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A report from Australian Institute of Health and Welfare depicts that indigenous people with socio-economic disadvantage lives in rural and remote locations are likely to be deprived of adequate health services than the other Australian people. The current essay will discussed about the social, economic and political forces that are responsible for health disadvantageous position of the indigenous people. Additionally, the current study will also focus on the role of Aboriginal Controlled Community Health Services (ACCHSs) in addressing the inequity or health disadvantages faced by these people.
Social, economic and political forces contributing to health disadvantages to indigenous people of Australia
The social determinants can be considered as the way of living and working that impact on the health of indigenous people. The main issues that socially affect the health of the indigenous people in Australia are social discrimination, lack of employment, cultural disconnection, lack of education and others. From political viewpoint, it can be stated that inequitable policies lead to inequalities in health which has resulted due to unequal power and resource distribution among non-indigenous and indigenous people (The Power to Persuade, 2020). It is the political failure that there is a lack of system that may act according to the basic human rights of these people.
Colonization has been identified to result in racism, disruption and inequity among the of Aboriginal and Torres Strait Islander cultures. During colonization, some protection policies applied upon these people such as restriction in visiting any place without permission, barring from schools and hospitals, discrimination in wages and others. As a result of this, most of these people experience higher rate of illness and shorter life expectancy. As compared to non-indigenous people, indigenous people are 2.9 times more likely to have long term hearing problem, 2.7 times more likely to have psychological distress and so on (Australian Institute of Health and Welfare, 2020).
In the context of economic wellbeing the indigenous people are disadvantaged also. In order to understand the reason behind the health disadvantages, economic factors such as working capacity, income level are mainly responsible for health backwardness of these people (Gray & Auld, 2018). It has been identified that as compared to 86% non-indigenous students, only 62% indigenous people have reached the education level of 12 grade in the year 2014-15. On the other hand, where 75% of 15-64 aged non-indigenous people are employed, only 48% of indigenous people of this age group are working. It can be stated that as the reach of education is too low for these indigenous people they are unlikely to make healthy choices which improves wellbeing (Department of Health, 2020). It is also difficult for these people to find jobs that may support them in considering healthy lifestyle and to access primary health care services in adequate level.
Key features of the Aboriginal Community Controlled Health Services (ACCHSs) as a model of Primary Health Care delivery (PHC)
The “National Aboriginal Community Controlled Health Organisation (NACCHO)” is the major system that represents 143 “Aboriginal Community Controlled Health Services (ACCHSs)” across Australia in addressing the issues regarding aboriginal health and wellbeing issues. ACCHS is instigated and controlled by Aboriginal community which aims at delivering comprehensive, holistic and culturally appropriate healthcare to the community. The services are delivered by the locally elected management board. This body operates in different remote, urban and rural areas within Australia. This entity employs numerous medical practitioners for serving a range of multi-functional services. The services are relied on the aboriginal health workers and nurses that offer bulk of primary care services to the aboriginal people. Services are often focused on preventive healthcare and educational services.
It works independently from any autonomous body and from the government. This is the primary health care model of ACCHSs which follows the philosophy of holistic view of health and aboriginal community control (Australians Together, 2020). It has been identified that only the involvement of the local aboriginal people and control in health care delivery in addressing the ill health is feasible for reducing the inequities in healthcare of indigenous people.
Role of ACCHSs in reducing health inequity between indigenous and non-indigenous people
ACCHSs are a culturally attuned body that works upon social, medical and cultural needs of the indigenous people effectively. It has been identified that ACCHS plays the major role for improving the health of the aboriginal people through increasing access of the aboriginal people to primary health care. A recent report suggests that this independent body has served with health care services to more than 49% indigenous people in the year 2014-15 (Panaretto et al., 2014). A closer look may provide a clear understanding that 70% of Victorian aboriginal population could access ACCHSs on a regular basis. It has been identified that attracting the doctors to the rural areas of Australia is difficult which is a major concern of this body as this slower the process of reaching with adequate primary healthcare to the indigenous people. There has been a distributional bias towards the indigenous people regarding reaching with primary health care services in rural and very rural areas.
Therefore, ACCHSs show that how important their role is in reaching with essential healthcare services with primary health care services in rural areas. Australian Institute of Health and welfare has identified thirty seven areas in total, where, it is very important to reach with modern health care services to the people unless where inequities may increase the health issues more. ACCHS conducts different programs through which the service utilisation process is enhanced and improved health outcomes have been received (Australian Human Rights Commission, 2020). For instance, ACCHS conducts antenatal programs through which the antenatal attendance are tried to be improved for indigenous women and their babies so that their prenatal outcomes can be improved.
Other areas of primary healthcare have also been provided to the indigenous people expecting better health outcomes. It has been observed that this entity has also developed program through which primary health care services have been provided to the people affected by cancer and other chronic diseases (Daly & Smith, 2018). An integral process has been developed by ACCHSs through which the access of the indigenous students to education has also been enhanced. On the other hand, it has been identified that the rate of treatment adherence has been observed to increase possibly due to the services offered by this entity. For instance, the number of people taking pneumococcal vaccine has been increased to 16% among the indigenous people. It has also contributed to the health policy for the aboriginal or indigenous people in Australia (RACGP, 2020). ACCHSs have advocated on the behalf of the indigenous people so that significantly effective health policy can be developed. Therefore, the main aim of the services provided is top gain improved individual health outcomes and their emotional wellbeing, gaining improved community health outcomes by embedding the services with increasing community skills and involvement to solve the problem they face and providing cultural security while delivering modern healthcare services to the indigenous people.
Barriers that may prevent ACCHSs reducing health inequities between indigenous and non-indigenous people
It has been identified that there are mainly two issues that are creating barrier for ACCHS to reach with effective primary health care services to the indigenous people. This includes transport issues and increased cost. Along with this, lack of sufficient number of health practitioners and others are also potentially harmful for reaching to indigenous people with primary health care services (Department of Health, 2020). It has been observed that there was an issue in developing effective comprehensive healthcare model that can be translated into a useful policy guiding actions of the ACCHS. The main problem faced is in implementation as there is always a requirement for improvement in the accessibility to effective equipment, policies and health care planning.
For instance, there was a lack written asthma care plan due to which people of Torres Strait Islander patients could not be sufficiently provided with required healthcare services. There are other numerous reason tht works has barrier potentially preventing the success of ACCHS to reach with health care services to the indigenous people (Brown, 2019). The program inflexibility due to which implementation in remote areas has suffered was a barrier behind the potential success of this organisation. There are indigenous people that could not be reached with healthcare services as they avoided the return visit which shows a lack of collaboration and support from the indigenous people towards the healthcare services provided by ACCHS (National Aboriginal Community Controlled Health Organisation, 2020). Lastly, insufficient resources and lack of staff training are also the reason that might prevent the ACCHS to provide effective healthcare services to the indigenous people.
In conclusion, it can be stated that the indigenous people in Australia has been disadvantaged in their scope for getting appropriate healthcare, education, employment and others as compared to the non-indigenous people. As a result of this, the death rate and illness rate is high among these people. However, ACCHSs is an independent body that designed and developed supportive services for the indigenous people to reach with educational and health opportunities so that their conditions can be improved.
Australian Human Rights Commission, (2020), Social determinants and the health of Indigenous peoples in Australia – a human rights based approach. Retrieved 26 July 2020, from https://humanrights.gov.au/about/news/speeches/social-determinants-and-health-indigenous-peoples-australia-human-rights-based
Australian Institute of Health and Welfare. (2020), Australia's health 2018: in brief, All is not equal - Australian Institute of Health and Welfare. Retrieved 26 July 2020, from https://www.aihw.gov.au/reports/australias-health/australias-health-2018-in-brief/contents/all-is-not-equal
Australians Together, (2020). Indigenous disadvantage in Australia. Retrieved 26 July 2020, from https://australianstogether.org.au/discover/the-wound/indigenous-disadvantage-in-australia/
Department of Health (2020), 5.2.3 Barriers to accessing health care access, Retrieved 26 July 2020, from https://www1.health.gov.au/internet/publications/publishing.nsf/Content/whdp-09~whdp-09-ch5~whdp-09-ch5-2~whdp-09-ch5-2-3
Department of Health, (2020). Economic Evaluation of the Indigenous Australians’ Health Programme Phase I. Retrieved 26 July 2020, from: https://www1.health.gov.au/internet/main/publishing.nsf/Content/E829D2AE47571554CA2581F4007535E9/$File/Economic%20Evaluation%20of%20the%20Indigenous%20Australians%E2%80%99%20Health%20Programme%20Phase%201%20Report.pdf
National Aboriginal Community Controlled Health Organisation, (2020), About NACCHO. Retrieved 26 July 2020, from https://www.naccho.org.au/about/
Panaretto, K., Wenitong, M., Button, S., & Ring, I. (2014). Aboriginal community controlled health services: leading the way in primary care. Medical Journal Of Australia, 200(11), 649-652. doi: 10.5694/mja13.00005
RACGP, (2020). Inequities in Aboriginal health. Retrieved 26 July 2020, from https://www.racgp.org.au/afpbackissues/2005/200510/200510couzos.pdf
The Power to Persuade, (2020), Political determinants of health must be recognised for Aboriginal & Torres Strait Islanders — Power to Persuade. Retrieved 26 July 2020, from http://www.powertopersuade.org.au/blog/the-impact-of-political-determinants-of-health-must-be-recognised-for-aboriginal-and-torres-strait-islander-women/21/2/2018
Gray, M., & Auld, A. J. (2018). Towards an index of relative Indigenous socioeconomic disadvantage. Canberra, ACT: Centre for Aboriginal Economic Policy Research (CAEPR), The Australian National University.
Brown, L. (2019). Indigenous young people, disadvantage and the violence of settler colonial education policy and curriculum. Journal of sociology, 55(1), 54-71.
Daly, A. E., & Smith, D. E. (2018). The continuing disadvantage of Indigenous sole parents: a preliminary analysis of 1996 Census data. Canberra, ACT: Centre for Aboriginal Economic Policy Research (CAEPR), The Australian National University.
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