Health Disparities and Close the Gap Campaign
Discuss about the Well-being and prevention in health.
Australia is one of the colonized country that is struggling to eliminate disparities in health outcome between the indigenous and non-indigenous population. Indigenous people continue to have worse health outcome and low-life expectancy than non-indigenous population and they are over-represented as poor and disadvantaged group in Australia (Durey & Thompson, 2012). In response to the rising disparities in health outcome of indigenous people, the Close the Gap Campaign was initiated in 2006 to provide Aboriginal and Torres Strait Islander people same opportunity for healthy and happy life by 2030. The main aim of the campaign was to close the gap in life expectancy, educational achievement and employment opportunities between indigenous and non-indigenous group (Australian Human Rights Commission, 2018). Australia’s indigenous and non-indigenous health bodies and NGOs entered into partnership to promote health equality between the two group and implemented many initiative to improve health of indigenous people. Despite the implementation of Closing the Gap initiative, Australia is still not on track to fulfill the goal of equal health outcome and life expectancy for both Aboriginal and Torres Strait Islander people (indigenous) and non-indigenous population by 2030. Mixed record on success has been obtained based on recent review of Close the gap report (Commonwealth of Australia, 2017). In response to this issue, the main purpose of this essay is to critically reflect on holistic health for the indigenous group and evaluate strategies implemented in the past 50 years to improve health of indigenous population.
With regard to health inequalities globally, the inequality in health between Aboriginal and Torres Strait Islander people and the non-indigenous population is the most cited in research work and current reports. Life expectancy is an important parameter to predict general health of a population and the data obtained for life expectancy in 2012-2012 shows that life expectancy of indigenous male population is 10.6 years lower than non-indigenous group and the life expectancy is lower than 9.5 years for females (pmc.gov.au, 2017). The prevalence of non-communicable disease like cardiovascular disease, diabetes and mental health disorder among indigenous population is responsible for 70% of the heath gap (Markwick et al., 2014). This is a significant gap which needs to be critically analyzed from the perspective of holistic health and by comparison with social determinants of health. .
From the holistic context, health and well-being of a population encompassed mental, physical, cultural and spiritual health. All this is achieved when an individual or group have equal access to all social determinant of health. Social determinants of health include the factor like proper housing, employment, education and environment for people (Pacquiao, 2016). Physical and mental health of Aboriginal and Torres Strait Islander people was affected by historical effect of migration and colonization process. Due to dispossession of land, they were forced to migrate and settle in lands vulnerable to natural disaster, poor access to health services and inadequate sanitation. Hence, migration affects social and economic factors required for health and well-being of the group. Migration and dispossession of land was responsible for poverty, unemployment and poor access to education in children (Snyder & Wilson, 2015). The historical context of the Aboriginal and Torres Strait Islander people contributed to inequality in social determinant of health and inequality in health status of the group.
Holistic Health and Social Determinants of Health
In response to unemployment issues, poverty and lack of education in indigenous children, the Close the Gap campaign worked to improve access to all social determinant of health. Indigenous education, employment and health was a clear priority of the campaign. Despite this, limited success was achieved. This can explained by the loss of cultural, social and spiritual factors of health living. Indigenous people are very attached to their land and culture. Land is central to their health and well-being because indigenous people have strong physical, spiritual, social and cultural connection to their land compared to non-indigenous population. While the non-indigenous people associate land as a commodity, the aboriginal people have spiritual connection with their land. Land is part of their culture and they intertwine land with Aboriginal law and spirituality (Snyder & Wilson, 2015). However, loss of their own land, migration and family separation had profound psychological impact on indigenous community of Australia. Psychological distress, self-harm and suicide became a common issue for the population group. Presence of negative social forces, loss and stress across their life span increased distress level of aboriginal group compared to non-indigenous group. A recent study showed that being female, having lower education, lower income and lack of appropriate food intake was associated with high distress in the group (McNamara et al., 2018). This evidence gave the indication that colonization and loss of land created significant barrier to health and well-being of Aboriginal group. To reduce gap in health outcome between indigenous and non-indigenous group, there is a need to implement holistic and culturally safe programs and services to improve health of the population and contribute to social and emotional well-being too (Markwick et al., 2014).
From the above discussion, it is understood that holistic and culturally sensitive approach to health promotion is necessary to close the gap in health outcome between aboriginal people and non-indigenous group. The review of strategies implemented in the past 50 years may help to predict whether they had been effective in improving health of the Aboriginal and Torres Strait Islander people or not. To improve health and life expectancy of indigenous population, the Australian government implemented the ‘Healthy for Life Program’ to improve the capacity and quality of primary health care services for indigenous people. This initiative was implemented in response to high incidence of chronic disease in Aboriginal and Torres Strait Islander people. The key strategic direction of the program was to improve access to primary health care, mental and child health service to meet health care needs of the indigenous population. The health department prioritized reducing chronic disease risk factors, improving follow-up care and improving chronic disease management process. The key performance indicators for the success of the program was reduction in mortality rate among indigenous people and reduce in chronic disease related mortality (health.gov.au 2010). Due to the implementation of such initiative, significant decline in mortality rate due to respiratory disease and kidney disease for urban population was observed. However, the rate of mortality due to cancer increases and not changes in diabetes related mortality was found (pmc.gov.au, 2014).. Hence, the limitation found in the Healthy for Life program was early detection of chronic disease was not prioritized. In addition, chronic disease was found to increase with remoteness; however no significant steps were taken to make health care services accessible for people residing in remote areas. In addition, a generation gap was a need to achieve Close the Gap target and address social determinants of health.
Evaluation of Strategies to Improve Indigenous Health
Poor physical and mental health outcome was found to be significantly high in indigenous people who smoked. In 2008, the federal government took part in Tobacco Control initiative by increasing fund for Australian Government Tacking Indigenous smoking measure. The target of the program was to decrease smoking rate in Aboriginal and Torres Strait Islander people by 50% by the year 2018. Many Aboriginal community-controlled health services (ACCHSs) and the National Aboriginal Community Controlled Health Organization (NACCHO received funds to implement tobacco control initiative. The wide range of activities that were implemented in the Australian context included introduction of smoke-free legislation, increased taxation for tobacco products, changes in cigeratte packing and online social marketing campaigns. The Talking About the Smokes (TATS) project evaluated the outcome of the tobacco control policies on health of indigenous population. It showed that out of 32 ACCHSs, about eighteen had dedicated staffs focusing on tobacco control. In addition, the rate of staffs attending tobacco control training also improved in ACCHSs. The number of mainstream quit program and specific tobacco control program increased in Australia. However, despite such comprehensive initiative, significant difference in quit decision was not achieved (Davey et al., 2015). This implies that cultural factors contributing to risk of smoking was not considered during health promotion for the indigenous population.
Cultural gap between health care workforce and Aboriginal and Torres Strait Islander people was also one significant barrier to health care access and improved health outcome in the target population. However, in the past 50 years, many initiatives were taken to develop the rural health workforce and maintain their skills to meet health care needs of aboriginal population. The common findings from such evidence were that aboriginal people faced challenges in engagement with people and their attitude towards indigenous group directly affects service delivery (Gwynne & Lincoln, 2017). This limitation and lack of skills of rural work force was the reason for uneven health care and insufficient supply of health care resource to remote areas. Because of the inappropriate steps taken to improve skills of worker, the goals of Close the Gap policy could not be achieved. Hence, in the future, it is necessary that both knowledge as well as cultural barrier to health care access is addressed to achieve the goal of the Close the Gap campaign by 2030 (Li, 2017).
The essay summarized the issue of health disparity between indigenous and non-indigenous population and justified limited success of the Close the Gap campaign in meeting its target by linking it with holistic health context. The Aboriginal and Torres Strait islanders experienced inequalities in social determinants of health because of the impact of colonization and migration. Loss of their land and separation from family resulted in negative social, physical, spiritual and cultural health of the group. The review of three strategies implemented in the past to improve the health of the indigenous population also suggests that the Australian government needs to priorities culturally safe program to improve overall health of the indigenous population.
References:
Australian Human Rights Commission (2018). Close the Gap: Indigenous health campaign. Retrieved from: https://www.humanrights.gov.au/our-work/aboriginal-and-torres-strait-islander-social-justice/projects/close-gap-indigenous-health
Commonwealth of Australia (2017). National Strategic Framework for Aboriginal and Torres Strait Islander Peoples’ Mental Health and Social and Emotional Wellbeing. Canberra: Department of the Prime Minister and Cabinet. Retrieved from https://pmc.gov.au/sites/default/files/publications/mhsewb-framework_0.pdf
Davey, M. E., Hunt, J. M., Foster, R., Couzos, S., van der Sterren, A. E., Sarin, J., & Thomas, D. P. (2015). Tobacco control policies and activities in Aboriginal community-controlled health services. The Medical Journal of Australia, 202(10), 63-66.
Durey, A., & Thompson, S. C. (2012). Reducing the health disparities of Indigenous Australians: time to change focus. BMC health services research, 12(1), 151.
Gwynne, K., & Lincoln, M. (2017). Developing the rural health workforce to improve Australian Aboriginal and Torres Strait Islander health outcomes: a systematic review. Australian Health Review, 41(2), 234-238.
health.gov.au (2010). Indigenous health. Retrieved from: https://www.health.gov.au/internet/budget/publishing.nsf/Content/2009-2010_Health_PBS_sup1/$File/Outcome%208%20-%20Indigenous%20Health.pdf
Li, J. L. (2017). Cultural barriers lead to inequitable healthcare access for aboriginal Australians and Torres Strait Islanders. Chinese Nursing Research, 4(4), 207-210.
Markwick, A., Ansari, Z., Sullivan, M., Parsons, L., & McNeil, J. (2014). Inequalities in the social determinants of health of Aboriginal and Torres Strait Islander People: a cross-sectional population-based study in the Australian state of Victoria. International journal for equity in health, 13(1), 91.
McNamara, B. J., Banks, E., Gubhaju, L., Joshy, G., Williamson, A., Raphael, B., & Eades, S. (2018). Factors relating to high psychological distress in Indigenous Australians and their contribution to Indigenous–non?Indigenous disparities. Australian and New Zealand journal of public health, 42(2), 145-152.
Pacquiao, D. F. (2016). Social Determinants of Health. Global Health Care: Issues and Policies, 159.
pmc.gov.au (2014). Aboriginal and Torres Strait Islander
Health Performance Framework 2014. ReportRetrieved from: https://www.pmc.gov.au/sites/default/files/publications/indigenous/Health-Performance-Framework-2014/tier-1-health-status-and-outcomes/123-leading-causes-mortality.html
pmc.gov.au (2017). Aboriginal and Torres Strait Islander
health performance framework 2017 report. Retrieved from: https://www.pmc.gov.au/sites/default/files/publications/indigenous/hpf-2017/tier1/119.html
Snyder, M., & Wilson, K. (2015). “Too much moving… there’s always a reason”: Understanding urban Aboriginal peoples’ experiences of mobility and its impact on holistic health. Health & place, 34, 181-189
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