Social, Behavioural and Cultural Factors in Public Health

Introduction to Health Inequities Between Indigenous and Non-Indigenous Populations

The Australian indigenous population has worse health conditions whereas the non-indigenous Australians have a better health status. According to the World Health Organization (2010), they face many disadvantages like poverty, disparities among the distribution of resources, and low life expectancy. In access to the treatment, they face health disparities that are observed in many serious illnesses like kidney disease, cardiovascular disease, cancer, and oral health. The contrast between non-indigenous Australians and indigenous Australians are specifically in three areas that lead to health gap: social determinants, health risk factors, and acquire the chances to use appropriate health services. According to Waterworth et al. (2015), many forces contribute to health inequities. However, the Aboriginal Controlled Community Health Services (ACCHS) plays a role to reduce the health inequities by reducing the barriers that prevent access to comprehensive, intervention, and early care for indigenous people. The sections below will discuss in brief the health inequities between non- indigenous and indigenous Australians, factors contributing to them, and the role of ACCHS in reducing the same.

Part 1 - The Health Disadvantages Causing Factors

The health disadvantages suffered by aboriginal Australians are because of some factors: economic, and political, and social (Panaretto et al., 2014). According to the Australian Institute of Health and Welfare (2020), the social determinants affecting the indigenous populations in Australia are income, poorer quality housing, lower levels of education, and employment than in comparison to non-indigenous populations. The economic factors are - the unemployment rates rose for both non-indigenous and indigenous Australians between 2008 and 2012–13, but the rate for indigenous people raised more with 11.7 percentage points. Therefore, poor economy, low education, and employment levels ultimately result in poverty, financial hardship, family breakdown, and debt. These will impact the health access and opportunities creating a gap between non-indigenous and indigenous populations (Harfield et al., 2018).

According to Smallwood et al. (2020), the political factor, during colonization when the British implemented paternalistic policies which are evident even today in Australia. These policies restrict individuals to make choices with their consent. These policies aimed to change individual ideology in areas of alcohol, drugs, and reliance on welfare payments. These lead to the indigenous population becoming the victims of extraordinarily high levels of violence at the work-place, racism, marginalization, and disparities on health care grounds. Such inequalities in policies resulted in health inequities as there was an unequal distribution of power and resources. According to the National Aboriginal Community Controlled Health Organisation (2020), the families of aboriginal children were removed or separated at a high rate than the non-indigenous children. Due to deplorable outcomes of such politically advantageous policies, the indigenous population started committing suicide at a high rate (Panaretto et al., 2014). It was also found that less indigenous were employed than the non-indigenous, if no education or no employment than economic strength weakens, resulting in fewer chances of getting a healthy lifestyle and ultimately health inequalities (National Aboriginal Community Controlled Health Organisation, 2020).

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 an in primary health care (PHC) services operated and local Aboriginal community initiates it, to deliver comprehensive, cultural, and holistic appropriate health care services for the indigenous community. ACCHSs along with their PHC model of care that ensures comprehensive health care and community governance, ACCHSs have reduced barriers for indigenous Australians to use health care, unintentional racism, and the individual health outcomes are also improving at an effective rate for indigenous Australians. According to Campbell et al. (2018), the services of varied varieties are known as primary (health) care services within the Australian context. For such services of health care, the major providers are community health services, general practices provided by the general practitioner as a care provider, and aboriginal medical services. The characteristics of PHC include health workers collaborating in teams, patient/family centeredness, proactive preventive focus, better management of chronic conditions. These are necessary for indigenous Australians because the indigenous populations are living below the poverty line, hence the services are unattainable for them (Paradies, 2018).

The ACCHSs Roles

According to VicHealth (2018), ACCHS are designed to provide effective cultural health care, with Aboriginal staff and culturally trained staff, to ensure that clients feel comfortable when they seek health care and to eliminate discrimination within services. ACCHSs focus on prevention, comprehensive care, and early interventions have reduced barriers to unintentional racism and access, resulting in improved health outcomes of the indigenous population of Australia. It was found by the service data that the use of ACCHSs was more by indigenous populations in regional areas. According to World Health Organization (2010), based on the Australian Bureau of Statistics – the data showed that a high number of aboriginals were accessible to services like employment or health care access and were using the services as well.

With the help of the ACCHS programs the Aboriginal people get increased access to cardiac and respiratory rehabilitation programs, cervical cancer screening, eye health, mental health, sexual health, increased access to various programs like child care programs, child protection and care programs for the aged or disables ones. These were few out of many identified benefits of ACCHSs for Indigenous Australians. Moreover, ACCHSs also resulted in improved and effective health outcomes for indigenous Australians. According to Campbell et al. (2018), the improved health outcomes include high smoking cessation rates, an increase in immunization rates, more awareness about healthy eating and cooking skills, a reduced oral antibiotic, and improved growth and nutritional status. 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 services and access to aboriginals show that ACCHSs contribute towards reducing health inequities (Stewart & Warn, 2017).

 The Barriers That Might Prevent ACCHSs 

 The barriers that might prevent ACCHSs are as follows:

Economic barriers – many aboriginals of Australia live life in poverty as a result they cannot afford the cost of PBS payments, doctor fees, payments for online appointments, travel costs, and many others (Paradies, 2018). Social barriers – such populations do not get easy access to offers and opportunities as in comparison to non-indigenous populations. As a result, they do not get proper education, equal access to employment offers, suffer from racism and discrimination, resulting in a big barrier for ACCHSs to reduce the health inequities for indigenous populations (Smallwood et al., 2020). Political barriers – if ACCHSs are granted autonomy and increased government funding, several political barriers like the policies that restricted aboriginals from equal health care services and opportunities, and other barriers will be removed.

According to Smallwood et al. (2020), the researchers concluded that 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. Moreover, government funding is always important for any health care program or service (Sherriff et al., 2019). 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. However, despite the commitment to Closing the Gap in 2008, funds have been reduced increasingly resulting that the goals of ACCHSs will not be met (Conigrave et al., 2020).

Conclusion on Health Inequities Between Indigenous and Non-Indigenous Populations

The Australian indigenous population has worse health conditions whereas the non-indigenous Australians have a better health status. The health disadvantages suffered by aboriginal Australians are because of some factors: economic, and political, and social. 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. The barriers that restricted the indigenous populations to health care, possess them to face discrimination, and racism, are resolved by ACCHSs and PHC and they are also progressively improving individual health outcomes for indigenous Australians. Moreover, ACCHSs also contribute to better health outcomes for Indigenous Australians. However, these face many barriers to achieve their goals like the government funding is getting reduced with every year resulting in difficulty to lower down the inequities in the field of health care or health services between the non-indigenous and indigenous populations.

References for Health Inequities Between Indigenous and Non-Indigenous Populations

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

Campbell, M. A., Hunt, J., Scrimgeour, D. J., Davey, M., & Jones, V. (2018). Contribution of aboriginal community-controlled health services to improving aboriginal health: An evidence review. Australian Health Review, 42(2), 218-226. Retrieved from: http://www.amsj.org/archives/3012

Conigrave, J. H., Lee, K. K., Zheng, C., Wilson, S., Perry, J., Chikritzhs, T., & Hayman, N. (2020). Drinking risk varies within and between Australian Aboriginal and Torres Strait Islander samples: A meta‐analysis to identify sources of heterogeneity. Addiction. Retrieved from: https://doi.org/10.1111/hsc.12464

Harfield, S. G., Davy, C., McArthur, A., Munn, Z., Brown, A., & Brown, N. (2018). Characteristics of Indigenous primary health care service delivery models: A systematic scoping review. Globalization and Health, 14(1), 12. Retrieved from: https://doi.org/10.1186/s12992-018-0332-2

Henderson, J., Javanparast, S., MacKean, T., Freeman, T., Baum, F., & Ziersch, A. (2018). Commissioning and equity in primary care in Australia: Views from Primary Health Networks. Health & Social Care in the Community, 26(1), 80-89. Retrieved from: https://doi.org/10.1111/hsc.12464

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

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

Panaretto, K., Wenitong, M., Button, S & Ring, Ian. (2014). Aboriginal community controlled health services: Leading the way in primary care. The Medical Journal of Australia, 200. 649‐ 52. Retrieved from: https://onlinelibrary.wiley.com/doi/abs/10.5694/mja13.00005

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: https://doi.org/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

VicHealth. (2018). A sample council strategy to reduce health inequalities. Retrieved from: https://www.vichealth.vic.gov.au/-/media/Indicators/Overview-sheets/10/VH_LG_Guides_Health-Inequalitites_web.pdf?la=en&hash=31DA3F4472AD70E5C4B7F537938B8EDD6E90B931

Waterworth, P., Pescud, M., Braham, R., Dimmock, J., & Rosenberg, M. (2015). Factors influencing the health behaviour of indigenous Australians: Perspectives from support people. PloS One, 10(11). Retrieved from: https://doi.org/10.1371/journal.pone.0142323

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

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