Indigenous people have worse health in comparison to the non indigenous; they are over represented amongst the poor and have lower life expectancies. The relative socio economic disadvantages faced by this group of people have placed them at a bigger risk in terms of environmental and behavioural risks. Indigenous people are deprived not only in terms of health but also in the scale of unemployment, education, addiction, depression, self destruction and more. ‘Closing the gap’ is a government policy that focuses on to reduce the grievances of the aboriginals and the Torres Strait Islanders with respect to health disparity, racism, life expectancy, education, child mortality and employment (Parker & Milroy 2014). The essay gives a brief description of the ‘closing the gap’ policy and its significance in the life of the aboriginals. The essay provides insight on how diabetes impacts the life of Judy and how it can be managed. It also provides with the information how ‘closing the gap’ policies have taken initiatives to manage chronic diseases like diabetes. It also provides information about the role of the ALO (Aboriginal Liaison officer) and the AMS (Aboriginal medical service) in aboriginal health care.
The Council of Australian Governments (COAG) had introduced a policy on 20 December 2007, whose purpose was to close the gap in life expectancy among the aboriginal population (Healthinfonet.ecu.edu.au, 2018). The council consisted of leaders of both the federal, state, territory and the local government, who were committed to closing the gap. (Behrendt et al.2012).
‘Close the gap’ campaign began with the National Indigenous health equality campaign. A number of aboriginal health and non aboriginal health organizations were in support of this campaign (Browne et al. 2012). The main targets of ‘close the gap’ campaign was to close the gap in life expectancy within 2031, To close the gap in the rates of mortality among the aboriginal children, to ensure a safe and a healthy childhood, to remove the gap in education- reading, writing, and mathematics, to remove the gap in the employment among the aboriginals (Behrendt et al.2012).’Close the gap’ policy regarding health equality among the aboriginals is a policy that continues to grow every year with different pledges across the Australian community (Parker & Milroy 2014).
According to Behrendt et al.(2012), despite of the changing government, budget cuts and the constant bureaucracy churn, the health outcomes of the aboriginals have shown some encouraging improvements. According to the news, close the gap has failed to increase the life expectancy of the aboriginals at a considerate level (Holland 2014).
According to the annual report card on the indigenous health 2016, life expectancy of the aboriginals is still around 10 years, which signifies a wide gap (Holland 2014). The government needs to redouble its involvement with the indigenous Australians. Number of students finishing the high school is still considerably low (Browne et al. 2012). According to the government report, 2015 the child mortality rate has decreased by 33% (Healthinfonet.ecu.edu.au, 2018). Key factors such as access to antenatal care, decrease in the smoking and alcohol consumption rates during pregnancy will help to achieve the target by 2018 (Browne et al. 2012). According to the reports the total indigenous mortality rates had been decreased by 15 % between the years 1998 and 2015 (Healthinfonet.ecu.edu.au, 2018). Recent reports have shown decrease in the smoking rates among the aboriginals up to 9 %. COAG has updated the early childhood education target, which aims at reaching 95 % of all indigenous children enrolled in schools by 2025 (Healthinfonet.ecu.edu.au, 2018). According to the government reports of 2015, about 87 % of the four year olds have enrolled in schools compared to the 98% of the non indigenous ones (Holland 2014). The target to halve the gap in employment by 2018 is not on the track. There had been a decline since 2008 (Closingthegap.pmc.gov.au, 2018).
There are certain barriers behind closing the gap policy which includes distribution of resources, inadequate transport, cultural sensitivity, and shortage of staffing (Browne et al. 2012). The aboriginal values are linked to their traditional culture and they have very less reliance towards non aboriginal culture and treatments, due to their black past and they fear of losing their cultural heritage (Greenwood &de Leeuw 2012). Racism has always been a life stressor and negatively affects the cardiovascular system and mental health. Racism can be considered as a significant barrier to the Aboriginal health improvement (Holland 2014). Furthermore geography poses an important problem in indigenous employment. Most of the indigenous population resides in remote places where employment rate is very low and the chances of suitable employment are also not high (Browne et al. 2012).
Aboriginals have lower levels of usage of the Medicare and Pharmaceutical benefits. Aboriginals have less access to primary care facilities (Greenwood &de Leeuw 2012). They are less likely to use the preventive health care services and hence greater use of hospital outpatient services. All these can be considered as barriers to the improvement of ‘close the gap’ policy for the aboriginals.
It is evident from the case study that Judy had been suffering from a diabetic leg ulcer which is heavily exudated and requires regular dressing. As told earlier, the health status of the aboriginals are largely affected by their socio economic status, their accessibility to proper food and unhygienic housing. Reports say that the aboriginals are six times more likely to die out of diabetes than the non indigenous Australians (Behrendt et al.2012). The conventional risk factors that are responsible for diabetes can be genetic factors, lifestyle, substance abuse, lack of education, less physical activity and poor nutrition. Judy’s foot ulcer could have been prevented if treated beforehand, but it can be expected that Judy could not get access to proper diabetic care. Furthermore it is evident from the case study that Judy is a widow and currently lives alone. It should be noted that diabetes is also associated with stress and anxiety. Poor socioeconomic condition, along with loneliness might have taken a toll on her health and have deteriorated her health condition. Chronic diseases like diabetes accounts for about two thirds of the gap related to mortality in the aboriginals (Greenwood &de Leeuw 2012). About 10 % of the patients with diabetes require dialysis, and closing the gap policy has introduced the facility for dialysis even in the remote areas (Healthinfonet.ecu.edu.au, 2018). In Australia the ‘Aboriginal community controlled health services’ (ACCHS) has been introduced to access the care to the aboriginal community level (Holland 2014).
According to the ‘closing the gap’ policy, there had been an increase in the Medicare benefits and diabetes care plan. There had been many approaches for introducing new therapies in dispensaries such as long acting glucose lowering agents. The main factor that is associated with the management of diabetes is self efficacy (Pruett & DiFonzo 2014). Schemes like national diabetes service scheme (NDSS) have been able to increase the number of registrations from the aboriginal communities on NDSS (Holland 2014).
There had been changes in the pricing of food in the remote community stores, such that the poor aboriginal populations are able to access those (Adegbija et al. 2015). Remote housing and overcrowding can also be associated with the progression of chronic diseases like diabetes.
On registering under the ‘close the gap’ policy Judy will be able to access the Medicare facilities. The policy has also aimed to introduce cashless debit cards which would probably help her to get access to nutritious food (Azzopardi et al.2012). There would be ‘grants’ for proper housing (Adegbija et al. 2015). Judy is entitled to receive the residential aged care. There would be mobile dispensaries that would help Judy to get proper dressing of her wound and would also help her to get proper glycaemic medications. The health care workers offering home visits to Judy will be able to impart education regarding the management of diabetes, such as glycemic control of foods, medications (Azzopardi et al.2012). Since diabetes can be linked to bad oral health.’ Closing the gap’ policy would also ensure oral hygiene in Judy (Browne et al. 2012). Judy will be able to participate in the national diabetes prevention program which would include group prevention courses that is culturally accepted by the aboriginal community.
The aboriginal liaison officer (ALO) assists the aboriginals in their decision making process during their times of needs. They provide social, emotional and cultural support to the aboriginal people at the time of a hospital stay (Holland 2014). It is evident from the case study that Judy had been under a residential stay. ALO can help the aboriginals to talk to the health care professionals and understand the medical procedures. In Judy’s case ALO can educate Judy regarding herself management of diabetes or how to take care of her ulcerated foot or regarding the dosage and the duration of the medications. ALO can help Judy to attach with community programs and can refer clinicians or nurses to Judy’s care, if required. (AMS) Aboriginal medical services are a health service that is funded by the government to provide services to the Indigenous Australians (Pruett & DiFonzo 2014). It pioneered the concept of Aboriginal community controlled health care across Australia. The service provides medical, diabetes, aged care to the aboriginal Australians. In this case study Judy had been under the health care of the AMS due to her diabetic leg ulcer.
In order to close the gap in Australia, for improving the health care outcome in the aboriginals, culturally safe care has to be established and policies should be made such that the health care is accessible even to the remote locations. The cause of the growing gap in health is multifactorial and is linked to the social determinants. The problem has to be treated as an immediate health priority, thus government; focus groups have to be more involved. The government needs to focus more on the long term priorities of health, education, employment, safety and well being. The aboriginal community controlled sector has to be more strengthened in order to close the gap in chronic diseases. Targeted financial business assistance has to be provided to the indigenous counterparts. Furthermore, community safety, such as reducing substance harm, domestic violence supporting victims, women and children should be taken up by the government. Aboriginal people have actively noted the importance of the human rights based approach for addressing their grievances and ensuring the sustainability of their cultures.
References
Adegbija, O., Hoy, W.E. &Wang, Z., 2015. Corresponding waist circumference and body mass index values based on 10-year absolute type 2 diabetes risk in an Australian Aboriginal community. BMJ Open Diabetes Research and Care, vol.3,no.1, p.e000127.
Azzopardi, P., Brown, A.D., Zimmet, P., Fahy, R.E., Dent, G.A., Kelly, M.J., Kranzusch, K., Maple-Brown, L.J., Nossar, V., Silink, M. &Sinha, A.K., 2012. Type 2 diabetes in young Indigenous Australians in rural and remote areas: diagnosis, screening, management and prevention. Med J Aust, vol.197, no.1, pp.32-6.
Behrendt, L.Y., Larkin, S., Griew, R. &Kelly, P., 2012. Review of higher education access and outcomes for Aboriginal and Torres Strait Islander people.pp.13-26
Browne, J., Hayes, R. & Gleeson, D., 2014. Aboriginal health policy: is nutrition the ‘gap’in ‘Closing the Gap’?. Australian and New Zealand journal of public health, vol.38,no.4, pp.362-369.
Closingthegap.pmc.gov.au. 2018. Home | Closing the Gap. [online] Available at: https://closingthegap.pmc.gov.au/ [Accessed 3 Jan. 2018].
Greenwood, M.L. &de Leeuw, S.N., 2012. Social determinants of health and the future well-being of Aboriginal children in Canada. Paediatrics & child health, vol.17, no.7, pp.381-384.
Healthinfonet.ecu.edu.au. 2018. What is Closing the Gap? « Key facts « Closing the gap « Australian Indigenous HealthInfoNet. [online] Available at: https://www.healthinfonet.ecu.edu.au/closing-the-gap/key-facts/what-is-closing-the-gap [Accessed 3 Jan. 2018].
Holland, C., 2014. Close the Gap: progress and priorities report 2014. Close the Gap Campaign Steering Committee, The Close the Gap Campaign Steering Committee,SanFransisco,pp.86-105
Marley, J.V., Nelson, C., O’Donnell, V. &Atkinson, D., 2012. Quality indicators of diabetes care: an example of remote-area Aboriginal primary health care over 10 years. The Medical Journal of Australia, vol.197,no.7, pp.404-408.
Panaretto, K.S., Wenitong, M., Button, S. &Ring, I.T., 2014. Aboriginal community controlled health services: leading the way in primary care. Med J Aust, vol. 200,no.11, pp.649-52.
Parker, R. & Milroy, H., 2014. Aboriginal and Torres Strait Islander mental health: an overview. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice, vol. 2, pp.25-38.
Pruett, M.K. & DiFonzo, J.H., 2014. Closing the gap: Research, policy, practice, and shared parenting. Family Court Review, vol.52, no.2, pp.152-174.
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