Why+are+Indigenous+people+less+healthier?+The+health+inequality+between+Indigenous+and+non-Indigenous+Australian

Student name: Ho, Tsz Shan Student number: 08650306 Unit Coordinator: Dr Julie-Anne Carroll Tutorial: Judith Meiklejohn

= = = ** Why are Indigenous people less healthier? The health inequality between Indigenous and non-Indigenous Australians ** =



__** The cultural artefact **__
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This cultural artifact was a documentary broadcasted by the ABC (Australian Broadcasting Corporation) News on Youtube on the 26th of May, 2012. The title of this documentary was “Indigenous Health”. It was talking about the health inequalities between Indigenous and non-Indigenous Australians. The indicators for health inequalities were huge life expectancy gap and different prevalence of health-related diseases. Some suggested determinants for the health gap were poverty, unemployment, lack of education, poor nutrition, substance abuse, insufficient health services as well as the Indigenous historical background. Lastly, the video pointed out that although Australian Government has launched a campaign called “Close the Gap” to reduce the Indigenous health disparity, there is still a long way for Australia to accomplish health fairness.

= **__Public health issue __** =

The public health issue represented by this cultural artefact is Indigenous health inequality. It can be demonstrated by a range of health-risk behaviours and their associated health drawbacks.

**Current daily Males smokers** **Current daily Females smokers** About 50% of the adult Indigenous population was daily smokers and smoking was more common among Indigenous adults across all age group and gender (Australian Bureau of Statistics, 2012).

Risky/high risk Males alcohol consumption **Risky/high risk Females alcohol consumption** Around one-third of the adult Indigenous population was drinking alcohol at high risk level and alcohol abuse was typically more prevalent among Indigenous men aged 35 to 44 (Australian Bureau of Statistics, 2012).

**Abuse of selected substances ** According to Australian Bureau of Statistics (2012), the rate of substance abuse was 28% in 2005 among the adult Indigenous and a further 22% abused at least one time in their life. The above risky comportments have resulted in the following negative outcomes.

**Life expectancy at birth ** The life expectance gap between Indigenous and non-Indigenous male was 11.5 years whereas that between female was 9.7 years (Australian Bureau of Statistics, 2012).

**Infant Mortality Rate ** The infant mortality rate of Indigenous was three times higher than that of non- Indigenous (Australian Bureau of Statistics, 2010).

<span style="font-family: Arial,Helvetica,sans-serif;">As a result of the above alarming statistics, a health distinction between the Indigenous and non-Indigenous population is clearly shown. If nothing is done to relieve the problem, more distressing data would be shown and eventually the Indigenous health gap would become wider and wider. Therefore, Indigenous health inequality is an important issue that needs to be addressed for better Indigenous life.

== __**<span style="color: #000080; font-family: Arial,Helvetica,sans-serif;">Literature review **__ ==

<span style="font-family: Arial,Helvetica,sans-serif;">As we can see from the above statistics, there is a great health distinction between Indigenous and non-Indigenous Australian. But how has it come about? According to a lot of researches and evidences, Indigenous health disparity is a fairly complex problem caused by reasons in various aspects.


 * <span style="font-family: Arial,Helvetica,sans-serif;">Historical determinants:

<span style="font-family: Arial,Helvetica,sans-serif;">

<span style="font-family: Arial,Helvetica,sans-serif;">Indigenous Australians was colonized by European in the past and colonisation has had deep influences on Indigenous health (Gracey & King, 2009, P.65). The invaders introduced unexposed diseases such as smallpox, measles, and tuberculosis as well as addictive substances such as tobacco and alcohol which have caused long-term detrimental effects on both physical and mental Indigenous health (Gracey & King, 2009, P.66). Secondly, traditional life of Indigenous used to be simple and unpolluted. However, the European damaged the farmlands, fishing and hunting regions which altered and contaminated Indigenous traditional lifestyles (Gracey & King, 2009, P.66). Indigenous people were suffered from malnutrition because of the shortage of foods. In addition, Indigenous community was marginalized to live in infertile and backwards towns or even polluted refugee camps with industrial wastes surrounded(Gracey & King, 2009, P.66). All the above unjust conditions triggered infectious diseases, declined mental and social well-beings as well as a gloomy health prospect of the future Indigenous generations (Gracey & King, 2009, P.66).


 * <span style="font-family: Arial,Helvetica,sans-serif;">Social determinants:

<span style="font-family: Arial,Helvetica,sans-serif;">According to Lee et al. (2013, P.614), perceived discrimination would lead to low self-esteem, high level of depression and deprived physical health. Thereby, when Indigenous were discriminated and forced to approach with the majority culture, they were likely to be stressed and thus adversely affected their mental health particularly if the majority culture were unfriendly and scary (Lee et al., 2013, P.608).

<span style="font-family: Arial,Helvetica,sans-serif;">In addition, Indigenous children have poor dietary patterns which would critically upset their health. This is partially contributed by European colonisation as Indigenous’ diets have changed from traditional healthy nutritious foods to unhealthy energy dense processed foods since then (Gwynn et al., 2012, P.1). Inaccessible healthy foods, insecure food and financial burden also donated to the poor nutrition circumstances (Gwynn et al., 2012, P.1). Consequently, unhealthy diet would increase the risk of chronic diseases among the Indigenous poeple in the long-term (Australian Human Rights Commission, 2005, P.23).

<span style="font-family: Arial,Helvetica,sans-serif;">According to Whelan & Wright (2013, P.1), the health inequality between the Indigenous and non-Indigenous is possibly caused by inaccessibility of health services. It was supported by Newbold’s single equation methods which proved Indigenous visited general practitioner relatively less often comparing to the entire population (Whelan & Wright, 2013, P.1). Therefore, Indigenous Australians (particularly remote Indigenous) have less access to health service if they are ill comparing to non-Indigenous Australians (Whelan & Wright, 2013, P.8).

<span style="font-family: Arial,Helvetica,sans-serif;">Housing could be another social determinant of Indigenous health. Most Indigenous people felt they were belonged to the economic disadvantaged with poor housing status (Macdonald, 2010, P. 37). As a result, poor and unhygienic living environment facilitates the transmission of infectious diseases that would detrimentally affect Indigenous health (Australian Human Rights Commission, 2005, P.23).

<span style="font-family: Arial,Helvetica,sans-serif;">Moreover, Aboriginal and Torres Strait Islander people have relatively lower education level. They were 50% less than non-Indigenous to complete post-secondary qualification or above (Australian Human Rights Commission, 2005, P.24). The Indigenous students were also 50% less than non-Indigenous students to continue to year 12 in school (Australian Human Rights Commission, 2005, P.24). As a result, Indigenous people are lack of knowledge and skills to use health information (Australian Human Rights Commission, 2005, P.23).


 * <span style="font-family: Arial,Helvetica,sans-serif;">Economic determinants:



<span style="font-family: Arial,Helvetica,sans-serif;">There is a huge income gap between the Indigenous and non-Indigenous household. According to Macdonald (2010, P. 36), the mean gross household income of Indigenous was only 59% of that of non-Indigenous and the median gross individual income of Indigenous was 50% less than ($278 per week compared with $473) that of non-Indigenous people. This would diminish the health status of the Indigenous because they could not afford comparatively expensive drugs and health services (Australian Human Rights Commission, 2005, P.23).

<span style="font-family: Arial,Helvetica,sans-serif;">Furthermore, Indigenous people are more likely to be unemployed. The unemployment rate for Aboriginal and Torres Strait Islander people was 20% regarding to the Census in 2001 and that percentage was three times higher than that of non-Indigenous (Australian Human Rights Commission, 2005, P.24). Among the employed Indigenous population, about 20% were working in Community Development Employment Projects which was funded by the Australian Government (Australian Human Rights Commission, 2005, P.24). Joblessness would weaken the Indigenous health as well because decreased income reduces their approachability to health services.


 * <span style="font-family: Arial,Helvetica,sans-serif;">Legislative determinants:

<span style="font-family: Arial,Helvetica,sans-serif;">Indigenous people have lost their land right due to the European invasion. The loss of land had destructive effects on Indigenous health because when their land was industrialized, they might not adopt the new lifestyle and resulted in chronic diseases (The Lancet, 2009, P.2). Other than physical health, Indigenous people’s emotional health would also be deteriorated because they were depressed and stressed after losing their land (The Lancet, 2009, P.2). The worst outcome could be a high suicide rate of young Indigenous (The Lancet, 2009, P.2).

<span style="font-family: Arial,Helvetica,sans-serif;">In addition, Indigenous people were not given their native title until 1993 but native title is the Indigenous natural wealth and resources (Australian Human Rights Commission, 2007, P. 5). Not supporting Indigenous culture such as customary law and governance structures would impair their health status (Australian Human Rights Commission, 2007, P. 5).

<span style="font-family: Arial,Helvetica,sans-serif;">Thousands of Indigenous children were taken away from their families and placed in the white communities owing to the European settlement. This stolen generation were likely to suffer from harmful psychological stresses and dislocated social cohesion (Shepherdet al., 2012, P.9).

===<span style="font-family: Arial,Helvetica,sans-serif;">Limitations of the researches: ===

<span style="font-family: Arial,Helvetica,sans-serif;">1. Incompatible Indigenous status question

<span style="font-family: Arial,Helvetica,sans-serif;">Although the Standard Indigenous Question for identifying Aboriginal and Torres Strait Islander is recognized nationally in Australia, it is not used in all researches and circumstances (Australian Institute of Health and Welfare, 2013, Para 8). Thus, the collected data about Indigenous status may not be able to entirely reflect the actual Indigenous situations.

<span style="font-family: Arial,Helvetica,sans-serif;">2. Small investigated group

<span style="font-family: Arial,Helvetica,sans-serif;">A relatively small amount of Indigenous people have participated in the researches therefore it increases the risk of getting statistical errors (Australian Institute of Health and Welfare, 2013, Para 13). Hence, it influences the accuracy of the Indigenous data.

<span style="font-family: Arial,Helvetica,sans-serif;">3. Deficient data collection

<span style="font-family: Arial,Helvetica,sans-serif;">Indigenous data collect only twice a decade so it is difficult to figure out any improvement or deterioration of Indigenous health in the short-term (Australian Institute of Health and Welfare, 2013, Para 15).

<span style="font-family: Arial,Helvetica,sans-serif;">4. Insufficient identification

<span style="font-family: Arial,Helvetica,sans-serif;">Participants’ Indigenous status may be wrongly recorded or missed in some occasions (Australian Institute of Health and Welfare, 2013, Para 9). Nevertheless, it is impossible to go back and check the identities thus biased data may be resulted (Australian Institute of Health and Welfare, 2013, Para 9). As a consequence, Indigenous people’s health outcome could not be properly addressed and so as the strategies to overcome Indigenous inequalities.

== __**<span style="color: #000080; font-family: Arial,Helvetica,sans-serif;">Cultural and Social Analysis **__ ==

<span style="font-family: Arial,Helvetica,sans-serif;">Take Marxism as a social theory and comprehend how it analyses the causes of Indigenous health inequality. Marxism concentrates on social structure and investigates how class disparity affects inequality. Marxism also indicates the privileged and the disadvantaged as a result of the disparity.

<span style="font-family: Arial,Helvetica,sans-serif;">The following elements illustrate how class difference brings about health inequality. In the first place, education is perceived as the way of society progress because higher-educated people often have better health status (Isaacs & Schroeder, 2004, P. 1140). That is because they have access to health information that equips them as healthy persons (Isaacs & Schroeder, 2004, P. 1140). Income is considered as another health determinant because people need money to consume clean foods, accommodations and drugs (Isaacs & Schroeder, 2004, P. 1140). Richer people tend to have good health as they can afford better living environment and medical services (Isaacs & Schroeder, 2004, P. 1140). The allocation of wealth could also be a factor since people have higher life expectancy in places with more equal wealth distribution such as Japan and Sweden (Isaacs & Schroeder, 2004, P. 1140). Employment status contributes to health inequality as well. People with lower-status occupation or unemployment are job insecure and have greater stress level (Isaacs & Schroeder, 2004, P. 1140). To sum up, there is an obvious linkage between lower classes (i.e. lower education level, lower income, unequal distribution of wealth and poor job status) and poor health. Therefore, it is crucial to consider society or social position when examining Indigenous health unfairness.

<span style="font-family: Arial,Helvetica,sans-serif;">Other than social classes, the Australian government is the most influential social force that has implemented abundant Indigenous policies and swayed Indigenous health.

<span style="font-family: Arial,Helvetica,sans-serif;">In the first place, some measures in the Northern Territory Emergency Response (NTER) lead to undesirable health impacts on Indigenous population(O'Mara, 2010, P. 547). For examples, the ‘external leadership, governance and control’ and ‘compulsory income management’ measures deteriorated the Indigenous’ mental and social health as well as their social wellbeing and cultural integrity (O'Mara, 2010, P. 547). In addition, the ‘prohibited materials’ measure depreciated the cultural integrity and social wellbeing of Indigenous men (O'Mara, 2010, P. 547).

Indeed, the Australian Government has launched a policy called ‘close the gap’ to reduce the Indigenous health inequality problem. Nonetheless, the policy has generated two key concerns. Firstly, the policy could not address unequal power distribution due to its individualism (Pholi, 2009, P.10). Secondly, the policy biasedly stereotyped all Indigenous people are associated with many problems which would upset the Indigenous population (Pholi, 2009, P.11).

Besides the ‘close the gap’ policy, the Government has also implemented the Community Development Employment Projects (CDEP) scheme to support the Indigenous. Though Indigenous health has shown improvement, the scheme was blamed as a barrier for Indigenous to take part in the mainstream labour market (Jordan, 2012, P. 33). That is because participates may get wages even though they do not work, and what's more, they only learn limited skills which discourages them for seeking other jobs (Jordan, 2012, P. 34).

<span style="font-family: Arial,Helvetica,sans-serif;">It is important to identity Indigenous Australians and cope with their problems because of two reasons. Primarily, this action can evaluate the efficiency of the Indigenous community services so as to address their needs (Australian Institute of Health and Welfare, 2007, P. 1). Furthermore, this action assists the development and amendment of Indigenous health services which enhances their quality of life (Australian Institute of Health and Welfare, 2007, P. 1). As a consequence, public health expert should focus on social aspects such as income, employment, education and housing when analysing and solving the problem of Indigenous health inequality because they are preventable and most appealing to the Indigenous health gap.

== **__<span style="color: #000080; font-family: Arial,Helvetica,sans-serif;">Analysis of the artefact and learning reflection __** ==

<span style="font-family: Arial,Helvetica,sans-serif;">The artefact represents a health disparity between the Indigenous and non-Indigenous Australian population. It is a good ‘case in point’ of my topic because it clearly points out the issue by giving various examples such as life expectancy gap and distribution of health illness between the two groups. In addition, the documentary mentions some possible determinants of the health gap which can stimulate audiences to think deeply into both short-term and long-term factors that lead to the problem and its resulted disadvantages. This artefact means an inspiration which has raised my attention towards the health and welfare of the Indigenous Australians. They are the oldest people with beautiful and unique culture in Australia but it is sad to know they are suffering badly due to a range of disparity in various aspects. After doing this assessment piece, I have learnt to think critically but not outwardly about the causes of each incident. Apparently, Indigenous people seem to be solely responsible for their health issue because they have conducted a wide variety of health-risk behavior. However, if we look in detail and acknowledge the background as well as the situation that Indigenous people are facing, we could tell Indigenous are not the only one to be blamed. Accordingly, I would research for peer-reviewed evidence and analyze critically before judging any issues in my future learning. Objectiveness and rationality are acquired in every single thinking process and I will not criticize the others based on my own feelings.

__**<span style="color: #000080; font-family: Arial,Helvetica,sans-serif;">Reference List **__
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Australian Bureau of Statistics. (2012). //National Aboriginal and Torres Strait Islander Health Survey//. Retrieved from []

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Australian Human Rights Commission. (2007). Social determinants and the health of Indigenous peoples in Australia – a human rights based approach. Retrieved from []

Australian Institute of Health and Welfare. (2007). //Quality of Aboriginal and Torres Strait Islander identification in community services data collections: update on eight community services data collections// [Report]. Canberra, NSW.: Author

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Booth, A. L., & Carroll, N. (2008). Economic status and the Indigenous/non-indigenous health gap. //Economics Letters, 99//(3), 604-606. doi:10.1016/j.econlet.2007.10.005

Gracey, M., & King, M. (2009). Indigenous health part 1: Determinants and disease patterns. //The Lancet, 374//(9683), 65-75. doi:10.1016/S0140-6736(09)60914-4

Gwynn, J. D., Flood, V. M., D'Este, C. A., Attia, J. R., Turner, N., Cochrane, J.,. . . Wiggers, J. H. (2012). Poor food and nutrient intake among indigenous and non-indigenous rural australian children. //BMC Pediatrics, 12//(1), 12-12. doi:10.1186/1471-2431-12-12

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Jordan, K. (2012). Closing the employment gap through work for the dole? indigenous employment and the CDEP scheme. //Journal of Australian Political Economy, the, 69//(69), 29-58. Retrieved from []

Lee, J., Donlan, W., Cardoso, E. E. O., & Paz, J. J. (2013). Cultural and social determinants of health among indigenous mexican migrants in the united states. //Social Work in Public Health, 28//(6), 607. Retrieved from [|http://www.tandfonline.com.ezp01.library.qut.edu.au/doi/full/10.1080/19371918.2011.619457#.UkvRX7D1zrc]

Macdonald, J.J. (2010). Health equity and the social determinants of health in australia. //Social Alternatives, 29//(2), 34. Retrieved from []

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Pholi, K. (2009). Is 'close the gap' a useful approach to improving the health and wellbeing of indigenous australians? //Australian Review of Public Affairs, 9//(2), 1. Retrieved from [|http://web.ebscohost.com.ezp01.library.qut.edu.au/ehost/detail?sid=acf670fd-b4c0-4fbe-bc98-af1a823f0b6c%40sessionmgr4&vid=1&hid=21&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=anh&AN=52466345]

Shepherd, C. C. J., Li, J., Mitrou, F., & Zubrick, S. R. (2012). Socioeconomic disparities in the mental health of indigenous children in western australia. //BMC Public Health, 12//(1), 756-756. doi:10.1186/1471-2458-12-756

Shepherd, C. C. J., Li, J., & Zubrick, S. R. (2012). Social gradients in the health of indigenous australians. //American Journal of Public Health, 102//(1), 107-117. doi:10.2105/AJPH.2011.300354

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Whelan, S., & Wright, D. J. (2013). Health services use and lifestyle choices of indigenous and non-indigenous australians. //Social Science & Medicine (1982), 84//, 1-12. doi:10.1016/j.socscimed.2013.02.013

__** Reflection **__
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