The chosen health issue for the Indigenous people of Australia is diabetes. Australia has social and cultural diversity, diabetes is a common health issue common across the country, it is especially prevalent among the indigenous communities (AGDH, 2016). A big gap exists between the current health status of indigenous Australians as compared to non-indigenous Australians. The current health status of the Indigenous people of Australia is discussed in relevance to the mental health issue as there exists a health disparity among the Aboriginal and non- Aboriginal people of Australia. This essay describes the extent of incidences of diabetes experienced by Indigenous Australians in terms of epidemiology, health status indicators, and the measures. This essay will then identify Government/ non- Government health interventions that work towards closing the health gap in terms of incidences of diabetes. The governmental interventions will describe the policies and rules for closing the gap and non- governmental interventions like the interventions from health care professionals such as health promotion strategies will be discussed.
Type 2 diabetes is prevailing among indigenous Australians (AIHW, 2018). Those who have type 2 diabetes their body stops responding to insulin and produced very little insulin. According to the Australian Health Survey one out of every five indigenous Australian adults has diabetes. There are considerably higher rates of diabetes in Indigenous people as compared to non-indigenous people. Indigenous people are four times more likely to get diabetes than the non-Indigenous population of Australia (Diabetes Australia, 2016). The Life expectancy of indigenous Australians suffering from diabetes is 10 years less than the life expectancy of non‐Indigenous people (Azzopardi et al, 2018). Indigenous Australians who have diabetes die before the age of 65 years compared to 19% of non- indigenous Australians (Azzopardi, 2018). The Indigenous adult population is at more risk of dying from diabetes than the non‐Indigenous population of Australia (Azzopardi et al, 2018). It has been reported that the age of onset of diabetes and other cardio-metabolic conditions is developed at an early age that in the non‐Indigenous Australian population (Haynes, 2015).
There is consistent reporting of early onset of type 2 diabetes in indigenous people from different states. There are increasing incidences of diabetes in Australia over the last 20 years however, the Indigenous population of the country has experienced a much higher rate of diagnosis. According to Western Australian data there is a significant discrepancy, where there are 12.6 cases of type 2 diabetes out of every 100000 Indigenous youth of age 16 years or whereas there are only 0.6 incidences in non‐Indigenous youth. The difference is quite striking (Diabetes Australia, 2016). Type 2 diabetes comes with high chances of other comorbidities. 59% of indigenous youth with type 2 diabetes also have hypertension, 61% have obesity and 24% have dyslipidemia. These comorbidities can lead to cardiac, neurological renal, and ophthalmological complications. (Australian Bureau of Statistics).
To address diabetes and metabolic conditions prevailing among the Indigenous population of Australia action plans, better communication and funding are required. It is critical to design interventions to prevent the prevalence of emerging health issues such as diabetes keeping the Indigenous communities into consideration Identifying childhood metabolic disorder to prevent diabetes by intervention before conception (focusing on the general health of sexually mature women), during pregnancy (diagnosing disease early), after pregnancy (improving breastfeeding rate) and in childhood, (encouraging physical activities and proper diet to the child) Spreading awareness through public health messages, e.g. breastfeeding for 4 months and more, cutting down smoking, consuming healthy food in appropriate proportions for young people are possible interventions that can help reduce chances of metabolic disorders. (Van Buren, 2014). According to international studies children of age group 7–10‐ who have a greater chance of having type 2 diabetes should be screened for early diagnosis and managing of the disorder effectively.
Till the end of 18th century indigenous Australians lived as hunters and gatherers but after the arrival of Europeans in 1788, the lifestyle of the indigenous community changed drastically. Colonization and dislocation of the indigenous community caused a significant effect on their health conditions. Traditional activities such as finding food, hunting wild animals, cultural practices changed. Bush medicines and their traditional food became inaccessible. Due to reduced physical activities and poor eating habits: the risk of having diabetes increased in indigenous Australians. The first incident of diabetes in the indigenous community was in 1923.
Indigenous people before this time were fit lean and hunted for food. Studies showed the relationship between change in the lifestyle of indigenous people and increased incidents of diabetes. The first incident of diabetes in the indigenous community was in 1923. Indigenous communities before this time consisted of healthy individuals who hunted for food Today Hunting and fishing are limited due to government policies. Indigenous people started to consume European food. Consumption of processed food, food with low content of fiber, food high in fat and sugar, and reduced physical activity leads to obesity, which are risk factors for diabetes. In today's society a combination of cultural factors, social factors, and health factors contributes to diabetes in indigenous factors. The difference between the health status with regards to diabetes between indigenous Australians and non-indigenous Australians corresponds to the different socioeconomic status of the two groups with indigenous communities being the disadvantaged groups – have a high risk of exposure to health conditions and higher hospitalization and death rates. (AIHW, 2018).
Socioeconomic factors include education, employment, income, housing, services, discrimination, and imprisonment. Health factors that increase the chances of diabetes in indigenous Australians include high cholesterol, high levels of blood pressure, smoking, low levels of physical activities, overweight, and having a poor diet. Fiber and nutrient-rich diet of indigenous people are replaced with a poor diet of snacks, packed juices, packaged food, bread, and canned meat along with the reduced physical activity. Indigenous communities consist of more obese individuals of all ages than non-Indigenous people 69% of all indigenous adults smoke (Australian Bureau of Statistics, 2014). When the body carries an excessive amount of fat, the cells of the body stops responding to the insulin produced by pancreatic cells and this signals the pancreas to produce more insulin. Pancreas ultimately wears out and stops producing insulin leading to the development of diabetes. Diabetes in indigenous Communities has been linked with the incidence of high blood pressure (Angela, 2015). One-fifth of the indigenous population over 18 years of age suffers from high blood pressure.
They have higher risks of diabetes. (AIHW, 2015). Due to high body fat, speed with which the blood pumps through the heart increases. Heart muscles, in the long run wear out. A combination of diabetes and high blood pressure is lethal as diabetes damages the arteries. High blood pressure and diabetes can lead to strokes or heart failure. 69% of indigenous adults smoke (Australian Bureau of Statistics (2014). Smoking increases the chance of diabetes in a person especially type 2 diabetes. The chemical present in cigarettes interferes with the normal functioning of body cells causing inflammation reducing the effect of insulin. When the chemicals present in cigarette binds with the oxygen present in the body, it leads to cell injury also called oxidative stress. Both inflammation and oxidative stress increase the risk of diabetes in a person. The genetic makeup of indigenous was such that in times of scarce food they would retain their body fat to survive however this nature of their genetic system is a disadvantage to them as it promotes weight gain and diabetes.
There have been many governments and non-government interventions in the past decade for curbing diabetes in Australia. National Diabetes Strategy 2000– 2004, which was signed by health ministers of state, territory, and Commonwealth health ministries. This strategy was reported to achieve very less and the National Diabetes Strategies Group of the Commonwealth Department of Health and Ageing was dismissed (Diabetes Australia, 2016). In 2008 The National Preventative Health Taskforce was introduced whose responsibility was to come up with a National Preventative Health Strategy (NPHS). The NPHS main emphasis was on obesity, tobacco smoking and alcohol consumption and other such targets to prevent diabetes. In 2009, a National Partnership Agreement on Preventive Health (NPAPH) with the Council of Australian Governments (COAG) was established. Several targets and actions were set. Targets such as a reduction in alcohol consumption and obesity-specific actions were undertaken (Indigenous health,2016). A $449 million investment was announced by the Australian Government for better diabetes care however; the funding was dropped.
The South Australian Aboriginal Diabetes Strategy for the year 2017 – 2021 was introduced. The strategy consisted of multiple goals to be achieved along with the suggested way to achieve them. These goals were focused on the reduction of incidences of type 2 diabetes, improving diabetes care, reducing complications, and reduction in the number of diabetes cases in pregnancy (SAHMRI 2015). A national diabetes strategy aimed to emphasize the response against diabetes, better identification and early diagnosis, and better quality medicines. Interventions such as cashless debit cards to decrease the consumption of alcohol and gambling, better pricing of healthy food so a nutrient-rich diet is available to indigenous communities in remote locations in Australia. Collaborative efforts between leaders of Indigenous communities and the Australian Federal Government were made to provide $3.3 billion primary healthcare packages. Aboriginal Community Controlled Health Services (ACCHS). These services targeted indigenous communities in Australia and provided better health care for diabetes and positive outcomes in the community. Clinic consultation increased as well as the engagement of Indigenous Australians in health care. Australian National Diabetes Strategy 2016–2020. It focuses on identifying ways to reduce the incidence of diabetes especially in indigenous Australians. Socioeconomic factors are put into consideration to minimize the gap in the health status. The strategy aims to make health care better for indigenous Australians (AGDHl, 2016).
The conclusion drawn is that the difference between the health status of the Indigenous Australians and non-Indigenous Australians are very well recognized. The leading causes of Diabetes in the indigenous community consist of social, political, and economic factors. Historical experiences of colonization and uprooting of Indigenous communities contributes to growing health concern in the indigenous population of Australia, e.g. loss of culture and land, grief and loss, trans-generational trauma, racism, and social exclusion. Preventing and management of diabetes among Indigenous people is very critical since they are at four times more risk of diabetes than non-indigenous Australians. Improving the nutritional status of infants, providing subsidized food, increased physical activity and health awareness among Indigenous Australians are some interventions to tackle diabetes. Health care approaches such as diabetes screening electronic information systems, management protocols, and better access to specialists for remote indigenous groups.
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