The Role Of Culture And Empowerment In Indigenous Health Care In Australia

Challenges Faced by Indigenous Populations in Australia

Question:

Discuss about the Research Program Design and Evaluation.

Indigenous populations in Australia are subject to venerable outcomes of historical suppression. These consequences result to high mortality rates, poor health conditions n comparison to non indigenous populations and inexplicably high levels of diseases like diabetes, mental health problems and alcoholism. There extreme poverty levels translate directly to low levels of education that reflect to economic adversity, lower attainment in education, no access or little access to high quality healthcare and social dysfunction (Iwelunmor et al., 2014).

Traditional Medicare approaches primarily focus on disease treatment and progression, therefore cultural complexities and indigenous healing processes are not captured in plan designs meant to improve healthcare and change health behaviors’ in these communities. These papers role hence is to describe the role of culture as a determinant of health and strategies to work effectively with these cultures.

Modern medical science views health as primarily lack of defect or disease in the body, whereby, the body systems are operating normally. These poses limitations as new technology, new drug and treatment discoveries increase the cost of Medicare. This has continued to rise in the recent past. In practice, this materialistic approach therefore results in symptomatic and piecemeal approach to ill health. Specific cures fix symptoms and cure diseases without dealing with symptom causes and individuals as a whole.

Focusing only on aspects measured and observed in the laboratory leaves a large blind spot that the medical model cannot solve as it views people like body systems working together. Using an approach that takes into account human spirit, emotions and mind brings about other factors that determine healthcare. The population health approach insists on a state of complete mental, social wellbeing.  In analyzing individual and populations’ health, non medical determinants come into play. Cultural identity, equity, safety, education, social economic status management, infrastructure, social integration, inclusions, community and geography influences provision of or access to medical services (Basnyat & Dutta, 2012). Important determinants of Australians indigenous populations’ health is inequality; including the lower standards of infrastructures of health and healthcare equal access when compared to other Australians. The National Strategic Framework for Aboriginal and Torres Strait Islander Health 2003-2013 guides Australia’s indigenous health policy. The main concern therefore is to bridge the gap between the indigenous people and the other population.

Rights inherent to all human beings are termed as human rights. No matter what our place of dwelling, nationality, color, national or ethnic group, language, religion or other status, human rights are entitled to all without discrimination. These rights are indivisible, interdependent and interrelated. They are guaranteed and expressed by law in forms of customary international law and treaties. The ICESCR (International Covenant on Economic, Social and Cultural Rights) includes the right to education, the right to adequate living standards i.e. adequate food, housing and clothing and the right to enjoyment of the highest attainable standard of mental and physical health in articles 13, 11 and 12 consecutively. The covenant in article 2 requires that governments to the maximum of their resource will take steps to make realizable all the rights in the covenant. In addition to that non discriminatory enjoyment of the rights should apply. The human rights based health approach has a set framework that is focused to offset inequalities and ensure people enjoy the highest health standards attainable (Dutta et al., 2015).

Importance of Cultural Factors in Health Care

It emphasis governments accountability for outcomes of social economic nature in different sectors as legal obligations measured against human rights system norms. Fundamental principles are established that guide development of policies management that ensure equal opportunity provision to indigenous people and that there is no discrimination against through distinctive cultural status recognition. It outlines a criteria used to asses program interventions and health policy to ascertain that services are of sufficient quality, appropriate, available and accessible by ensuring they don’t fall below the essential minimum level for human rights. Requires the government to demonstrate; targeted approach of issues in collaboration with indigenous people; to achieve within a timeframe the defined goals (Rubincam et al., 215). It places on the government a burden to justify use of all resources in its disposal as a matter of priority to satisfy the right to health.

In the empowerment matrix, community health work terrain is multidimensional with the health worker being the primary instrument that is involved in practice since the work is about relationships and partnerships.  Awareness of the dimensions puts one in a place to use their power transformatively in power cultural dynamics disempowerment. This matrix provides useful means of bringing into concept the relationships between empowerment process, social identities and cultural systems. It refers to the elements landscape existing outside and within an individual and its interaction make up communities or individuals capacity to assume control over their wellbeing and health (Betsch et al., 2015).

Psychological elements or more subjective empowerment elements like identity, consciousness and culture form the internal empowerment terrain. Identity embeds ones’ self esteem, sense of belonging and self. Consciousness includes intuition, knowledge, critical thinking ability and skills. These are basically individual capacities that they carry around with them. They combine to bring out a person’s capacities.

On the other hand, material elements that are outward oriented constitute external empowerment terrain. These include strategic partnerships, social structures, community cohesiveness, physical resources, community social networks and other economic resources. Currently, contemporary and social historic colonization process is considered an important element characterizing external empowerment terrain and has real life effects on people (Airhihenbuwa et al., 2016). The Australia’s indigenous cultural health determinants include;

Cultural determinants	Sources/ bodies	domain
Self determination	UNDRIP; UDHR	Social inclusion, HR, law and justice (Basilio et al., 2016).
Freedom from being discriminated against	ICESCR; ICERD	Social policy, politics, service delivery, law and justice
Collective and individual rights	ICCPR; UNDRIP	Social policy, employment, law and justice, economics
Freedom from culture destruction and assimilation	ICCPR	Politics, social policy, education, service delivery, law and justice
Protection from relocation	CRC; UNDRIP; ICERD	Service delivery, law and justice
Connection and utilization of traditional and country lands	ICESCR	Environment and native title land rights
Promotion, reclamation, preservation and revitalization of cultural practices and language	ICESCR;CRC	Employment, education
Promotion and protection of TK, IIP	ILO convention	Ethics, law and justice
Understanding of law, responsibilities and traditional roles	UNDRIP	education

There is a wide social economic gap between indigenous people and the other population, averagely their gross household income is half that of the other population. Indigenous people’s unemployment rate is three times that of the other non indigenous population. By the year 2004 only half of indigenous students could continue their education to their 12^th year comparing to non- indigenous students. Poverty is hence related to poor health (Thiam et al., 2015). Literacy and poor education contribute to poor health as it limits the people’s capacity to use and benefit from health information. Accessibility to medicine and health services is reduced by poor income. Poverty contributes to run down and overcrowded housing that increase spread of communicable diseases, poor diet for infants and future chronic diseases. High risk behaviors’ and smoking have been seen to be contributed by low social economic status. Poor people have less forms of control over their lives i.e. financial control, in many cases these contribute to a high unhealthy stress burden. They have a high psychological demands exposure and limited possibilities to have power over the situation (Currie et al., 2015). Chronic stress can impact on the bodies’ metabolic functions, immune system and circulatory system through various hormonal pathways bringing rise to a series of health problems e.g. heart disease, violence against women mental health and dysfunction in the community.

The Role of Empowerment in Health Care

Indigenous people stated that there was a link between their control of community self esteem, dignity, justice and their environmental control to their health as shown in their National Aboriginal Health Strategy (Gill et al., 2016). It is not just a matter of absence of disease, provision of medicines, doctors or hospitals. They had anticipated the social determinants development early therefore generally a person’s lack of control over his/her life contributes to a burden of unhealthy/ chronic stress that results to violence, mental health issues and substance abuse. Within a group of indigenous people, notable substance abuse, and high risk behavior rates indicates chronic stress. Reports showed that in 2002, over half of population aged 15 years and over were every day smokers and one In every six consumed high risk levels of alcohol. Mental problems arising at high rates also indicate the group’s chronic stress. Compared to other Australians, indigenous people were twice more likely to be hospitalized for behavioral and mental disorders. Hospitalization rates due to intentional self harm and assault are also indicators of mental distress and illness (Kagawa Singer, 2012). This stress has been triggered by negative social environment features that are relatively permanent including: racism and intergenerational poverty. It leads to circulatory disease which is currently the biggest indigenous people killer disease. With reports showing better mental social health for children living in very remote communities as compared to the ones that have been exposed to other peoples lifestyle (Garnweidner et al., 2012). Thus, traditional ways and culture are protective against poor social, emotional and environmental safety of the indigenous people. Moreover control over their own ways can help in their economic and social regeneration.

A community’s ability to address and decide on their own health priorities increases communities’ primary healthcare. Aboriginal and Strait Islander people with a mental health project resulted to Geraldton hospital receiving decreased psychiatric admissions (Alden et al., 2014).

Cultural health determinants promote a perspective that is strength based. In this perspective, stronger country and culture connections build stronger collective and personal identities, resilience, self esteem sense and other health determinants outcome improves i.e. safety, economic stability and education (Good & Hannah, 2015). In exploring these determinants, one must recognize social justice sectors, the ACCHS movement and human rights networks which exist in a community.

As a practitioner in a cultural setting, one has to have extensive knowledge in the following cultural determinant of health. They should not however limit themselves to only these (Al-Bannay et al., 2014). They include self determination; freedom from culture destruction and assimilation; collective and individual rights and discrimination; protection from relocating/removal; protection indigenous intellectual property and traditional knowledge promotion; understanding of traditional responsibilities and roles; custodianship, connection to and utilization of traditional and countries lands; preservation, reclamation, promotion and revitalization of cultural practices and language (Chandra et al., 2016). It has been proofed that promotion and protection of traditional knowledge, culture, family and kinship add to personal resilience and cohesion of the community.

Human Rights and Health Care

In addition, strong cultural practices and links improve SDH outcomes and indigenous point of view improves perspective for all. The above health determinants relate to specific domains as follows: education; service delivery, law and justice; land rights, native title environment; ethics, law and justice; employment, economics and social policy; politics (Napier et al., 2014). All these domains directly affect cultural health determinants and it is by dealing effectively with them that the gap of health between indigenous and non- indigenous communities can be bridged.

determinant	example	Examples of indicators
Self determination	ACCH sector	Number of established and new CCHS
Collective and individual rights	Cultural rights, citizenship, human rights	Constitution reforms not to allow enactment of racist reforms, domestic legislation incorporates international human rights instruments
Freedom from being discriminated against	Provision of services that are culturally safe	Zero tolerance policies, number of complaints to the AHRC decrease. Number of social initiatives increase
Freedom from culture destruction and assimilation	Resourcing and inclusive policies	School curriculum to incorporate indigenous culture in history. Political representation.
Protection from relocation	Education, dialysis, birthing	Develop service delivery models. ACCHS provision of co-located care
Connection and utilization of traditional and country lands	Upscale indigenous enterprises through validation and acknowledgement of cultural knowledge	Increase rangers and trainees, more opportunities in micro finance.
Promotion, reclamation, preservation and revitalization of cultural practices and language	APY council for women	Employment, language and education courses. Funded local education initiatives
Promotion and protection of TK, IIP	International human rights instruments	Domestic laws, legal protection and ethical guidelines
Understanding of law, responsibilities and traditional roles	Strong, not lazy men, not addicts and wife beaters, strict social structures	Cultural education network for men

We have the chance to honor indigenous people, treat them equally for them to enjoy the highest standards of mental and physical health attainable. We need a commitment to deeply engage in ethical practice at different levels (Airhihenbuwa et al., 2014). Models of care should be standardized to reduce disparities in indigenous health.

References

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