Chronic diseases are one of the main causes of burden of diseases, potentially avoidable deaths and hospitalizations in Australia. Chronic conditions such as circulatory and heart diseases, diabetes, respiratory diseases, high blood pressure etc. are significant problem for Indigenous Australians. As per the statistics, it has been found that 20% of the Australians from the year 2015-2017 lived in very low socio-economic regions and are twice more likely to have at least two chronic illnesses such as diabetes, cardiac diseases. The aboriginal and Torres strait Islanders are always at disadvantage in comparison to the other Australians in several aspects which even includes quality healthcare services (Ride., 2017). The gap includes the life expectations and vast healthcare disparity between the non-indigenous and indigenous Australians. Although the strategy like closing the gap showed some improvements but still the national statistics suggests that there are still more areas for improvement. There were other matters of concerns which included family and community violence, child removals etc.
In order to overcome these challenges, the government of Australia brought closing the gap policy which ensured equality in health sector by educating on health and quality of living, increasing their sources of income (Australian Government., 2018). There is a rise in chronic diseases like diabetes in indigenous people due to their poor lifestyle and low nutrition diet. The data also shows that in rural area there is also increase in the number of kidney diseases among the local indigenous people due to inaccessibility to quality healthcare facilities. This paper will provide a brief analysis on closing the gap policy and its significance to Aboriginal and Torres island people, its importance to Judy’s diabetes along with the other benefits and at last the discussion of ALO and AMS in context of Judy’s.
The government policy “closing the gap” was established in response to the Social Justice report of 2005 (Australian Indigenous HealthInfoNet., n.d.). A campaign was propelled in April 2007 by Indigenous and non-Indigenous health bodies, NGOs and civil rights groups to attain health and lifespan parity for Australia’s Aboriginal and Torres Strait Islanders with Non-Indigenous Australians citing the same social justice report and the campaigned was named as “Close the Gap”. The government policy targeted to lessen the hindrance amongst these people in the field of lifespan, child mortality, child education and occupational outcomes(Panaretto, et al., 2014).
A formal agreement and guarantee was made which was named “the Indigenous health equality summit statement of intent” between Aboriginal and Torres Strait Islander populaces and the Australian government in March 2008, to make parity in lifespan and health status in relative terms amongst Aboriginal and Torres Strait Islander populaces and non-Indigenous Australians by the year 2030 (Australian Human Rights Commission., 2018).The council of Australian governments (COAG) fixed assessable targets to monitor progresses, in health and wellbeing wise of the Aboriginal and Torres Strait Islander population such as to close the gap in lifespan by 2031, cut up the child mortality rate in half by 2018, admission of 95 percent four year olds in school by 2025, cut up the gap in half for areas as reading, writing and numeracy by 2018, cut up the unemployment rate in half by 2018.
The policy intended to help the underprivileged Indigenous Australian people of rural areas who had to travel long distance to get hospital services(Stoneham, Goodman & Daube., 2014). Relatively aboriginal people have shorter lifespan to that of non-indigenous Australians due to minimal healthcare. The policy also aimed to reduce extra cost of healthcare affecting the lifespan of indigenous Australians. Closing the gap policy intended to increase the education level and hence encourage healthy lifestyle adoptions. The policy enhanced healthcare literacy and adoption of healthy lifestyle.
Different governments and political parties have tried to encourage the indigenous people to work together in bridging the gap. The most critical challenge faced by this policy is the lack of adequate fund to properly implement the policy. Government efforts have frequently failed to source funds and lack of appropriate resources. In year 2008 saw then Health minister Nicola Roxon and Kevin Rudd signed a joint agreement which intended to fund the policy to close the gap. The funds were not adequate to develop long term action strategy directed at the healthcare sector for the Aboriginals and Torres Strait Islanders people to increase lifespan and proper availability of healthcare. One of the major hindrances to this policy also has been failure of the successive government to get approval amongst the majority of Indigenous Australians(Martin, 2014).
As Judy is suffering from type-2 diabetes and has returned home with leg ulcer which needs daily dressings, registering her on CTG will help her to get suitable and effective healthcare services. It will enable her to live a healthier and better life. It will also increase her life expectancy as she will be able to obtain appropriate healthcare facilitiesto deal with her chronic diabetes. It will also help improve her living conditions as the main aim of this CTG policy is to improve working and living conditions of people that includes proper and improved accessibility to healthcare services and housing to manage diabetes. She will also be able to enjoy basic human rights as per WHO (World Health Organization) and also supported by Australian government which involves right to access food, shelter, education and healthcare facilities.It will also provide her cultural appropriate healthcare with equal opportunities to access several healthcare services.
It will also help her to get diet and nutrition advice for diabetes which will ensure her healthy life and decrease the risk of being malnourished. Thus, it will also help to control Judy’s diabetes by providing her with quality medical care considering her social and cultural beliefs as well. Closing the Gap will have significant impact on Judy’s Life once she is registered to it. It will improve her overall health and standard of living by educating her on healthy living and proper management of diabetes to increase life expectancy.
Infant mortality, chronic diseases, and external factors such as accidents, self-harm, assault have also led to the gap in lifespan amongst the indigenous and non-indigenous Australians. Chronic diseases like circulatory diseases, cancers, have been on the rise. Chronic diseases and external causes are responsible for 60% of the deaths in Indigenous population. Chronic diseases are responsible for about two-thirds of the gap in deaths amongst Indigenous and non-Indigenous Australians.
There are several social determinantsof healthsuch ascrowded housing, poor accommodation, unemployment, poverty, remote location and substance abuse etc. that has high impact on the health of Indigenous people and has huge contribution to the burden of chronic health issues (Cohen, 2017). Judy is from the aboriginal community and has type 2 diabetes. She is qualified to be put under the CTG as she is not able to access the healthcare service that she needs for her current condition. CTG provides social support to the Indigenous people so that they can have easy and equal access to the health services provided in Australia. Once she is registered for CTG, it will enable her to get daily dressing for her condition of leg ulcer. As this policy makes sure to provide the easy accessibility of health services to the indigenous Australians who are living in rural places as well. As Judy is a 57 years old diabetic patientand lives by herself, she needs more care, regular monitoring and medical facilities for her state. Diabetesleads to several other issues like diabetic foot, ulcers, frequent urination etc. which puts her in more demanding state of healthcare and support.
There are several other challenges such as old age, lack of social and family care and support, lower income, lower education level etc. which may act as a barrier to her effective recovery(MacRae, et al., 2013). As per the CTG policy, the current condition of Judy that includes her living conditions, availability of social support and working condition will be addressed by it.
The national health performance framework of Australia which involves community and socioeconomic factor in terms of education,income and health literacy outlines the importance of social determinants of health.
Aboriginal and Islander Medical Services (AMS) is an organization managed by aboriginal healthcare personnel with understanding of the essentials of community(Baba, et al., 2014). They provide appropriate healthcare facilities to the Aboriginal and the Torres Strait Islanders. Aboriginal Liaison Officer (ALO) pledges the Torres Strait Islanders besides the Aboriginal people, access to the conventional healthcare services. Patients and relatives both get societal, sensitive and ethnic support from the Aboriginal Link Officers(Anon., n.d.). The information about the medical services provided by the officer along with the co-operative comfort acts as a link between the hospital and the natural community assets. These two offer facts that Judy should manage her diabetes and curtail inappropriate lifestyle amongst the indigenous Australian Population. Judy was suggested by the AMS and ALO that she could not be offered the required services, therefore she seeks the services of community nurse assigned by them to her. In this case of Judy, the Aboriginal Liaison Officer and Aboriginal and Islander Medical Services officials both worked together to embark on the referral services. Because of the integration of the CTG to the Aboriginal Australians, effective engagement amongst the native community and the national healthcare services, Australian health care sector’s delivery to the aboriginals becomes enhanced.
In conclusion, it is evident that the introduction of CTG policy ensures that there is equality in health facilities between the indigenous and non-indigenous people by providing better education, improving their knowledge on health care, increasing their income by introducing more sources of income. The outcomes of this policy have positively influenced the social determinants of health and thereby improving the target areas like life expectancy, quality of living and overall improved standard of living. The introduction and successful implementation of closing the gap policy with the help of ALO and AMS along with other organizations and agencies have resulted in the effective and efficient management of chronic diseases like diabetes prevalent in the indigenous people. Even after the implementation of CTG policy there are several areas and challenges which has to be dealt with new strategies and plans to improve the overall health of entire community.
References
Australian Government, (2018). [Online] Available at: https://closingthegap.pmc.gov.au/sites/default/files/ctg-report-2018.pdf?a=1
[Accessed 11 August 2018].
Australian Human Rights Commission, (2018). [Online] Available at: https://www.humanrights.gov.au/our-work/aboriginal-and-torres-strait-islander-social-justice/projects/close-gap-indigenous-health [Accessed 11 August 2018].
Anon., n.d. Aboriginal Health. [Online] Available at: https://www.swsphn.com.au/aboriginalhealthcommunity [Accessed 11 August 2018].
Australian Indigenous HealthInfoNet, (n.d).[Online] Available at: https://healthinfonet.ecu.edu.au/learn/health-system/closing-the-gap/history-of-closing-the-gap/[Accessed 11 August 2018].
Baba, J. T., Brolan, C. E. & Hill, P. S., 2014. Aboriginal medical services cure more than illness: a qualitative study of how Indigenous services address the health impacts of discrimination in Brisbane communities. International Journal For Equity In Health, Volume 3, pp. 13-56.
Cohen, N., 2017. Closing the gap in diabetes. How is it going to be achieved?. EndocrinologyToday, 6(2), pp. 31-33.
MacRae, A., Thomson, N. & Burns, J., 2013. Overview of Australian Indigenous health status 2012. [Online] Available at: https://health.act.gov.au/sites/default/files/Overview%20of%20Aboriginal%20and%20Torres%20Strait%20Islander%20Health%20Status,%20HealthInfoNet,%202012.pdf[Accessed 11 August 2018].
Martin, D., 2014. Closing the Gap challenge is harder in remote areas. [Online] Available at: https://ruralhealth.org.au/media-release/closing-gap-challenge-harder-remote-areas[Accessed 11 August 2018].
Panaretto, K. S., Wenitong, M. & Button, S., 2014. Aboriginal community controlled health services: Leading the way in primary care. Medical journal of Australia, 200(11), pp. 649-652.
Ride, K., (2017). Plain language review of diabetes among Aboriginal and Torres Strait Islander people. Perth: Australian Indigenous People. Australian Aboriginal Journal pp1-14
Stoneham, M., Goodman, J. and Daube, M., 2014. The portrayal of Indigenous health in selected Australian media. The International Indigenous Policy Journal, 5(1), pp.1-13.
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