Aboriginal Health and Closing the Gap

This assignment delves into the critical issue of Aboriginal health disparities in Australia. It examines various factors contributing to these inequalities, including social determinants of health, access to healthcare, and cultural considerations. The analysis focuses on the 'Closing the Gap' initiative, evaluating its progress and highlighting key strategies for improving health outcomes within Aboriginal communities.

Running head: CONTEMPORARY INDIGENOUS HEALTH AND WELLBEING
CONTEMPORARY INDIGENOUS HEALTH AND WELLBEING
Name of the Student
Name of the university
Author’s note

1CONTEMPORARY INDIGENOUS HEALTH AND WELLBEING
Contemporary Indigenous Health and Wellbeing
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

2CONTEMPORARY INDIGENOUS HEALTH AND WELLBEING
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

3CONTEMPORARY INDIGENOUS HEALTH AND WELLBEING
(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

4CONTEMPORARY INDIGENOUS HEALTH AND WELLBEING
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.

5CONTEMPORARY INDIGENOUS HEALTH AND WELLBEING
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

6CONTEMPORARY INDIGENOUS HEALTH AND WELLBEING
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.

7CONTEMPORARY INDIGENOUS HEALTH AND WELLBEING
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.

8CONTEMPORARY INDIGENOUS HEALTH AND WELLBEING
Healthinfonet.ecu.edu.au. 2018. What is Closing the Gap? « Key facts « Closing the gap «
Australian Indigenous HealthInfoNet. [online] Available at:
http://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.