Key Demographic, Cultural, and Socio-economic factors affecting Indigenous health
Improving the overall health condition of Indigenous population in Australia is a prolong challenge for the government of Australia. The main gap in the health status of Indigenous and non-Indigenous Australians remains unacceptably wide and the main reason behind this the prevailing health inequalities among the indigenous and non-indigenous population of Australia (Australia Institute of Health and Welfare [AIHW] 2018). AIHW (2018) highlighted that poor social determinant of health is the alarming cause behind the health-inequalities and this health-inequalities increases the susceptibility of developing chronic health diseases. Diabetes is a chronic condition which is characterised by high levels of glucose in the blood. Over the years, this high level of glucose in blood can cause permanent damage of kidneys, heart, eyes and nerves leading to both physical and mental disability (AIHW 2018). There are two main types of diabetes, type 1 and type 2 diabetes of which type 2 diabetes is popular among the aboriginals (AIHW 2018). However, diabetes is preventable is the modifiable risk factor is controlled accordingly. It is the due to this reason MacRae et al. (2013) stated that T2DM is the second highest disease factor which contributes towards avoidable death among aboriginal and Torres Strait Islander death. The following essay aims to analyse the reason for the development of T2DM among indigenous Australians, the contemporary healthcare strategy in relation to T2DM and health perspective of indigenous Australian. At the end, the essay will highlight author’s perspective to improve health status of indigenous Australians.
The reports published by the AIHW (2018), around 1.2 million people in Australia are affected by type 2 diabetes during the tenure of 2014 to 2015. The rate of occurrence of diabetes is higher in males, elderly and throughout the indigenous Australian population residing in remote or socioeconomically disadvantaged area. According to the reports published by Diabetes Australia (2018), aboriginals and the Torres Strait Islander people are four times more likely to develop type 2 diabetes mellitus (T2DM) in comparison to the non-indigenous Australians. The development of T2DM leads to coronary heart disease and renal failure and thus causing chronic health outcomes among the aboriginal people residing in Australia. The vulnerability of the aboriginal and Torres Strait Islander population in developing T2DM is another cause behind the decrease in their life expectancy by 17 years in comparison to the non-indigenous Australia (Azzopardi et al. 2017). Although diabetes is a lifestyle disease and is mainly popular among the older adults, the scenario is different among the indigenous Australia population. According to Azzopardi et al. 2017, there are increase in the incidence of development of T2DM among indigenous children and youth and the vulnerability further increases if there is an pre-existing family history of T2DM. Thus overall it can be said that incidence of T2DM is higher in aboriginals and thus endangering their health and well-being.
Historical context of Race Relations in Australia and its effects on Indigenous health
Figure: Prevalence of T2DM among aboriginals on the basis of remoteness
Source: Department of Prime Minister Cabinet Australia 2014)
Figure: Prevalence of T2DM among aboriginals on the basis of jurisdiction
Source: Department of Prime Minister Cabinet Australia 2014)
Figure: Prevalence of T2DM among aboriginals on the basis of age
(Source: Department of Prime Minister Cabinet Australia 2014)
The main demographic factor contributing towards the development of T2DM among the aboriginals and Torres Strait Islander in Australia include lack of proper education, which is highlighted by the poor socio-economic condition (Azzopardi et al. 2017). According to Azzopardi et al. 2017, the majority of the aboriginal people experience disadvantage through lack of proper education, employment, income and housing. It is this poor demographic condition or below average socio-economic status which increases the pre-mature death among the aboriginals due to chronic disease like diabetes. In the cultural context in can be said that aboriginals are more likely to indulge in intoxication like consumption of alcohol and smoking of tobacco, which further increases the chance of developing T2DM or increasing the overall severity of the disease (Adegbija, Hoy & Wang 2015). Aboriginals are also more likely to thrive on unhealthy diet plan like poor consumption of green vegetables, which again risk the chance of developing T2DM (Brimblecombe et al. 2013). Hodyl et al. (2014) highlighted that consumption of alcohol, smoking, unhealthy diet and lack of physical exercise are all modifiable risk factors for diabetes leading and hence proper controlled can lead to decrease in T2DM incidence. Under the social context, it can be said that due to lack of proper employment access or job, aboriginals lack behind adequate daily physical activity, this lack of physical activity promotes obesity and thereby leading to the development of T2DM. The society of the aboriginal is also suffers from the lack of proper access of healthcare service. Skinner et al. (2013) highlighted that the majority of the aboriginals who reside in rural or remote areas do not have proper access of healthcare. Thus, cases of T2DM remain undiagnosed and untreated increasing the death tolls or decrease in the overall life expectancy. Research have highlighted that the greater distance from the healthcare unit, lower is the rate of access of health care service and higher is the incidence of diabetes (Skinner et al. 2013).
Figure: Risk factor contributing to diabetes development
(Source: Australian Government 2013)
Australian Government – Department of Health have framed Australian National Diabetes Strategy (2016 to 2020). The main aim of the strategy is to strengthen all sectors of diabetes control starting from developing, implementing and evaluation a coordinated and an integrated approach of decreasing economic, social and human impact of diabetes in Australia. This strategy has seven different goals. Among these, the fifth goal is to reduce the impact of diabetes among aboriginals and Torres Strait Islander people. Some of the potential areas of actions of this strategy include development of community wide awareness programmes which are culturally relevant. According to the National aboriginal and Torres Strait islander health plan 2013-2023, proper education and awareness program will help to reduce the health inequalities among the aboriginals which in turn will help to reduce the chances of occurrence of T2DM. Other goals include development of community-wide intervention program and subsequent implementation of the same in an affordable manner in order to curb the chances of developing diabetes. This community wide intervention program mainly includes reduction in the consumption of sugar along with increase in the intake of green vegetables (Australian Government 2015). According to Brimblecombe et al. (2013) having a proper diet plan will help to reduce blood cholesterol and subsequently reducing diabetes development. The strategy also encourages increase in the access of the primary healthcare services in the aboriginal community in order to promote early detection of T2DM and subsequent treatment of the same. This goal is indeed effective because American Diabetes Association (2016) is of the opinion that T2DM is at times confused with Type 1 diabetes mellitus (T1DM) due to similar symptoms and late detection of T2DM increases the severity of the disease. Early detection along with proper diet plan and lifestyle changes help to overcome the hurdle of T2DM. Thus, overall the strategy is effective in targeting the gaps in healthcare the aboriginal community and thereby creating provision in T2DM reduction.
Approaches for promoting social, emotional, and physical well-being of Indigenous Australians
One of the health perspectives of the aboriginals Torres Strait Islander people is, increase in the consumption of alcohol or smoking of tobacco helps to relief depression and stress (Noble et al. 2015). However, this health perspective cannot solely be imparted over the aboriginal communities because same belief is prevalent among the other human race. However, the tendency to smoke and drink is high among the aboriginals and the Torres-Strait Islander (Gould et al. 2013). According to AIHW (2011a) the aboriginals and Torres Strait islanders are more likely to smoke than the non-indigenous Australian population and the percentage is high by 17%. Noble et al. (2015) stated that lack of proper job opportunities, financial crisis and social discrimination increases the level of stress and depression among the aboriginal and Torres Strait Islander population and this provokes them to indulge into intoxication. They feel that this kind of intoxication will help to cope with their depression. However, the actual outcome is quite different. Smoking and drinking are two common lifestyle factors, which are regarded as few of the reversible cause behind the development of T2DM. According to Guo et al. (2013) alcohol decreases the body’s sensitivity towards insulin (American Diabetes Association 2015). Thus, glucose in the blood becomes non-responsive to insulin leading to lack of proper uptake of glucose in the cells and causing T2DM. Excessive smoking of tobacco also increases insulin sensitivity and thereby promoting T2DM (Guo et al. 2013).
In order to improve the health status of the aboriginals and the Torres Strait Islander, I will educate the indigenous people about the ill effects of the tobacco smoking and alcohol consumption. My main target will be the young adults or the middle-aged men. According to Azzopardi et al. (2012) the tendency of smoking and drinking is mostly prevalent among indigenous men. There is another reason why I will target youth, because youth are the flag bearers of the future and are victims of T2DM. So increasing awareness about alcohol consumption and smoking will help to reduce the chances of occurrence of lifestyle disease T2DM. The awareness program will mainly be based via community health approach (Best & Fredericks 2017). According to Australian Government (2013), community based awareness program has been found to provide better health outcomes. This community based awareness program will mainly include pictorial or audio-visual presentation of how alcohol and tobacco is making them endangered towards developing T2DM along with the chronic effects of T2DM. Apart from the awareness program, steps must be undertaken in order help the indigenous people to adjust with the withdrawal symptoms. According to Guo et al. (2013) prevention of smoking and drinking altogether creates intense withdrawal syndromes. So in order manage those withdrawal symptoms I will plan to engage the indigenous people under mild to moderate physical activity. According to Guo et al. (2013) mild to moderate daily physical activity helps to fight against the withdrawal symptoms. Moreover, Guo et al. (2013) have highlighted that physical activity also reduces the risk of developing T2DM.
Changing patterns of epidemiology for Aboriginal and Torres Strait Islander people in Australia
However, apart from this initiative, the government of Australia should also come forward in creating employment for indigenous people so this financial stability in their life will help to decrease depression and this in turn will promote healthy lifestyle. Increasing the employment is what is being also proposed by the National aboriginal and Torres Strait islander health plan 2013-2023, closing the gap 10 yr review. According to the review, increasing employment will help to fight against poor social determinants of health.
Conclusion
Thus from the above discussion, it can be concluded that diabetes is a growing health concern among the indigenous population of Australia. The main victims are the men and the young adults. Lack of proper education, high consumption of alcohol, smoking of tobacco and lack of proper access to the healthcare services are the principal reason behind the development of the lifestyle disease, T2DM. The contemporary healthcare strategy used to promote T2DM include awareness and education program. However, the health perspective of the indigenous populations needs to be changes. They believe that consumption of alcohol reduces depression. However, this in turn increases the threat from the modifiable risk factor of developing T2DM. In order to reduce the smoking and drinking tendency among indigenous people, community health awareness approach are required to be undertaken. This will help to decrease the tendency of substance abuse and thereby helping to improve the health condition. The government of Australia is also taking initiatives to in order to increase the job opportunities among the indigenous people. This will help to cure depression and will bring financial stability. This will also help to fight against withdrawal symptoms.
References
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