Discuss about the Indigenous Health System.
Cultural safety term was introduced by the New Zealand Nursing Council to improve the quality of health service by the Pakeha nurses to the Maori people. In 1992 a definition was given by the nursing council for the cultural safety as the proper nursing of the culturally diverse people by the nurses who has the knowledge about their own cultural background. They should acknowledge ethical, political and social environmental effect on the health and should be responsible to build a trustworthy and respectful relation with the client. Cultural safety is maintained by having an effective communication, acknowledging the cultural diversity of varied ethnic communities and the effect colonisation has caused on these communities. (New Zealand Council of Nursing, 2011).
The nurses take an oath that they will not treat the people from different cultural background differently or badly but is it actually practised? I’m not a racist, I treat everyone the same. The principle of equal treatment is a good measure to but does it really implies to all the people. As per Reibel & Walker (2010) – although the guidelines and polices focus on the importance of cultural competency in improving the maternal services of health care organization, there are no strategies to imply cultural competency in the services of health care organization to provide quality services to the aboriginal women.
The difference between equality, equity and disparity in respect to public health is often misunderstood. One need to have a clear view of the meaning and implication of these terms especially when it is about health and is related to diverse people from many different cultures. Health equity implies that every individual has equal right to have good health in his life. Health services in Australia need to be accessible to everyone in the country. Not everyone in Australia have a good health. The no. of death and diseases, life expectancy, health behaviour, health literacy and the utilisation of the care services by the health organization is different in varied population group in Australia. (Health association of Australia, 2008).
Health inequality is the difference in the resource distribution, access to services and the unfair circumstances. It is mainly related to the external factors which are not under control of an individual. Health inequalities are the result of injustice and inequalities that put some population communities highly susceptible to bad health than other population communities. Disparity in terms of health is very much observed in Australia referring to the diverse population groups. People living in the remote area, with low economic condition and having different cultural origin experience a noticeable disparity in the overall health outcome compared to the other people. (Australian Bureau of Statistics, 1999).
Mortality rate and morbidity is high in case of Aboriginal and Torres Strait Islander community women and their children whereas in the other women and babies this rate is low. The Australia Health Ministers’ Advisory Council (AHMAC) has made several new plans and strategies to minimise this difference and ensure good health to all its citizens mentioned in National Maternity Services Plan (NMSP) (2011b).
The aboriginal women and the Torres Strait Island women in the villages and remote regions are not allowed to utilise the good quality health care and services by the health professionals. (Hirst, 2005; Kildea et al, 2010). Also the Aboriginal and Torres Strait Islander community people were diagnosed with more than 3 times higher rate of having any form of diabetes compared to the other community people in Australia. They have a much higher rate of dying from diabetes (6 times greater) than the non- indigenous people. (Australian Indigenous HealthInfoNet, 2016). This shows that the functioning of the primary health care organization is not good and efficient to meet the demands of Indigenous people in Australia. As per the Queensland Council of Social Service (2011) Aboriginal and Torres Strait Islander community in urban, villages and backward settings are unable to access health care since there are many ethnic, financial and regional barriers.
There are many factors responsible for the low health safety in case of indigenous people of Australia. The major problem is the lack of information about their health issues. There are not studies done on the relation of the relationship of the culturally diverse people with the other people or conditions within the community. (Pholi et al, 2009). As per Whitehall study people with lesser rate of control on the environmental situations will pose low health compared to the people with high degree of control, in reference to health behaviours, social determinants and environmental conditions. (Bosma et al, 1997).there is lesser knowledge about the control of Indigenous people of Australia on their health and the social wellbeing. (Australian Institute of Health and welfare, 2009).
The national report on Aboriginal and Torres Strait Islander reports about the racial discrimination by the individuals (Australian Bureau of Statics) but there are no measures of racism in regards to Indigenous Australians in context to the broader population. Due to lack of information about the broader social issues and the inequities among the Australian communities, there are no measures to tackle with such issues on broader aspects. Cultural difference and racism is not measured on the social or broader level but is restricted to individual level. (Morrissey et al, 2004). People of colour have to face a very bad health effects compared to the white people in respect to disease and the treatment facilities for many severe and infectious diseases. Disparities based on the cultural and colour and race have been observed in other aspects also like social treatment, financial status and in terms of education. For eg. The death rate of babies is higher in case of black women who might have a graduation degree while it is low in case of white women who are still in high school. Financial status, qualification, and many other social environmental issues are although worth to notice yet not much considered on the broader aspect.
Racism is not observed in biology. There is no genetic difference that discriminate people on the basis of their cultural background and colour. It is the outcome of the human behaviour and thoughts that cause teh discrimination among the same species.
Good services should be offered to the indigenous population within the community setting to allow a better access by the women as soon as possible in their pregnancy. (NSW health, 2005; Reibel and Walker, 2009). Many models and strategies are designed especially for these women to improve their health. These programmes should intake health professionals from the indigenous communities for a better implication. (Kruske, S., 2012). The data analysis and record is must to ensure the access to the services by the Aboriginal and Torres Strait community women and the children. (Riebel & Walker, 2010). Several consultations with the culturally diverse women is being done from the 30 years about the health services and they have recommended several changes in the hospitals which should be taken into consideration. They feel unsafe in the hospitals and are afraid about the safety of their new born. (Hirth, C., 2005). These people are associated with their land. Relocating them to distant hospital disrupt the relationship. (Scherman et al, 2008). The difference in the cultural, social and health literacy should be better analysed. (National Aboriginal and Torres Strait Islander Health Strategy, 2000). The ethical, social and psychological issues that cause mental stress, self management and inefficient control over the circumstances are important issues to consider in relation to health of the culturally diverse population in comparison with health literacy. It is important to include these points to improve the services and provide a better health safety to these people. (Pincus et al, 1998).
Nurses have to face many challenges while facing the diverse population clients having different cultural background. Various approaches and guidelines like transcultural nursing and cultural safety are established to overcome these issues. The major role of cultural safety guidelines is to ensure the services by the nurses to all the people irrespective of their colour, creed, cultural background or financial status. But with the growing disparity among the people with less knowledge about health literacy it became important to formulate plans to provide services as per the client‘s creed, cultural background and colour. (Papps & Ramsden, 1996). Many surveys and studies relate the discrimination on the basis of colour and creed to poor health services. The effect of racism is very bad if continued for the whole life. It can lead to many severe and chronic stress and anxiety issues. The frustrations and the anger result in long term depression and stress diseases that cause adverse effect on the body of the individual who are victim of racism. Discrimination can be observed individually, socially and has an effect on the treatment given to these people, in terms of the jobs availability and the place of living and overall services and benefits they receive from the communities Cultural safety needs nurses to acknowledge their responsible and irresponsible attitudes towards the clients belonging to different cultural background, gender, colour or financial status. (NURS3005: Modules 1-5, 2016).
Conclusion
Nursing is a job which carries a lot of responsibilities. It requires providing the best care to the clients. To provide the best care facilities it is important for the nurses to undergo training that can help them to come up to the expectations of the various client. The care should be centralised to the people. Nursing should be in way to safeguard the cultural background especially in a country like Australia. The Aboriginal and the Torres Strait Islander Community should be treated with no cultural harm and should be provided facilities in their cultural beliefs and environment.
References
AHMAC. (2011b). Aboriginal and Torres Strait Islander Health Performance Framework Report 2010. Canberra: Australian Health Ministers’ Advisory Council, Commonwealth of Australia.
Australian Bureau of statistics. (1999). Health and socioeconomic disadvantage of area. Australian Social Trends 1999. Cat. No. 4102.0, Canberra: ABS. Viewed on 27 Sep 2016 from www.abs.gov.au
Australian institute of health and welfare. (2009). Aboriginal and Torres Strait Islander health performance framework 2008 report: detailed analyses, AIHW. Canberra [online[. Available on 27 Sep 2016 from https://www.aihw.gov.au/publications/index.cfm/title/10664.
Bosma et al. (1997). Low job control and risk of coronary health disease in Whitehall II (prospective cohort) study. BMJ. Vol. 314, no. 7080,558-565.
Burns, J. (2016). ‘Overview of Aboriginal and Torres Strait Islander health status’. Australian Indigenous HealthInfoNet. Perth, WA: Australian indigenous HealthInfoNet. Available on 27 Sep 2016 from https://www.healthinfonet.ecu.edu.au/uploads/docs/2015-overview.pdf
Hirth, C. (2005). Re-birthing, report of the review of maternity services in Queensland. Brisbane.
Kildea, et al. (2010). ‘Closing the Gap’: How maternity services can contribute to reducing poor maternal infant health outcomes for Aboriginal and Torres Strait Islander women. Rural and Remote Health 10. 1383.
Kruske, S. (2012). Culturally competent maternity care for aboriginal and Torres Strait women report. Maternity services inter- jurisdictional committee. available on 27 Sep 2016 from https://www.health.gov.au/internet/main/publishing.nsf/content/…/$file/culture.pdf
Morrissey et al. (2004). Culture as a determinant of Aboriginal Health. Beyond bandaids: exploring the underlying social determinants of Aboriginal health.
National Aboriginal and Torres Strait Islander Health Council. (2000). National Aboriginal and Torres Strait Islander Health Strategy, consultation Draft. Canberra ACT: national Aboriginal and Torres Strait Islander Health Council.
New Zealand Council of Nursing. (2011). Guidelines for cultural safety, the Treaty of Waitangi, and Maori health in nursing education and practice. Wellington: nursing Council of New Zealand
Papps, E & Ramsden, I. (1996). Cultural safety in nursing: the New Zealand experience. International Journal for Quality Health Care. Vol. 8, no. 5, 491-497.
Pholi et al. (2009). Is ‘close the Gap’ a useful approach to improving the health and wellbeing of Indigenous Australians? Australian Review of public affairs. Vol 9, no. 2. 1-13. Australia: faculty of economics and business, the university of Sydney.
Pincus et al. (1998). Social conditions and self- management are more powerful determinants of health and access to care. Annals of internal medicine. 129(5); 406- 411.
Queensland Council of Social Service (QCOCC). (2011). ‘health equity and access’, West End, Queensland. Available on 27 Sep 2016 from https://www.qcoss.org.au/sites/default/files/QCOSS_Policy_Position_Aug_2011_Health_Equity_and_Access.pdf
Reibel, T. & Walker, R. (2010). Antenatal services for Aboriginal women: the relevance of cultural competence. Quality in Primary Care 18, 65-74.
Scherman et al. (2008). The five year of a midwifery-led model of care in Far North Queensland. Medical Journal of Australia. 188(2):85-88.
Transition to professional practises. (2016). School of Nursing & midwifery. NURS3005. Tutorial streams 1-5 indigenous health.
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