Indigenous+culture+necessary+for+improved+health+status

Paula Daniels, n7585675, Tutor: Michelle Cornford //**Present your Artefact **//

This artefact is a picture of an Indigenous man and woman standing in a Medical Centre. They are standing next to a wall that has signs which obviously direct people around the centre. These signs use Indigenous words to describe the different areas of the centre such as ‘Nungun’ men and ‘Wakal’ children. The signs also give direction to a Pharmacy and Wellbeing centre. This centre is clearly an Indigenous focused medical centre, providing specialised care to these people. 

//**Public Health Issue **//

The topic that this artefact represents is ‘social Identities, physiologies and human health; how gender, ethnicity, sexuality, and geography affect morbidity and mortality’. More specifically this artefact focuses on how ethnicity affects morbidity and mortality. The focus is on Indigenous Australians and how their health status is significantly lower than non-Indigenous Australians. The range of health-risk behaviours and health outcomes that are associated with identifying as an Indigenous Australian will be discussed. However the centre of this will discuss the importance of identifying as Indigenous, the process of identifying, and the health implications of a positive social recognition of a black identity in Australia today. This artefact represents how Indigenous people identify with their culture through language. The importance of culture and the inclusion of culture within health centres and health promotion ultimately lead to a positive social recognition of a black identity in Australia today.


 * //Literature Review //**

It is widely accept that Aboriginal and Torres Strait Islander people experience poorer health and higher rates of chronic diseases than non indigenous people. The burden of disease suffered by Indigenous Australians is estimated to be two-and-a-half times greater than the burden of disease in the total Australian population (ABS, 2010). Indigenous peoples in many countries continue to be among the poorest and the most marginalized, with the average conditions of Indigenous peoples well below national levels (Stephens, C., et al., 2006, p.2025). Among highly-developed countries, Canada, the United States, Australia, and New Zealand are often seen as natural comparators in terms of Indigenous well-being. These countries consistently place near the top of the United Nations Development Programme's Human Development Index (HDI) rankings, yet all have minority Indigenous populations with much poorer health and social conditions than their non-Indigenous compatriots (Table 1) (Cooke, M., et al., 2007, p.9).  With an estimated resident Indigenous population of 2.5% of the total Australian population (AIHW, 2011). It is not credible to suggest that one of the wealthiest nations of the world cannot solve a health crisis affecting less than 3% of its citizens.
 * Table 1 ||

To further explain this health crisis it is important to portray the health status of Indigenous Australians. Health and functioning greatly impact on the health status of individuals. Mortality and life expectancy is significantly lower for Indigenous Australians, with life expectancy at birth representing gaps of 11.5 years for males and 9.7 years for females, compared with all Australians (ABS, 2010). This gap in life expectancy is represented in Table 2 (Australian Human Rights Commission, 2008). The Indigenous infant mortality rate is almost twice that of non-Indigenous infants and in 2008 Indigenous young people died at a rate of 2.5 times as high as that for non-Indigenous young people (AIHW, 2011). Between 2004 and 2008, two-thirds (66%) of Indigenous deaths occurred before the age of 65 years compared with 20% of non-Indigenous deaths (AIHW, 2011). In that same period, endocrine, metabolic and nutritional disorders contributed to Indigenous mortality at 6-7 times the non-Indigenous rates (AIHW, 2011). In 2008, an estimated 8% of Indigenous adults had a profound or severe core activity limitation and the level of need for assistance among Indigenous Australians was more than twice as high as that among non-Indigenous Australians (ABS, 2010).


 * Table 2 ||

The most concerning health statistics for Indigenous Australians is the prevalence of chronic conditions. For example, the estimated prevalence of diabetes among Indigenous adults is between 10%-30%, 2-4 times higher than that of non-indigenous Australians (Si, D., et al., 2008, p. 2). The death rate associated with diabetes for 35-54 year old Indigenous people was 27-35 times higher compared to non Indigenous Australians (Si, D., et al., 2008, p. 2). Indigenous Australians were also 3 times as likely to be diagnosed with liver cancer and 2.8 times as likely to be diagnosed with cervical cancer as their non-Indigenous counterparts (ABS, 2010).

Behavioural factors also greatly impact on the health status of Indigenous Australians. The smoking rate amongst Indigenous Australians is 45% which is more than double that for non-indigenous Australians (AIHW, 2011). In 2008, 17% of Aboriginal and Torres Strait Islander people aged 15 years and over reported drinking at chronic risky/high risk levels in the last 12 months, representing no significant change from 2002 (15%) and a further 46% were low risk drinkers (ABS, 2010). Socioeconomic factors also affect Indigenous Australians. The unemployment rate for Indigenous Australians was 17% in 2008, three times higher than the rate for non-indigenous Australians (ABS, 2010) and in terms of housing situations, one quarter (25%) of all Indigenous adults lived in overcrowded housing in 2008 (AIHW, 2011).

<span style="font-family: Arial,Helvetica,sans-serif;">The socio-economic disadvantage and ill-health experienced by Indigenous Australians has continued at alarming rates despite increased research into Indigenous health and the burdens faced by Indigenous peoples. Given the state of ill-health in Indigenous communities, there is increasing recognition of the need for greater understanding of Indigenous health needs and means by which to deal with them (McLennan, V., & Khavarpour, F., 2004, p.237).

<span style="font-family: Arial,Helvetica,sans-serif;">There are many opinions as to why there is such a gap in health between Indigenous and non-Indigenous Australians today. A recurring theme in Indigenous affairs in Australia is a tension between maintenance of Indigenous culture and achievement of socio-economic ‘equity’. There is the view that attachment to traditional cultures and lifestyles is a barrier to achieving ‘mainstream’ economic goals (Dockey, A., 2010, p.315). However research shows that stronger attachment to traditional culture is found to be associated with enhanced outcomes across a range of socio-economic indicators (McLennan, V., & Khavarpour, F., 2004, p.237).



<span style="font-family: Arial,Helvetica,sans-serif;">Part of the process of colonisation in Australia was the implementation of assimilation practices (Eckerman, 2010, p.22). These practices of assimilation did not take into consideration any part of the Aboriginal’s people’s human existence and lifestyle (Haebich, 2008, p.115) and as such their original way of life and their human existence involving connection to mother earth, spirituality, cultural identity and traditional healing methods became threatened, and ultimately eliminated under white governance (Thomson, 2003, p.97). For Aboriginal people, the definition of health is broad, including the social, spiritual, emotional and physical wellbeing of the whole community (Reilly, R., et al., 2011, p.2). To make Indigenous health improvement a reality, the experts in Aboriginal health, namely Aboriginal people, need to be able to voice and action initiatives that address their health issues (Sherwood, J., & Edwards, T., 2006, p.178). While programs and policies continue to be developed, implemented and evaluated by non-Indigenous people and are underpinned by a philosophy of ‘a white way of doing things’ the health status of Indigenous Australians will remain unchanged (Angus, S., & Lea, T., 1998, p.637).

<span style="font-family: Arial,Helvetica,sans-serif;">Dr Lara Wieland, a medical doctor working with Indigenous communities in Cape York, is adamant community control is the key to improving Indigenous health (Armstrong, F., 2004, p. 17). This has been proven around the world, Dr Wieland said. It is these smaller, community-based, person-driven initiatives, that have the most impact in a community, yet they are the ones that we don’t hear much about, as opposed to well-publicised government initiatives that have little impact on the ground (Armstrong, F., 2004, p. 17).

<span style="font-family: Arial,Helvetica,sans-serif;">//‘There is a whole lot of flow-on effects as well, such as raised self-esteem, employment, pride, role modelling and a feeling of community, all of which have been shown to contribute to better community health’// (Armstrong, F., 2004, p. 17).

<span style="font-family: Arial,Helvetica,sans-serif;">It is clear that current and past government campaigns to improve the health of Indigenous Australians and “close the gap” have been unsuccessful in creating such an effect. If policies and strategies and frameworks made people healthy, then aboriginal people would possibly be the healthiest people in the world.

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

<span style="font-family: Arial,Helvetica,sans-serif;">Society and culture are crucial to understanding and addressing the health status of Indigenous Australians. Australian federal and jurisdictional governments are implementing ambitious policy initiatives intended to improve health care access and outcomes for Aboriginal and Torres Strait Islander people (Peiris, D., et al., 2012, p. 1). However, it is well know that non-Indigenous Australians have differing values and rituals associated with health than their Indigenous counterparts, yet most health promotion campaigns aimed at improving the health of Indigenous Australians are designed with the ‘western culture’ in mind rather than the culture and traditions of these people.

<span style="font-family: Arial,Helvetica,sans-serif;">Research states that Indigenous people make the biggest health gains from culturally appropriate care (Armstrong, F., 2004, p. 16). Hays (2002, p. 286) notes that it is a foregone conclusion that people become unhealthy when they have been cut off from their land, culture, kinships and life purpose. Culturally appropriate interventions take account of Aboriginal models of health and social determinants, and the wider social context of the everyday lives of Aboriginal people within which ‘health behaviours’ take place (Reilly, R., et al., 2011, p.2). This type of health promotion is essential to the upkeep of indigenous culture and the maintenance of their overall health. A doctor interviewed as part of the Kanyini Health Systems Assessment, a study to explore staff perspectives on health systems issues within Indigenous communities, made a very logical statement.

<span style="font-family: Arial,Helvetica,sans-serif;">//“I suppose, as an Indigenous doctor, you often get (patients saying) ‘I’m happy to talk to you about this, but I wouldn’t really want to talk to the GP down the road about it’...If it’s something to do with emotional, cultural, spiritual stuff, then that really does need to be addressed. But you know, mainstream practices might not see it as ‘true’ medicine”// (Reilly, R., et al., 2011, p.2).



<span style="font-family: Arial,Helvetica,sans-serif;">Recent data shows that only 0.3% of doctors and 0.5% of nurses in Australia are Indigenous, well below the 2.5% Indigenous representation in the Australian population (Armstrong, F., 2004, p. 16). Getting more Indigenous people into the workforce to provide culturally appropriate care is therefore critical to improving Indigenous health.

<span style="font-family: Arial,Helvetica,sans-serif;">This large gap in health between Indigenous and Non-Indigenous Australians can be attributed to a number of factors; however the most influential social change era was definitely the ‘Stolen Generation’. Perhaps the most destructive element of past government policy was the removal of Aboriginal children of mixed descent from their Aboriginal families and their adoption and institutionalisation by Europeans (Malin, M., & Maidment, D., 2003, p.86). The ideology underlying the assimilation era had been that if Aboriginal Australians could adopt the values and behaviours of White Australians, they would be accepted into the majority society (Malin, M., & Maidment, D., 2003, p.86). Now Indigenous Australians are being monitored using the Australian government’s ‘Close the Gap’ campaign. The ‘Close the Gap’ approach constructs the people of Indigenous Australia as statistical units; this illustrates a substantial imbalance in power and control over the Indigenous affairs agenda in Australia, which is the ‘gap’ that must be addressed for the health and wellbeing of Indigenous Australians to improve (Pholi, K., et al., 2009, p. 1).

<span style="font-family: Arial,Helvetica,sans-serif;">This is a major public health issue in Australia today. As mentioned earlier, Australia is one of the wealthiest nations, with one of the highest Human Development Index ratings in the world. However, the original owners of this land are still suffering while others thrive, this is not acceptable. Indigenous Australians deserve appropriate health care and attention whilst respecting their culture. Health promotion and interventions in the future need to take special care in assuring these needs are met.

<span style="font-family: Arial,Helvetica,sans-serif;">The artefact that I have chosen perfectly represents the topic of Indigenous health. The main point that has been argued in this analysis is the fact that current health initiatives are based on western culture and don’t take into consideration the important aspects associated with Indigenous health such as their traditions and rituals. The image I have selected portrays the integration of cultures. The cultural naming of certain sectors of the medical centre and the inclusion of the Wellbeing Centre suggests the consideration of the Aboriginal definition of health which embraces social, spiritual, emotional and physical wellbeing of the whole community. This artefact and topic in general are of great importance to me as I didn’t realise there was such a gap in health between Indigenous and non-Indigenous Australians. As an Australian, I take pride in my country and the opportunities that it presents to people of all backgrounds, but I feel a sense of guilt and shame due to the way our traditional owners are, and have been, living because of ‘white Australians’. It is almost an embarrassment to the very core of the Australian ethos that is multiculturalism, as we do not accept or embrace the culture of our own Indigenous people. This will definitely affect and shape my future learning and thinking as a student and as a professional. I feel it is potentially a role of mine, as a future teacher, to educate my students about the health disparities in Australia and encourage them to want to make a change as well.
 * //<span style="font-family: Arial,Helvetica,sans-serif;">Analysis of the Artefact and Reflection //**

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

http://healthcultureandsociety2013.wikispaces.com/A+Few+Reasons+Why-+Transgender+Rights+and+the+Human+Rights+Argument

http://healthcultureandsociety2013.wikispaces.com/ATTENTION+shoppers!+Beware+of+that+bargain..

//**<span style="font-family: Arial,Helvetica,sans-serif;">References **// <span style="font-family: Arial,Helvetica,sans-serif;">ABS. (2010). The Health & Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples, Oct 2010. Retrieved 26 October, 2013 from http://www.abs.gov.au/ausstats/abs@.nsf /mf/4704.0/

<span style="font-family: Arial,Helvetica,sans-serif;">AIHW. (2011).The health and welfare of Australia's Aboriginal and Torres Strait Islander people. Retrieved 26 October, 2013 from http://www.aihw.gov.au/indigenous-observatory-health-and-welfare/

<span style="font-family: Arial,Helvetica,sans-serif;">Angus, S., & Lea, T. (1998). Planning for better health outcomes requires indigenous perspective. Australian and New Zealand Journal of Public Health, 22(6), 636-637. Retrieved 24 October, 2013 from http://search.proquest.com/docview/215708408?accountid=13380

<span style="font-family: Arial,Helvetica,sans-serif;">Armstrong, F. (2004). 'DEADLY': Indigenous health today. Australian Nursing Journal, 12(5), 16-18. Retrieved 25 October, 2013 from http://search.proquest.com/docview/236620321? accountid=13380

<span style="font-family: Arial,Helvetica,sans-serif;">Australian Human Rights Commission. (2008). A statistical overview of Aboriginal and Torres Strait Islander peoples in Australia: Social Justice Report 2008. Retrieved 26 October, 2013 fromhttp://www.humanrights.gov.au/publications/statistical-overview-aboriginal-and-torres-strait-islander-peoples-australia-social

<span style="font-family: Arial,Helvetica,sans-serif;">Cooke, M., Mitrou, F., Lawrence, D., Guimond, E., & Beavon, D. (2007). Indigenous well-being in four countries: An application of the UNDP'S human development index to indigenous peoples in Australia, Canada, New Zealand, and the United States. BMC International Health and Human Rights, 7(1), 1-11. doi:10.1186/1472-698X-7-9

<span style="font-family: Arial,Helvetica,sans-serif;">Dockery, A. M. (2010). Culture and wellbeing: The case of indigenous Australians. Social Indicators Research, 99(2), 315-332. doi:10.1007/s11205-010-9582-y

<span style="font-family: Arial,Helvetica,sans-serif;">Eckermann, A. (2010). Binan goonj: Bridging cultures in aboriginal health. Chatswood, N.S.W: Elsevier Australia.

<span style="font-family: Arial,Helvetica,sans-serif;">Haebich, A. (2008). Spinning the dream: Assimilation in Australia 1950-1970. North Fremantle, W.A: Fremantle Press.

<span style="font-family: Arial,Helvetica,sans-serif;">Hays, R. (2002). One approach to improving indigenous health care through medical education. The Australian Journal of Rural Health, 10(6), 285-287. Retrieved 26 October, 2013 from http://web.ebscohost.com.ezp01.library.qut.edu.au/ehost/pdfviewer/pdfviewer?sid=389aa1ce-291a-4bbf-9f7e-13cf297c3970%40sessionmgr15&vid=2&hid=28

<span style="font-family: Arial,Helvetica,sans-serif;">Malin, M., & Maidment, D. (2003). Education, indigenous survival and well-being: Emerging ideas and programs. The Australian Journal of Indigenous Education,32, 85-100. Retrieved 26 October, 2013 from []

<span style="font-family: Arial,Helvetica,sans-serif;">McLennan, V., & Khavarpour, F. (2004). Culturally appropriate health promotion: Its meaning and application in aboriginal communities. Health Promotion Journal of Australia: Official Journal of Australian Association of Health Promotion Professionals, 15(3), 237-239. Retrieved 28 October, 2013 from http://search.informit.com.au.ezp01.library.qut.edu.au/document Summary;dn=454259874107813;res=IELHEA

<span style="font-family: Arial,Helvetica,sans-serif;">Peiris, D., Brown, A., Howard, M., Rickards, B. A., Tonkin, A., Ring, I., & Cass, A. (2012). Building better systems of care for Aboriginal and Torres Strait islander people: Findings from the kanyini health systems assessment. BMC Health Services Research, 12(1), 1-15. doi:10.1186/1472-6963-12-369

<span style="font-family: Arial,Helvetica,sans-serif;">Pholi, K., Black, D., & Richards, C. (2009). Is ‘Close the Gap’ a useful approach to improving the health and wellbeing of Indigenous Australians? Australian Review of Public Affairs, 9(2), 1-13. Retrieved 27 October, 2013 from []

<span style="font-family: Arial,Helvetica,sans-serif;">Reilly, R. E., Cincotta, M., Doyle, J., Firebrace, B. R., Cargo, M., van den Tol, G., Morgan-Bulled, D., & Rowley, K. (2011). A pilot study of aboriginal health promotion from an ecological perspective. BMC Public Health, 11(1), 1-9. doi:10.1186/1471-2458-11-749

<span style="font-family: Arial,Helvetica,sans-serif;">Sherwood, J., & Edwards, T. (2006). Decolonisation: a critical step for improving Aboriginal health. Contemporary Nurse, 22(2), 178-190. Retrieved 25 October, 2013 from http://search.informit.com.au.ezp01.library.qut.edu.au/fullText;dn=200612530;res=APAFT

<span style="font-family: Arial,Helvetica,sans-serif;">Si, D., Bailie, R., Cunningham, J., Robinson, G., Dowden, M., Stewart, A., & Weeramanthri, T. (2008). Describing and analysing primary health care system support for chronic illness care in indigenous communities in Australia’s northern territory - use of the chronic care model. BMC Health Services Research, 8(1), 1-14. doi:10.1186/1472-6963-8-112

<span style="font-family: Arial,Helvetica,sans-serif;">Stephens, C., Porter, J., Nettleton, C., & Willis, R. (2006). Disappearing, displaced, and undervalued: A call to action for indigenous health worldwide. <span style="font-family: Arial,Helvetica,sans-serif;">Lancet, 367(9527), 2019-2028. doi:10.1016/S0140-6736(06)68892-2

<span style="font-family: Arial,Helvetica,sans-serif;">Thomson, N. (2003). The health of indigenous Australians. South Melbourne, Vic: Oxford University Press.