In the month of March in the year 2008, the Australian government understood the depth of the issue of health inequality and health inequity faced by the indigenous people of the nation and therefore proposed the “closing the gap” policy. They agreed to work with indigenous people for achieving the equality in health as well as in the life expectancy between the non-Indigenous Australians and the Aboriginal and Torres Strait Islander people by the year 2030 (Pyne et al. 2016). The Council of Australian Governments (COAG) mainly took the responsibility of establishing six ambitious targets across the areas of the health, employment and even in education for making progress and developing the quality of lives of the indigenous people (Taigman et al. 2014). This assignment would show how different strategies have been initiated by CTG and how these would help a patient to manage her diabetes effectively by overcoming various barriers.
The history of the strategy dates back to the year 2008 when it was established in response to the call of the Social justice report 2005 along with the close the Gap social justice campaign. In the year 2005, Tom Calma, who was the Aboriginal and Torres Strait Islander Social Justice Commissioner had released the Social justice report 2005. This important report showed the different data and statists which called for the government of the nation for committing to the achievement of the equality for both the indigenous people and the non-indigenous people in the area of health as well as life expectancy within the period of 25 years (Perso 2016). Another important aspect that contributed to the formation of the Closing the Gap policy was the “Close the Gap” campaign. This campaign aimed at the achievement of the health equality for the native people by 2030 and began as the National Indigenous Health Equality Campaign in the year 2006 with different governmental and non-governmental organizations. It was launched in the city of Sydney in 2007 and was organized by NACCHO, ANTaR and Oxfam Australia. It mainly helped in uniting the voices of about 40 organizations with an urge to the state, territory and federal governments for committing to the closing of the health and life expectancy gap between the native and non-native people. This paved the way for the emergence of closing the gap policy in 2008 (Chikarovski 2015).
The main areas where special attention had been provided for the development of condition of the native people and closing the gaps are child mortality, schools attendance, early childhood education, reading as well as numeracy, Year 12 or equivalent attainment, employment as well as life expectancy. It put an important focus on the development of primary healthcare services that would help in addressing the healthcare problems of the native people and solving them accordingly (Pace 2015). Addressing the behavioral and social factors leading to poor health had been identified and accordingly funds and interventions were incorporated for the development of quality of life for the patients. Effective partnership with the native people, supporting the indigenous Australians with disabilities, school nutrition projects in the northern territories, social and emotional well-being and many others were all planned by the professionals. National Indigenous Critical Response Service, aged care services, Encouragement of healthy lifestyle choices, reduction in the substance abuse misuse and harm are intricately associated with the objectives of the Closing the Gap program. Immunization as well as development of the housing quality all helped in meeting the perspectives (Chan 2014).
Between the periods of 2005 – 2007 and that of another phase of 2010 – 2012, there was seen to be a significant amount of reduction in life expectancy of gap. This gap was seen to be of 0.8 years for males and that of 0.1 years for females. Over the long term, although the mortality rates of the indigenous people have declined by a whooping number of 14 percent since the year of 1998, there has been no improvement since the year of 2006 baseline. Therefore, it can be stated that the target is not on track. Again, there had large number of significant improvements mainly to be seen in the mortality rate of the native people from the chronic disorders particularly from circulatory diseases. However, number of cancer cases is rising and gap is widening (Boyle et al. 2014). Again, there had been improvements in early detection and management of the chronic disorders and reductions in smoking. This would be helpful in the health improvement of the native people.
Some of the barriers had been identified which state the reason f some of the targets not meeting their desired goals. One of them is the financial barrier including the direct costs that seems to be associated with that of medication, consultations, and lack of knowledge about the bulk-billing practices as well as others. Lack of funding for the indigenous health programs are also other causes. Inadequate poor timetabling, public transport services, health services not easily accessible by the public transport and many others also act as barriers in meeting the aims of the closing the gap strategy (Kozlowska et al. 2017). Again, lack of cultural awareness as well as sensitivity in the different types of the mainstream care, staffs being not confident in asking patients about the indigenous status are some of the barriers. Workforce shortages, like that of particularly in the rural and remote areas, lack of staffs ability to take extra initiatives in closing the gap additional work all resulted in creating barriers in meeting the targets.
Judy has been diagnosed with diabetes and therefore she has to go through proper lifestyle management so that her blood glucose level remains under control. Besides her pharmacologic treatment, she also requires non-pharmacological interventions. Conducting vigorous exercises for about 30 minutes every day is important along with taking of quality nutrient dense food that is free from calories (Al Khalaileh et al. 2016). Here, weight should be kept under control and her blood pressure should be maintained. This would not only help in prevention of obesity which I turn complicates the condition of diabetes in the patient but other disorders like cerebro-vascular disorders would also be prevented. In order to help her to live quality life, it needs to be ensured that all the interventions and guidelines mentioned in the closing the gap policy are followed by the professionals. She might not have enough knowledge about her condition of the disorder due to poor health literacy. It is one of the most important social determinants of health and proper education system to help her understand her disorder should be introduced. This would ensure development of self-care and management strategies reducing the risk of any further complication (Deutsche et al. 2016). Moreover, she might not have financial stability to pursue costly treatments and therefore following the “Closing the gap” strategy, care should be taken that she does not face any inequality and inequity while accessing healthcare services. Culturally competent evidence based care should be provided to her as that would have given to the non-native patients with the same background without any racial discrimination and stigmatization. Poverty, economic inequality and social status are important determinants of health along with material deprivation, lack of education as well as social exclusion. All the aspects should be cared for by the professionals to ensure patient satisfaction and better quality lives. A holistic approach aligning with the full cultural, social, emotional and economic context of Indigenous people’s lives should be considered while treating her and this should include an awareness of the ongoing legacy of trauma, grief and loss associated with colonization. This would help the patient to develop trust and mutual respect for the professionals, the later would be empathetic and a compassionate with along with development of physiological condition of the patient would also assure psychological stability, satisfaction and compliance with western healthcare (Trivedi et al. 2017).
The closing the Gap initiatives had proposed a new scheme for helping the native people in enjoying equity in healthcare. The Closing the Gap PBS Co-payment Program had been implemented in the year 2010 on first July. It is one of the 14 measures in the indigenous Chronic Disease Package (ICDP). It was established for the reduction of the cost of the PBS medication for those native people who are eligible and are suffering from the risk of chronic disorder or are diagnosed with chronic disorders. When the patients would need to obtain the PBS medicines that are present at their local pharmacy, the general patients who are eligible would be given the opportunity to normally pay the full PBS co-payment which is currently $ 39.50 per item pay the concessional arte of only $ 6.40 per item. Those who are seen to normally pay the concessional price receive their PBS medicines without being required to pay for the PBS co-payment (Alford 2015). The main eligibility of this initiative is that patients would be experiencing setbacks in the prevention as well as the ongoing management of the chronic disorders if the person fails to take the prescribed medications. Eligibility is that the patients are unlikely to adhere to the different medications regimens without the assistance through the programs. Therefore, the patient in the case study would be highly benefiting herself from the initiative as this would be helping her to tackle her financial constraints properly, get easy access to healthcare and support and overcome ant negative effects that would have resulted if she would not have been able to buy medicines because of her poor economic background.
The Aboriginal Liaison Officer mainly helps the Aboriginal and Torres Strait Islander people mainly by providing emotional, social as well as cultural supports to the patients as well as their families. They are also seen to provide liaison services for the patients as well as the families. They also provide information about the different services provided at the hospital and they mainly help in acting as a linkage between the hospitals as well as the indigenous community services. They do not directly provide clinical healthcare services but mainly help patients in talking to the healthcare professionals for making the patients understand medical procedures as well as routines. They mainly help patients in taking decisions about their care. Therefore, although they are providing support but they cannot help Judy by providing her the service of community nurses. They can only refer Judy to AMS or the Aboriginal Medical Service. The later is mainly responsible in acting as the aboriginal community controlled healthcare services in the nation (Bove et al. 2018). They are mainly responsible for the establishment of community based primary health-care services. The later can take the responsibility of sending Judy healthcare professionals who would be responsibly conducting the dressing sessions helping her to develop her quality of life.
From the above discussion, it is clear that Closing the Gap policy is helpful for the Aboriginal and Torres Islander people, helping to get over the different social determinants of health through their initiatives and helping them to achieve health equity and equality. Different schemes like medication schemes had been introduced which help them to purchase medicines at lesser cost helping them to overcome economic barriers. Aboriginal Liaison Officer and the Aboriginal Medical Service have their own specific roles helping the patients to meet their needs and requirement successfully and live better quality lives.
References:
Al Khalaileh, M., Al Qadire, M., Musa, A.S., Al-Khawaldeh, O.A., Al Qudah, H. and Alhabahbeh, A., 2016. Closing the Gap between Research Evidence and Clinical Practice: Jordanian Nurses’ Perceived Barriers to Research Utilisation. Journal of Education and Practice, 7(8), pp.52-57.
Alford, K.A., 2015. Indigenous health expenditure deficits obscured in Closing the Gap reports. Med J Aust, 203(10), p.403.
Bové, H., Steuwe, C., Saenen, N., Rasking, L., Nawrot, T., Roeffaers, M. and Ameloot, M., 2018, May. White-light from soot: closing the gap in the diagnostic market. In Biophotonics: Photonic Solutions for Better Health Care VI (Vol. 10685, p. 106852C). International Society for Optics and Photonics.
Boyle, C., Zhang, H. and Chan, P.W.K., 2014. Closing the gap. In Equality in Education (pp. 217-222). SensePublishers, Rotterdam.
Chan, W.L., 2014. Closing the gap. Equality in Education: Fairness and Inclusion, p.217.
Chikarovski, L., 2015. Closing the gap. Superfunds Magazine, (399), p.21.
Deutsch, E.S., Dong, Y., Halamek, L.P., Rosen, M.A., Taekman, J.M. and Rice, J., 2016. Leveraging health care simulation technology for human factors research: closing the gap between lab and bedside. Human factors, 58(7), pp.1082-1095.
Kozlowska, O., Solomons, L., Cuzner, D., Ahmed, S., McManners, J., Tan, G.D., Lumb, A. and Rea, R., 2017. Diabetes care: closing the gap between mental and physical health in primary care. Br J Gen Pract, 67(663), pp.471-472.
McGaffigan, P.A., Ullem, B.D. and Gandhi, T.K., 2017. Closing the gap and raising the bar: assessing board competency in quality and safety. The Joint Commission Journal on Quality and Patient Safety, 43(6), pp.267-274.
Pace, A.K., 2015. Closing the Gap. Serials Review, 41(1), pp.3-7.
Perso, T., 2016. Closing the gap. Australian Mathematics Teacher, The, 72(3), p.28.
Pyne, H.H., Dutta, P.V., Sondergaard, L., Stevens, J., Thwin, M.M. and Kham, N.M., 2016. Closing the Gap.
Taigman, Y., Yang, M., Ranzato, M.A. and Wolf, L., 2014. Deepface: Closing the gap to human-level performance in face verification. In Proceedings of the IEEE conference on computer vision and pattern recognition (pp. 1701-1708).
Trivedi, A.N., Bailie, R., Bailie, J., Brown, A. and Kelaher, M., 2017. Hospitalizations for chronic conditions among indigenous australians after medication copayment reductions: the closing the gap copayment incentive. Journal of general internal medicine, 32(5), pp.501-507.
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