and 1930s by Indigenous Australians against colonizers looking for their countries, lifestyles, and families. These wars have been precluded from the history, leaving most Indigenous Australians without the information on their history and with the rendered generalization of being incompetent and lazy concerning the fact that they did not fight for their nation. Furthermore, during the early 1940s, the government in Australia issued exemption certificates to Indigenous people, imparting them with the citizenship rights that were otherwise not possessed by them. These included the basic rights enjoyed by other non-Indigenous communities such as attending schools, the allowance to vote, entering hotels, and exemption from the limitations of Indigenous protection laws. However, in return, they were asked to abandon their kinship associations with their communities and culture, except with close families (Grant et al., 2018). As per Waterworth et al. (2015), Indigenous Australians have a desire of retaining their cultural distinctiveness and identity and this cultural obligation influences their health behaviour both positively and negatively by placing physical and psychological demands over their resources.
Additionally, Wewer (2018) reported that Indigenous Australians suffered from another devastating event known as stolen generations, which occurred between 1910 and 1970. The term stolen generations refer to the confiscation of the children of Aboriginals and Torres Strait Islanders done forcefully under the influence of government policies. The primary reason for the stolen generation was the superiority of white people over black people (Wewer, 2018). Moreover, the trauma and loss are still reported to prevail in the Indigenous families who have suffered from this loss, and children residing in these households are rated to have poor health (Treloar et al., 2016). Furthermore, devastating missions, massacres, and reserves took place against Indigenous Australians by the colonisers in the past and the effects of these events still influence their health and wellbeing. These resulted in demolished culture and families. Wewer (2018) further stated that to exclude Aboriginal and Torres Strait Islander people from citizenship participation, they were removed from their homes into reserves like animals under government policies and legislation. Living and growing up in such abusive atmospheres made people traumatised and transmitted intergenerational poverty as a result of poor healthcare, nutrition, and education facilities (Grant et al., 2018).
Social-economical aspects related to the inferior health outcomes in Indigenous Aboriginal and Torres Strait Islander people included the societal and institutional discrimination faced by them (Andrews & Carlson, 2016). Andrews and Carlson (2016) further reported that in their history, indigenous people and places in Australia were given the least authority in the societal hierarchy, as a result of which, Indigenous Australians were at much higher risk of lower employment level as well as increased mental health complications. Moreover, worse mental complications were found associated with the extent of discriminatory experience rather than its type, and extreme psychological agony was shown to be a specific influence of experiencing discrimination (Ferdinand, Paradies & Kelaher, 2015). In addition to this, the availability of affordable and quality healthcare and food facilities to the Indigenous communities is still not adequate, contributing to the disparity in the status of health in non-Indigenous and Indigenous Australian communities (Reath & O’Mara, 2018). This suggests that discriminatory behaviour still exists against the Indigenous communities in Australia.
Deravin et al. (2018) reported that the difference in the status of health of Indigenous and non-Indigenous communities is an international concern and should be given serious consideration and course of action. They further elucidated that governments all over the world are seeking to ameliorate the status of health of Indigenous populations via a range of health initiatives and programs. To overcome this health outcome disparity among the Indigenous and non-Indigenous Australians, a National collaboration consensus known as closing the gap policy was made by the coordinated attempts of state and federal government of Australia (Deravin et al., 2018). Deravin et al. (2018) concluded that notwithstanding the efforts of the Australian Government, the partisanship in the health of Indigenous and other Australian communities will continue in both present and future as social changes take time.
They further demonstrated that while healthy wellbeing is of foremost importance under the closing the gap policy, some objectives lack proper tracking and have a mixture of success and failure. Furthermore, Reath & O’Mara (2018) also stated that even after 10 years of the strategy, closing the gap, which was aimed at eliminating the differences in the life expectancies of Aboriginals and Torres Strait Islanders, the gap between the same has still not closed conspicuously and will approximately take 10 more years. They further suggested that closing the gap requires a better approach implementation following the sincere involvement of indigenous leaders, focussing primarily on the amelioration of social factors influencing health (Reath & O’Mara, 2018).
These shreds of evidence point towards the need for effective communication between the non-Indigenous communities and the Indigenous communities of Aboriginals and Torres Strait Islanders. The cultural differences present between Aboriginals and Torres Strait Islanders and other Australians render the need for effective communication between the government diplomats or the healthcare workers involved in the strategic mission of improving the Indigenous health in Australia. Effective therapeutic communication used by medical staff, providing culturally safe and competent care to Indigenous Australians at the same time can also prove beneficial. Therapeutic communication refers to the patient-centred in-person interaction process between a healthcare professional and a patient, focused on the advancement of both the emotional and physical health of the patient (Martin & Chanda, 2016). Such a communication is wellbeing centred and stress-alleviating for the client resulting in better patient outcomes.
Ample pieces of evidence accumulated through different studies have proven that Indigenous communities of Australia have suffered through various discriminatory daunting events, which have negatively influenced their health outcomes. Although the pre-existing research on the topic is still lacking because the ample evidence present only focuses on the factors leading to the poor health outcomes of the Indigenous populations and not on the ways through which the outcomes can be improved. The discussions related to the policies such as the strategy, closing the gap, also focus on the shortcomings of the policy and not the solutions for the lacking outcomes. Therefore, further research is required to establish a link between the role of the involvement of Indigenous leaders and effective therapeutic communication in the improvement strategies to improve the outcomes of health in Aboriginals and Torres Strait Islanders.
Andrews, G. B. & Bronwyn Carlson, B. (2016). The legacy of racism and Indigenous Australian identity within education. Race Ethnicity and Education, 19(4), 784-807. Doi https://doi.org/10.1080/13613324.2014.969224
Deravin, L., Francis, K., & Anderson, J. (2018). Closing the gap in Indigenous health inequity - Is it making a difference? International Nursing Review. DOI 10.1111/inr.12436
Ferdinand, A. S., Paradies, Y. & Kelaher, M. (2015). Mental health impacts of racial discrimination in Australian culturally and linguistically diverse communities: a cross-sectional survey. BMC Public Health, 15, 401. https://doi.org/10.1186/s12889-015-1661-1
Grant, E., Greenop, K., Refiti, A. L., & Glenn, D. J. (2018). The Handbook of Contemporary Indigenous Architecture. Singapore: Springer.
Martin, C. T., & Chanda, N. (2016). Mental Health Clinical Simulation: Therapeutic Communication. Clinical Simulation in Nursing, 12(6), 209-214. DOI 10.1016/j.ecns.2016.02.007
Reath, J. S., & O’Mara, P. (2018). Closing the gap in cardiovascular risk for Aboriginal and Torres Strait Islander Australians. The Medical Journal of Australia, 209(1), 17-18. DOI 10.5694/mja18.00345
Treloar, C., Jackson, L. C., Gray, R., Newland, J., Wilson, H., Saunders, V., Johnson, P., & Brener, L. (2016) Multiple stigmas, shame and historical trauma compound the experience of Aboriginal Australians living with hepatitis C. Health Sociology Review, 25(1), 18-32, DOI 10.1080/14461242.2015.1126187
Waterworth, P., Pescud, M., Braham, R., Dimmoc, J. & Rosenberg, M. (2015). Factors Influencing the Health Behaviour of Indigenous Australians: Perspectives from Support People. PLoS ONE, 10(11), e0142323. https://doi.org/.10.1371/journal.pone.0142323
Wewer, E. (2018). Man, animal, other: the intersections of racism, speciesism and problematic recognition within indigenous Australia. NEW: Emerging Scholars in Australian Indigenous Studies, 2-3(1), 24-31. http://dx.doi.org/10.5130/nesais.v2i1.1469
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