1. It is a government strategy whose objective is to advance the lives of the Aboriginal along with the Torres Strait Islander individuals by minimizing disadvantage among them with respect to child mortality, educational accomplishment, employment outcomes, and life expectancy together with access to early childhood education (Brown, O’shea, Mott, McBride, Lawson and Jennings, 2015). Rudd administration instituted the National Indigenous Health Equality Council in 2008 and COAG endorsed the National Indigenous Reform Agreement the same year November that set out six closing the gap objectives. Moreover, it is a formal commitment created by all Australian authorities to accomplish Aboriginal and Torres Strait Islander health equality in 25 years.
Policy of closing the gap was created in retaliation to the call of the social justice report of 2005 along with the Close the Gap social justice campaign (Brown, O’shea, Mott, McBride, Lawson and Jennings, 2015). Australian government agreed to operate in line with Aboriginal and Torres Strait Islander individuals around March 2008 for the purpose of accomplishing equity in well-being status along with life expectancy amidst Aboriginal and Torres Strait Islander people and non-indigenous Australians by 2030 when they signed the “Indigenous health equality summit statement of intent.” Here, they spend one point six billion dollars over four years on its Indigenous Chronic Disorder Package and the package focused on preventive health, primary healthcare, and expansion of the Indigenous workforce (Brown, O’shea, Mott, McBride, Lawson and Jennings, 2015).
Through the policy of closing the Gap p the health results have improved since fewer indigenous individuals are dying from chronic diseases. The mortality rate of aboriginal children under five years since 1998 has reduced by 35 percent (Doran, Ling, Searles, and Hill, 2016). From 1998 to 2016, Indigenous mortality proportions from circulatory diseases fell by around 45 percent. Also, since 2006 until 2015 death rates from kidney disease reduced by 47 percent and since 1998 till 2015 death rates due to respiratory disease declined by 24 percent. Between 2008 and 2016 the percentage of site impairment along with blindness among Indigenous Australians has dropped from six times to three times that of non-Indigenous Australians (Doran, Ling, Searles, and Hill, 2016).
Moreover, the proportion of Indigenous individuals of the age of 18 years and above who smoke has reduced significantly between 1994 and 2014-15 from 55 to 45 percent. As Australians are on track to terminate trachoma as a public health issue by 2020, the frequency of active trachoma in Indigenous children of five to nine years in at-risk communities reduced from 14 percent to 4.7 percent between 2009 and 2016 (Doran, Ling, Searles, and Hill, 2016).
There are several barriers or challenges which influenced the change in the health outcomes of the Aboriginal and Torres Strait Islander individuals. The direct costs of consultations, medication, lack of knowledge on bulk billing operations and absence of financing for indigenous health programs was one of the challenges (Gibson et al., 2015). Furthermore, insufficient public transport services, poor timetabling, health services not available by public transport and the absence of cultural awareness along with responsiveness in mainstream attention. The health services being not aware of the number of indigenous clients, because staffs are not self-assured of querying patients on their indigenous situation and the Indigenous Australians, are not willing to identify themselves (Gibson et al., 2015). The last challenge is concerning staffing issues whereby there are staff shortages specifically in rural and remote regions and absence of indigenous staff that can take on extra closing the gap task (Gibson et al., 2015).
2. The effect of Type 2 Diabetes on Judy is microvascular complications which are the damage of the small blood vessels causing problems in the kidneys, feet, nerves, and eyes (Adeshara, Diwan and Tupe, 2016). Also, Judy might encounter macro vascular complications which cause plague to build-up damaging the large blood vessels of the heart, legs, and brain. Diabetes has been addressed within closing the Gap through the introduction of Aboriginal Community Controlled Health Services (ACCHS) which has enhanced involvement in health at a community level, contributed to developed health outcomes and elevated clinic consultations (Campbell, Hunt, Scrimgeour, Davey and Jones, 2018).
The long-term consequences of diabetes on the well-being of Aboriginal and Torres Strait Islander people consist of kidney failure, depression, nerve disease, blindness, amputation, stroke and heart attack (Low Wang, Hess, Hiatt, and Goldfine, 2016). Some of the social determinants which might affect Judy are unemployment, income along with social support (Cullen, Clapham, Hunter, Porykali & Ivers, 2018). When income is high it permits for greater access to goods and services which give health advantages like better housing along with food and extra health care options. Judy in her condition will be affected since she does not work and her two children although they help when they can it means that the income is low and could worsen Judy’s condition because she might not get enough money for her check-ups and for her medications.
Moreover, unemployment has a strong effect on mental and physical well-being through its psychological problems and the financial issues it comes with (Cullen, Clapham, Hunter, Porykali & Ivers, 2018). In the case scenario Judy is not employed which means that her financial status is bad and to manage her condition will be difficult unless she gets support from somewhere else. Finally, lack of social support leads to social exclusion which may result to discrimination since one is not socially connected into groups which can help in improving health outcomes. Judy lives by herself and it is not evident that she is in any social group which affect her health.
3. The benefit that Judy will get by being registered on Closing the Gap is that she will have access to low cost or free Pharmaceutical Benefits Scheme medicines due to the Closing the Gap (CTG) PBS (Pharmaceutical Benefits Scheme) Co-payment Program which was instituted to lower the prices of PBS medicine for available Aboriginal and Torres Strait Islander individuals having or being at peril of non-communicable diseases (Mellish et al., 2015). She will also be available to register for the PBS Safety Net whereby the Closing the Gap (CTG) Pharmaceutical Benefits Scheme (PBS) Co-payment measure do not change the amount which can be added to a family’s Safety Net Threshold (Mellish et al., 2015). Furthermore, the policy ensures that everybody achieves his or her full health potential and has equitable, barrier-free availability to healthcare notwithstanding of a person’s social, demographic, geographical or economic position.
When Judy is registered on closing the Gap policy means that she will be using little or no income to manage her condition and therefore she can save the little money she gets to improve her diet. Also, she will be enabled to engage in paid work since some of the diabetic Aboriginal, and Torres Strait Islander individuals are allowed to partake in paid work which might result to higher incomes that in turn provide resources that are positive for her health and well-being (Mellish et al., 2015). Therefore, her housing condition which could have worsened her situation will be improved thus stress reduced.
4. AMS stands for Aboriginal Medical Service (Dutton, Stevens and Newman, 2016) while ALO stands for Aboriginal Liaison Officer (Katzenellenbogen, Miller, Somerford, McEvoy and Bessarab, 2015). An Aboriginal Medical Service is a health service financed mainly to dispense services to Aboriginal and Torres Strait Islander individuals (Glover, 2017). Aboriginal Liaison Officer provides emotional, social, and spiritual along with cultural reinforcement to Aboriginal and Torres Strait Islander patients and their families when they utilize the hospital at GV health. Since Judy needs every day dressing as requested by Aboriginal Liaison Officer which is not provided at Aboriginal Medical Service, Judy had to be discharged home so that the community nurses could attend to her daily at home. Moreover, Aboriginal Medical Services do not do home visits that is the reason Judy was transferred to UTS Community Health Centre which does home visits.
Services provided at Aboriginal Medical Service include diabetes services, dental health services, chronic disease management, alcohol, and other drugs management, community-based programs, counseling, allied health services including Audiometry and Optometry and general practitioner clinics (Hamilton, Mills, McRae and Thompson, 2018). Also, they provide sexual health services and programs, postnatal services, hearing, and mental health programs, women’s and men’s health programs, nutrition and exercise programs along with visiting specialist services entailing respiratory, endocrinology, psychology, psychiatry together with pediatrics (Hamilton, Mills, McRae and Thompson, 2018). Aboriginal Liaison Officer provides services like discharge planning, assessments, arranging transport, accommodation, and family meetings along with support counseling (McKenna, Fernbacher, Furness and Hannon, 2015).
The association amidst Aboriginal Liaison Officer along with Aboriginal Medical Service is that the Aboriginal Liaison Officer provides details and reinforcement to GV health team to assist them deliver culturally delicate health services. Also, Aboriginal Liaison Officer is required to work effectively with a team of the Aboriginal Medical Service and work with community health centers to improve access to their services (Durey, McEvoy, Swift-Otero, Taylor, Katzenellenbogen and Bessarab, 2016).
A Adeshara, K., G Diwan, A. and S Tupe, R., 2016. Diabetes and complications: cellular signaling pathways, current understanding, and targeted therapies. Current drug targets, 17(11), pp.1309-1328.
Brown, A., O’shea, R.L., Mott, K., McBride, K.F., Lawson, T. and Jennings, G.L., 2015. A strategy for translating evidence into policy and practice to close the gap-developing essential service standards for Aboriginal and Torres Strait Islander cardiovascular care. Heart, Lung, and Circulation, 24(2), pp. 119-125.
Campbell, M.A., Hunt, J., Scrimgeour, D.J., Davey, M. and Jones, V., 2018. Contribution of Aboriginal Community-Controlled Health Services to improving Aboriginal health: an evidence review. Australian health review, 42(2), pp.218-226.
Cullen, P., Clapham, K., Hunter, K., Porykali, B., & Ivers, R. (2018). PW 1898 Embedding multi-sectoral solutions to address transport injury and social determinants of health in aboriginal communities in Australia.
Doran, C.M., Ling, R., Searles, A. and Hill, P., 2016. Does evidence influence policy? Resource allocation and the Indigenous Burden of Disease study. Australian Health Review, 40(6), pp.705-715.
Durey, A., McEvoy, S., Swift-Otero, V., Taylor, K., Katzenellenbogen, J. and Bessarab, D., 2016. Improving healthcare for Aboriginal Australians through effective engagement between community and health services. BMC health services research, 16(1), p.224.
Dutton, T., Stevens, W. and Newman, J., 2016. Health assessments for Indigenous Australians at Orange Aboriginal Medical Service: health problems identified and subsequent follow-up. Australian journal of primary health, 22(3), pp.233-238.
Gibson, O., Lisy, K., Davy, C., Aromataris, E., Kite, E., Lockwood, C., Riitano, D., McBride, K., and Brown, A., 2015. Enablers and barriers to the implementation of primary health care interventions for Indigenous people with chronic diseases: a systematic review. Implementation Science, 10(1), p.71.
Glover, R., 2017. Aboriginal and Torres Strait islander patients and their family’s experience when engaging in discharge. Communities, Children and Families Australia, 11(2), p.15.
Hamilton, S., Mills, B., McRae, S., and Thompson, S., 2018. Evidence to service gap: cardiac rehabilitation and secondary prevention in rural and remote Western Australia. BMC health services research, 18(1), p.64.
Katzenellenbogen, J.M., Miller, L.J., Somerford, P., McEvoy, S. and Bessarab, D., 2015. Strategic information for hospital service planning: a linked data study to inform an urban Aboriginal Health Liaison Officer program in Western Australia. Australian Health Review, 39(4), pp.429-436.
Low Wang, C.C., Hess, C.N., Hiatt, W.R. and Goldfine, A.B., 2016. Clinical update: cardiovascular disease in diabetes mellitus: atherosclerotic cardiovascular disease and heart failure in type 2 diabetes mellitus–mechanisms, management, and clinical considerations. Circulation, 133(24), pp.2459-2502.
Mellish, L., Karanges, E.A., Litchfield, M.J., Schaffer, A.L., Blanch, B., Daniels, B.J., Segrave, A. and Pearson, S.A., 2015. The Australian Pharmaceutical Benefits Scheme data collection: a practical guide for researchers. BMC research notes, 8(1), p.634.
McKenna, B., Fernbacher, S., Furness, T. and Hannon, M., 2015. “Cultural brokerage” and beyond: piloting the role of an urban Aboriginal Mental Health Liaison Officer. BMC public health, 15(1), p.881.
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