Working Effectively with Aboriginal and Torres Strait Islander People Why are Indigenous people in Australia still disadvantaged with regard to health care and services? For the last 200 years Indigenous people have been victims of discrimination, prejudice and disadvantage. Poor education, poor living conditions and general poverty are still overwhelming issues for a large percentage of our people and we remain ‘as a group, the most poverty stricken sector of the working class’ in Australia (Cuthoys 1983). As a people, our rate of chronic disease is still 2. times higher than that of other Australians, and Indigenous people in this country die 15 to 20 years younger than those in mainstream Australia. More than half of these figures are caused by chronic diseases such heart disease, stroke, diabetes, chronic respiratory disease and kidney disease. The majority of these chronic diseases are preventable and while research is continuing to find ways to reduce the risk factors, issues such as smoking, alcohol and substance abuse, diabetes, chronic kidney disease, and promoting healthy eating and active lifestyles are still major challenges in Indigenous communities throughout Australia.
Healthy living choices are not easy for people living in remote communities which results in a high incidence of preventable chronic disease. Good nutrition is fundamental to the maintenance of general wellbeing and the prevention of sickness and disease. It plays an imperative role in pregnancy and early childhood, prevents obesity and type 2 Diabetes and can lower the risk of recurrent heart disease by up to 70%.
However, remote communities face many barriers to healthy eating, including isolation, the high cost of food, the variable supply of fresh food, lack of community town infrastructure and inadequate health promotion support, are just a few of these barriers that prevent community people from being able to make healthy living choices. Community programs in the Northern Territory aimed at building healthy communities are based on nutrition-related Menzies research and work to support community capacity to create a supportive environment for healthy eating and physical activity.
These projects operate within the communities and are aimed at influencing food-related policy, promote healthy eating and physical activity, and encourage community engagement in activities for better health. Not as many health services are as user-friendly or culturally appropriate for Indigenous people as they are for non-Indigenous people, adding to higher levels of disadvantage and a greater reluctance to utilise these services. Sometimes this is because more Indigenous people live in remote locations and not all health services are offered outside of major centres.
Specific issues such as reducing the incidence of chronic disease requires a significantly greater effort in coordinating collective strengths, creating and delivering preventative programs and primary health care for Indigenous communities and while great work is being done, more efforts are required to reduce the high incidence of chronic disease on Indigenous people and communities. When designing and developing services to meet the needs of our Indigenous people, close collaboration and consultation with the people for whom the service will be provided is vital.
There is also much evidence suggesting that Indigenous women are over-represented in our hospitals and health clinics as victims of domestic and family violence. There is no clear measure of the extent to which Indigenous family violence is under-reported, but it is expected to be higher than for the general population (Cripps 2008; Cunneen 2009). In a report to the Australian Government about Indigenous violence, it was suggested that ‘priority should be placed on implementing anti-violence programs, rather than on further quantitative research’.
The key risk factors for Indigenous family violence relate to; social stressors; living in a remote community; levels of individual, family and community dysfunction; availability of resources; age; removal from family; disability; financial difficulties and substance use. Indigenous Australians make up 2. 6% of Australia’s population; however they experience health and social problems resulting from alcohol use at a rate disproportionate to non-Indigenous Australians. It is estimated that chronic disease associated with alcohol use by Indigenous Australians is almost double to that of mainstream Australia.
In 2003, alcohol accounted for 6. 2% of the overall incidence of disease among Indigenous Australians. According to available evidence, the use of volatile substances, especially petrol sniffing among the Indigenous population is much higher that of the non-Indigenous population. The use of volatile substances has major impacts on Indigenous people, families, communities and the wider Australian community. What resources are needed and required to address the issues and explain how you see that these resources be best distributed.
What projects need to be done? What makes health services more accessible for Indigenous people? ? Having more Indigenous Health Workers on staff; ? Increasing the number of Indigenous people working in the health sector (Aboriginal, health workers, social workers, doctors, dentists, nurses, etc); ? Designing more health promotion campaigns aimed specifically at Indigenous people; ? Better training of non-Indigenous staff to be more sensitive to the needs of Indigenous patients and to improve cultural awareness; ?
Making important health services available in remote locations (so Indigenous people do not have to travel to major centres, away from their support networks and the security of their own community); and ? Funding health services so they are affordable for Indigenous people who might otherwise not be able to afford them. As a result of our history and because of the continuing disadvantage, our people have needs that differ from those of mainstream Australians. Therefore, it is also imperative that we acknowledge and respect the impact of events and issues in Indigenous people’s history when designing and delivering these services.
The social determinants of health include if a person is; working, feels safe in their community without discrimination, has a good education, has enough money, and feels connected to friends and family. Social determinants that are particularly important to many Indigenous people are; their connection to land, a historical past that took people from their traditional lands and away from their families. If a person feels safe, has a job that earns enough money, and feels connected to their family and friends, they will generally be healthier.
Indigenous people are generally worse off than non-Indigenous people when it comes to the social determinants of health. Additionally, it is important to develop policy and practice to address substance use among Indigenous people. Programs addressing alcohol and volatile substance use should be operated in combination with a range of general programs aimed at ‘closing the gap’ between Indigenous people and other Australians in the areas of education, employment, income and housing. What strategies can be put into place to a. vercome access, equity, disadvantaged issues and; b. to make services culturally safe? A strengths-based approach involves working from a community’s collective strengths to assist them to address their challenges. Bringing together different people with specific skills to collectively address issues, communities can provide local solutions issues specific to their local area. This approach includes the practice of using culturally appropriate and consultative strategies, however, strengths-based approaches also focus on maximising the strengths of contributors.
By doing so, the targeted interventions are more likely to realise long-term change because they empower our communities to provide practical solutions that are appropriate for them (Haswell-Elkins et al. 2009; Leigh 2008). Australia has committed to developing strategies to address the causes of Indigenous disadvantage and six key areas have been identified as targets to reducing the divide between Indigenous and non-Indigenous Australians. These targets are to improve life expectancy within a generation; to halve the mortality rates for Indigenous children under five within a decade; to nsure all Indigenous four year olds in remote communities have access to early childhood education within five years; to improve reading, writing and numeracy achievements for Indigenous children within a decade; to improve the number of Indigenous students in year 12 attainment or equivalent; and to improve employment outcomes between Indigenous and non-Indigenous Australians within a decade. A substantial amount has been invested in improving Indigenous health outcomes and the way the Australian health care system prevents treats and manages the chronic diseases that shorten so many Indigenous Australians’ lives.
The aim is to reduce the risk factors for chronic disease in the community such as smoking, alcohol and substance abuse, improve chronic disease management and follow up through our health services, and increase the capacity of our acute care workforce to deliver effective care to Indigenous people with chronic disease. How can we advocate for anti-racism policies? Although many other Australian minority groups have been reported to be experiencing racism in our country, the experiences of racism are most protracted among our own Indigenous people.
Racist attitudes toward Indigenous people may be viewed as having two dominant waves; the first wave was predominant during the first 170 years following the arrival of the First Fleet, and the second was in the post-referendum era, which led to changes in Australia’s constitution that formally recognised Indigenous people as part of the Commonwealth of Australia. The belief in superiority based on skin colour was justified by the framing of Indigenous Australians as inferior humans. These politically entrenched attitudes justified dispossession of Indigenous people from their homelands.
Dispossession resulted in reluctance by mainstream Australia to acknowledge land rights, loss of spiritual values, disrupted law, and disconnection from land, community, family and cultural values. Most policies were backed by legal provisions instituted by Australian state governments. For example in Queensland, laws enacted treated Indigenous people like prisoners, with little freedom of choice. They were required to work without pay and prevented from undertaking traditional cultural practices.
These policies created a sense of powerlessness, hopelessness, stress and related illness. Today, there remains no ‘quick fix’ solution to changing the levels of disadvantage that have been generations in the making. To move forward we must learn from the past and build through good practice and recognising that there are successful public, private and community sector programs and initiatives that have made substantial progress. Addressing disadvantage places responsibilities on those providing support and assistance and on those receiving it.
For those who provide support there is a duty to those being assisted; for example, it means service providers should: work together with local Indigenous people and their communities; recognise and acknowledge our history and the consequences of past policy and practice; and empower local Indigenous communities to help themselves. For the communities being assisted, there is a responsibility to help ourselves as best as we can, this might mean looking for information on available services, assisting service providers to improve delivery outcomes, and recognising and addressing personal barriers to improvement.
Some Indigenous communities have identified that taking responsibility in education and employment is an important part of the way forward. In other communities, the importance of individual and family commitment to a healthy lifestyle has been identified. Meeting these targets will also require our own people to take responsibility for implementing some lifestyle changes if the problems of obesity, diabetes and substance abuse are to be improved. Local, Territory, State and Federal governments and peak Aboriginal bodies have collective social responsibilities to Indigenous people as their constituents.
Governments are responsible for ensuring that citizens have access to the resources and the opportunities needed to take their place in our society. Governments have the responsibility to ensure programs and services do not produce welfare dependency or other unintended consequences. Finally, Australian governments have responsibilities under the international treaties that Australia has entered into. References Review of volatile substance use among Indigenous people. d’Abbs P, Maclean S (2008) Volatile substance misuse: a review of interventions.
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