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Social, Behavioural and Cultural Factors in Public Health

Introduction to Health Inequities

There have been health inequity issues in Australia among the non-indigenous Australians and indigenous Australians. In Australia, it is found that the health status of the indigenous population is much better as they get access to many offers and opportunities that are not available or not accessible to the other group of the population (Ewen, Barrett & Howell-Meurs, 2016). According to the World Health Organization (2010), the disadvantages that are faced by the non-indigenous populations are in the following areas: poverty, low life expectancy, and disparities among the distribution of resources. The impact of the Aboriginal Controlled Community Health Services (ACCHS) resulted in a key role to reduce the health inequities by eliminating the barriers that restricted the affected group of the indigenous population to equal rights and benefits. The following sections will discuss the health inequities between non- indigenous and indigenous Australians, factors contributing to them, and the role of ACCHS.

Health Inequities - Part 1

Factors Causing Disadvantages

There are majorly 3 factors due to which the aboriginals in Australia suffer from health disparities. These 3 factors are - economic, and political, and social. The major political issues are associated with the colonization of Australia by the British. According to Smallwood, Wood, Power, & Usher (2020), the implementation of some paternalistic policies during the colonization in Australia led to some unfair and injustice related outcomes specifically concerning aboriginals and few similar negative outcomes/impacts are still observed in the country. These policies aimed to change individual ideology in areas of alcohol, drugs, and reliance on welfare payments, and these policies changed individual ideas and thinking about drugs, alcohol, and welfare. As s result, the indigenous population had to face an extreme level of violence, injustice, and disparities in various fields like racism and violence problems at workplaces, disparities on health care grounds, and the problems associated with marginalization. All these factors resulted in health equities among the two different populations in Australia due to unequal power and resource distribution. Many other negative outcomes were observed due to the political aspects and related policies. According to Panaretto, Wenitong, Button, & Ring (2014), there was increased access to education, employment, homes, and other better lifestyle-related opportunities only for the non-indigenous population. Whereas, the other weaker section of the population faced many economic weaknesses, which ultimately resulted in their poor health and these stress conditions also lead to an increased number of suicide among aboriginals.

According to the Australian Institute of Health and Welfare (2020), the employment rates for the indigenous population were 58% but that for non-indigenous was 73% in 2017. As the disparities were there, employment rates were low and with reduced access to education and lifestyle, the population was unable to prosper and develop. They faced a poor economy, financial hardship, debt, and family breakdown. These factors combine to generate health disparities and the health gap between non-indigenous and indigenous populations. The social determinants are lower levels of education, poorer quality housing, employment, and income. These factors with the increased culture of alcohol intake, obesity, and other related health complications played a major role in keeping the aboriginals restricted from the social equality that ultimately led to the wide gap between the health disparities.

Part 2: The ACCHS Roles For Health Inequities Reduction

The Aboriginal Community Controlled Health Services (ACCHSs) Features

 According to National Aboriginal Community Controlled Health Organisation (2020), an Aboriginal Community Controlled Health Service (ACCHS) is the primary health care (PHC) service operated and initiated by local aboriginals to deliver comprehensive, holistic and culturally effective health care to the community. With the primary health care model, the ACCHS ensures that there is the delivery of equal health services to the population to reduce the health disparities. They intend to reduce the marginalization and racism that led to health inequities among the non-indigenous and indigenous populations. Their characteristics are - providing accessible health services, better management of chronic conditions, flexible approach to care, immunization, adequate nutrition, prevention of illness, treatment of illness, continuing care, and many others (Langham, McCalman, & Matthews et al., 2017).

 ACCHSs Roles

According to Clapham, Bennett‐Brook, & Hunter (2018), the roles of Aboriginal Community Controlled Health Service (ACCHS) are to provide health care services to every group of the society with equal access to quality health care services, comprehensive PHC, health facilities, respectful services, medically appropriate health care, effective treatment, and many others. As a result of this improved and increased access to health services and reduced disparities, it was found that there are many positive health outcomes like increased participation in child health programs, awareness about the child protection programs, care programs for the aged or disables ones, and many others. With the help of ACCHS, the indigenous population gets better access to health services in cases of cancer, eye health, mental health, cardiac and respiratory rehabilitation programs, and many others. It was found by the service data that the use of ACCHSs was more by indigenous populations in regional areas (Stewart & Warn, 2017). Moreover, it was also found that there are an increase in the number of immunizations, improved growth and nutritional status, awareness about the offers and opportunities for health care services, and other community offers (National Aboriginal Community Controlled Health Organisation, 2020). According to Stewart & Warn (2017), it was found that the rates of the better health status of aboriginals, better economic status, and improved lifestyles. Other health outcomes that increased for aboriginals in Australia are – the psychiatric admissions are reduced by 58%, Reduction in vision impairment, and significant increases in mean hemoglobin. All these outcomes are possible with the efforts of ACCHS which is reducing the health inequities. Moreover, ACCHSs also resulted in improved and effective health outcomes for indigenous Australians.

Barriers for ACCHS

There are economic, social, and political barriers that act as roadblocks in the success of the ACCHS in reducing the health gap among the two populations in Australia. According to Paradies (2018), the social barriers are –the aboriginals were not treated equally, racism, discrimination, restrictions for the workplace, employment, education, and many others. These factors socially prevented their growth and development as well. However, with the help of ACCHS, these barriers were removed and health equity was established. The economic barriers are – due to poor education, they did not get employment in workplaces, faced issues like debts, cannot afford travel costs, costs for treatments and medical services, and many others. The political barriers include – the government did not provide sufficient funding for ACCHS and also did not provided much power to ACCHS so that they could remove the issues of health gap and health equities.

According to Sherriff, Miller, & Tong et al. (2019), the policies in Australia increased the generation of socioeconomic inequality resulting in health inequities. The Australian federal, state, and territory governments give inconsistent commitments for the goal of reducing health inequity. Due to Australia’s dominant ideology – neoliberalism, its policy prescriptions increase socioeconomic inequality resulting in health inequities. The neoliberal politics is acting as a roadblock for ACCHSs goals and thereby increasing the health inequities in Australia. Furthermore, it was observed that the government is decreasing the funds for the PHC model of ACCHS every year thereby decreasing its strength to achieve the aim of equal health services for al by reducing the barriers faced by aboriginals. The Australian government should recognize that if the continued reduction in funds for ACCHSs will occur then the goal of reducing the health inequities between non-indigenous and indigenous populations will become very difficult to achieve.

Conclusion on Health Inequities

The health conditions of the Australian indigenous population are comparatively poor as in the case with non-indigenous Australians. They also face many other issues like health disparities that lead to the risk of diseases like cardiovascular disease or cancer, to these individuals. There are majorly 3 factors like economic, political, or social, due to which the aboriginals in Australia suffer from health disparities. These factors also act as roadblocks for ACCHS and PHC models. These models are trying their best to reduce the health disparities and narrow the health gap so that there are no health inequity issues among the non-indigenous and the indigenous populations in Australia. The Aboriginal Community Controlled Health Service (ACCHS) in primary health care (PHC) services are initiated and operated by the local community of aboriginals, to deliver effective, cultural, and holistic improved/equal health care services for the indigenous population. So, to achieve this aim the government should also increase the funds for the models and also put efforts to reduce the barriers to get better and positive results.

References for Health Inequities

Australian Institute of Health and Welfare. (2020). 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

Clapham, K., Bennett‐Brook, K., & Hunter, K. (2018).The role of Aboriginal family workers in delivering a child safety‐focused home visiting program for Aboriginal families in an urban region of New South Wales. Health Promotion Journal of Australia, 29(2), 173-182. DOI: 10.1002/hpja.174

Ewen, S., Barrett, J., & Howell-Meurs, S. (2016). Health disparity and health professional education: a new approach. Medical Science Educator, 26(2), 247-253. DOI: 10.1007/s40670-016-0230-2

Goodman, A., Fleming, K., Markwick, N., Morrison, T., Lagimodiere, L., Kerr, T., & Society, W. A. H. R. (2017). “They treated me like crap and I know it was because I was Native”: The healthcare experiences of Aboriginal peoples living in Vancouver's inner city. Social Science & Medicine, 178, 87-94. DOI: 10.1016/j.socscimed.2017.01.053

Langham, E., McCalman, J., Matthews, V., Bainbridge, R. G., Nattabi, B., Kinchin, I., &Bailie, R. (2017). Social and emotional wellbeing screening for Aboriginal and Torres Strait Islanders within primary health care: a series of missed opportunities?. Frontiers in Public Health, 5, 159. DOI: 10.3389/fpubh.2017.00159

National Aboriginal Community Controlled Health Organisation. (2020). Aboriginal health history.Retrieved from: https://www.naccho.org.au/

Panaretto, K., Wenitong, M., Button, S & Ring, I. (2014). Aboriginal community controlled health services: Leading the way in primary care. The Medical Journal of Australia, 200. 649‐ 52. DOI: 10.5694/mja13.00005

Paradies, Y. (2018). Racism and indigenous health. Oxford Research Encyclopedia of Global Public Health. Retrieved from: https://oxfordre.com/publichealth/view/10.1093/acrefore/9780190632366.001.0001/acrefore-9780190632366-e-86

Sherriff, S. L., Miller, H., Tong, A., Williamson, A., Muthayya, S., Redman, S., & Haynes, A. (2019). Building trust and sharing power for co-creation in Aboriginal health research: a stakeholder interview study. Evidence & Policy: A Journal of Research, Debate and Practice, 15(3), 371-392. Retrieved from: https://doi.org/10.1332/174426419X15524681005401

Smallwood, R., Woods, C., Power, T., & Usher, K. (2020). Understanding the impact of historical trauma due to colonization on the health and well-being of indigenous young peoples: A systematic scoping review. Journal of Transcultural Nursing. Retrieved from: DOI: 10.1177%2F1043659620935955

Stewart, J., & Warn, J. (2017). Between two worlds: Indigenous leaders exercising influence and working across boundaries. Australian Journal of Public Administration, 76(1), 3-17.Retrieved from:https://doi.org/10.1111/1467-8500.12218

World Health Organization.(2010).Indigenous health.Retrieved from: https://www.who.int/healthsystems/topics/financing/healthreport/IHNo33.pdf

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