Priority area and at-risk groups
Aboriginal living in Victoria experiences wide gap in life expectancies as there is huge differences in the health outcomes between them and the general population. Therefore, the purpose of the Koolin Balit, Victorian Government strategic directions for Aboriginal health 2012–2022 is to work in collaboration with Aboriginal communities, service providers and government in achieving the commitment to improve their health in next 10 years. The plan outlines a vision to improve quality and length of Aboriginal in Victoria measurably and significantly. A healthy transition to adulthood is the key priority area; high-risk taking behaviour and self-harm attitude among adolescents are the two high-risk groups and three social determinants of Aboriginal health are social gradient, educational attainment and environmental determinant as they have poor access to support services that will be critically analysed in the following report.
The overarching aim of the health review plan is to give direction, predictability and stability to the commitment of the government in addressing Aboriginal health. This involves strategic development and community planning that can assist health system to build relationships and develop improved practices in fulfilling the health needs of Aboriginal Victorians. The Victorian Aboriginal Community Controlled Health Organization created the plan that is targeting the Aboriginal people living in Victoria to improve their health outcomes (Health.vic.gov.au 2018). They are aimed at closing the life expectancies gaps for the Aboriginal Victorians, reducing the differences in the morbidity, infant mortality rates and low birth weights between Aboriginal people and general population (Health.vic.gov.au 2018). Moreover, it also aims to improve the access to healthcare services and health outcomes for the Aboriginal population. The key priority areas that are outlined in the plan are reduction in perinatal mortality rates, healthy childhood, and healthy transition of children to their adulthood, caring for the older people, addressing of risk factors and managing to provide better care to Aboriginal people with effective services. High-risk behaviour and mental health issues among adolescents are the at-risk groups that are acknowledged in the plan (Health.vic.gov.au 2018). The determinants of Aboriginal health are education, social gradient and access to health services (environmental gradient) outlined in the plan and evaluation of programs, initiatives and services along with routine monitoring will determine the effectiveness of the plan.
A healthy transition to childhood (key priority 3) is one of the crucial stages in life as it lays the foundation for positive health for the rest of their lives. Most importantly, during this transition stage, Victorian Aboriginal people of the age 15–24 years are at high risk for ill behaviors like smoking, alcohol consumption, illicit drug use, discrimination and bullying at schools, sexually transmitted diseases (STDs) and self-harm. Therefore, Koolin Balit prioritizes this stage of life while focusing on the issues associated with young people so that positive and healthy behavior can be established in them (Health.vic.gov.au 2018). The health review is planning to reduce high-risk taking behaviors and rate of STDs, reduce presentations of self-harm and injury to emergency departments and improve their access to mental health services. They will achieve these aims by supporting initiatives that promote healthy lifestyle and behavior, strengthen young Aboriginal’s connection to their culture, community, and improve early identification and access to clinical and mental health services for them (Health.vic.gov.au 2018). The department is already working in partnership with Aboriginal communities and other stakeholders in fulfilling these aims so that positive social norms and healthy lifestyle can be promoted and a healthy transition to adulthood can be achieved for the young Aboriginal people. Based on this priority area, two at-risk groups are young Aboriginals, who are addicted to high-risk taking behaviors and those who are subjected to self-harm and injury. Excessive smoking and alcohol consumption is increasing the burden of disease among young Aboriginals, institutional racism; discrimination that they are experiencing is impeding their educational engagement and overall wellbeing (Health.vic.gov.au 2018). Moreover, lack of cultural identity, breakdown in family and kin also have significant impact on the spiritual and emotional wellbeing of the young Aboriginals that is making them subjected to high-risk taking behaviors and mental health issues. Therefore, it is important to prioritize them and build strong connection and cultural identity so that it supports their physical, emotional and social wellbeing.
Three relevant social determinants
This section focuses on the social gradient, educational attainment and environmental determinant that is linked to the priority area of healthy transition to adulthood. The socioeconomic constructs like employment, poverty, income and housing affect a range of physical and mental health outcomes. Poverty, poor housing and low levels of employment and income are incontrovertibly linked with poor health. Young Aboriginals belonging to poorer income families have reduced access to healthcare services and clinical facilities (Sherwood 2013). The low level of literacy and poor education is also linked to poor health status that affects their ability to use the available health information. This makes the young people get engaged to high risk taking behaviours like smoking, drinking and illicit drug use as they are not aware of their effects on physical and mental health.
The low socio-economic status and its dimensions like material deprivation in terms of shelter, food, safe drinking water and sanitation, unemployment, low income and social exclusion diminishes opportunities that undermines the hope of young Aboriginals, limits their choices and greatly threatens health. Poor social gradients have been associated with high risk of physical and mental health issues (anxiety, stress, lack of self-esteem and depression) and premature death. This burden of low socio-economic status falls heavily on the young people that result in ill-health and poor outcomes (Mitrou et al. 2014).
Relative poverty results in Aboriginal families’ inability to afford the goods, activities and services that are needed for full participation of their children in the society. In addition, Aboriginal adolescents are drastically over represented in the welfare system as they experience physical neglect. This is due to poor housing, poverty and low level of income that is making young Aboriginal people get addicted to substance abuse and ill health behaviours being a key factor in adolescent apprehension (Tesfaghiorghis and Altman 2018).
According to Australia Institute of Health and Welfare (AIHW) in 2015, about 42% Aboriginal children were categorized as developmentally vulnerable during their first year schooling year in key areas or domains of early childhood development (Australian Institute of Health and Welfare 2018). They have poor access to proper housing living in very remote areas by 1.5 times as compared to general population (Australian Institute of Health and Welfare 2018). There are low numeracy and literacy targets among young Aboriginals as they have poor level of educational attainment. During transition to adulthood, individual developmental pathways are determined by level of education attainment and low-socioeconomic status can disrupt their development which in turn interrupt their education and restrict them from attaining options in career and further life. The early and time-off transitions due to these social determinants disrupt their potential to attain proper physical and mental development compelling them to enter into such situations like high-risk taking behaviours, addictions, self-harm and injury.
The above social determinants greatly influence the transition of young Aboriginal to their adulthood. The use of illicit drugs, alcohol and smoking is also contributing to high rates of injury, self-harm, juvenile crime and involvement with crime justice system, social disruption and greatest burden of injury and disease among young Aboriginals. This addiction is making them experience reduced quality of life, disability and mental health issues affecting their overall wellbeing (Reading 2018). As they are marginalized and socially excluded from the mainstream society, they experience poor access to mental health services and support like primary and community health, preventative and specialized care. This depicts that transition to adulthood is a key priority area and social determinants of health like socio-economic status, education and access to mental health services are linked to young Aboriginal Victorians and their health outcomes (Yeung Thompson and Leadbeater 2013). As the Victorian Aboriginal population is growing as compared to the rest population, it is important that they need to be protected so that they start a new life, a healthy childhood and transition as aimed by Koolin Balit health review.
Conclusion
From the above discussion, it is evident that healthy transition to adulthood is a key priority for young Aboriginal people. The social determinants of health such as poverty, low educational attainment and poor access to mental health services greatly hamper their overall wellbeing and life transition. Considering this, Victorian Government has developed strategic directions for improving Aboriginal health through Koolin Balit, 2012-2022. The plan is aimed at achieving better health outcomes at every stage of life that encompasses cultural, emotional and social wellbeing of the whole community. Therefore, this plan will improve the key areas of school retention rates, smoking and alcohol problems and their over presentation in the criminal system.
References
Australian Institute of Health and Welfare., 2018. Australia’s welfare 2017: in brief, Indigenous Australians – Australian Institute of Health and Welfare. [online] Available at: https://www.aihw.gov.au/reports/australias-welfare/australias-welfare-2017-in-brief/contents/indigenous-australians [Accessed 1 Aug. 2018].
Health.vic.gov.au., 2018. [online] Available at: https://www2.health.vic.gov.au/Api/downloadmedia/%7B002CF79E-E84B-427A-BE25-6B068E7019C2%7D [Accessed 1 Aug. 2018].
Mitrou, F., Cooke, M., Lawrence, D., Povah, D., Mobilia, E., Guimond, E. and Zubrick, S.R., 2014. Gaps in Indigenous disadvantage not closing: a census cohort study of social determinants of health in Australia, Canada, and New Zealand from 1981–2006. BMC Public Health, 14(1), p.201.
Reading, C., 2018. Structural determinants of Aboriginal peoples’ health. Determinants of Indigenous Peoples’ Health: Beyond the Social, p.1.
Sherwood, J., 2013. Colonisation–It’s bad for your health: The context of Aboriginal health. Contemporary Nurse, 46(1), pp.28-40.
Tesfaghiorghis, H. and Altman, J., 2018. Aboriginal socio-economic status: are there any evident changes?.
Yeung Thompson, R.S. and Leadbeater, B.J., 2013. Peer victimization and internalizing symptoms from adolescence into young adulthood: Building strength through emotional support. Journal of research on adolescence, 23(2), pp.290-303.
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