Equitable Health for Indigenous population in Australia

This article discusses the challenges faced by the Indigenous population in Australia in terms of healthcare and the solutions to achieve equitable health. It explores the role of Aboriginal community-controlled health services (ACCHS) and socially inclusive nursing roles in Indigenous communities. The article emphasizes the importance of cultural acceptability and participation of the community in the overall health system.

Equitable Health for Indigenous population in Australia
Socially inclusive nursing roles in in Indigenous Community Controlled Health Services
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Equitable Health for Indigenous population in Australia
Introduction
If we go through the history of colonization, we find the local indigenous population
are affected in terms of loss of identity. Australia is not an exception and they could
recognize the impact of colonization on indigenous population after a long gap more
specifically in the matter of education and health. The ethnic group because of various
reasons like cultural and social were not getting the desired healthcare facilities. They are
culturally backward and as a result they have less representation among the health
workers. Studies have been conducted on this matter have come to the common
conclusion that people of this community like to see health workers from the same
community to manage their health problems. The gender of the health worker is also
important because the community people prefer health care workers of the same gender
to serve them. ("Improving the accessibility of health services in urban and regional
environments for indigenous peoples", 2019). It is therefore not possible to get the
positive impact of health care if the health care workers belong to non-indigenous
community. So an alternative approach is required to eliminate the health inequalities.
Discussion
a. Formation of ACCHS
The latest Census of Population of Government of Australia shows that the
indigenous people represented less than three percent of Australian population (" Census:
Aboriginal and Torres Strait Islander Population ", 2019). These indigenous community
people are experiencing health inequities since beginning. It is supported by the fact that
their life expectancy is around ten years less than that of non-indigenous community
people.
This health related imbalance can be eliminated by recruiting people from this
community in the health care setup. These health care workers can use their socio-
cultural skills to improve the health care provided to their community members and
support more appropriate care and services compared to their non-indigenous
counterparts (Miller & Speare, 2012).
Cultural acceptability is an important factor relating to this health imbalance. Some
members of these community still believe that the present medical system is not
culturally appropriate to them. Many of them do not know what are health facilities
available. The lack of knowledge due to the effects of colonization still persists, the
health workers from other community are reluctant to serve the ethnic community. Health
workers belonging to the ethnic community can better understand the health problems of
their own members of the community through cultural, physical, emotional, mental and
spiritual links.
The best solution to this issue is to allow participation of these community people to
the overall health system to take control of their own health issues. This is how the
creation of ACCHS has come into existence. Aboriginal community-controlled health

Equitable Health for Indigenous population in Australia
services (ACCHS) is engaged for providing the medical service to the ethnic group since
its inception in the early 1970s.
b. Nursing, the social determinants of health and primary health care
The outcome of health is influenced by the individual’s habits, good or bad, such as
whether he smokes, drinks alcohol, is immunized, follows a healthy diet or regularly does
physical activities. Health promotion and prevention, timely and effective treatment and
care also make an important contribution to good health. The health result depends on a
number of factors, such as living and working conditions and the social environment.
Factors such as income, education, working conditions and social support, work to
strengthen or undermine the health of individuals and communities. Because of the
effects of these factors, the outcomes of health efforts are strongly influenced, these
health-determining factors are known as 'social determinants of health' ('8.A. Workshop:
urban environments: action for health and justice', 2017).
The indigenous population of Australia has all the factors of social health
determinants. Many reports published by government media evidenced that there is no
uniformity in the health parameters within the Australian population. Inequality in health
parameters persists, although overall health improves with improvement of socio-
economic conditions. In 2008, the WHO Committee on Social Determinants of Health
made some recommendations on what is needed to close the health gap by taking action
in the field of social determinants. The WHO recommends that countries take
administrative measures to address the social determinants of health, with policies and
interventions from all sectors and levels of society, such as policies on housing and
transport at local level and policy on educational and social environmental at national
level (WHO 2011).
However, barriers remain in the pursuit of an approach with social determinants.
Despite genuine need to address the health inequalities, the complexity of social
determinants continues to be a challenge to conventional policy-making and action
(Baum et al. 2013; Carey et al. 2014). ACCHS has given a new direction to the care
solution for the indigenous population.
c. The nursing roles in community health practice
The roles identified for ACCHS nurses and other health workers are general nurses,
mental health nurses, family health workers, sexual health nurses, specialist education
officer, hospital connectivity agents, drug and alcohol abuse nurse, environmental health
worker, social worker, maternal and perinatal health worker, health worker in nutrition
and care coordinator etc. (Weightman, 2013).
After the establishment of ACCHS, employment for many indigenous people
increases considerably. Currently, around 62% of the workforce comes from the
indigenous communities. The largest representation is in the non-clinical staff category.

Equitable Health for Indigenous population in Australia
More efforts are needed to develop good career paths to get more doctors, nurses and
other health professionals.
There are many reasons behind starting this government sponsored community-
controlled health service (ACCHS). Plenty of opportunities are associated with the
community, which is essential for the success of this initiative. Moreover, if the staff
belongs to the same community, it is a motivating factor for them. The need for such a
form of health care has been long enough and it is an initiative in the right direction.
(Alford, 2014).
d. Symptoms and risk evaluation
Healthcare workers at ACCHS differ from other healthcare workers. They get
additional training to develop clinical skills in order to perform different types of tasks.
They can administer vaccinations for children under the supervision of a doctor, collect
blood samples and perform health checks. There are opportunities to gain experience
with specific health programs for areas, while in the case of government hospitals these
health workers limit themselves to one area or management such as transport or social
assistance.
Aboriginal women are authorized to participate in a number of programs. The
ACCHS institutions allow greater autonomy from the inception to design and implement
health programs. Nurses have successfully planned and implemented special programs,
such as a program for breastfeeding women, a stop smoking program, a cleanliness
project and also infectious diseases. These programs are designed with innovative
approaches to creating community awareness. For example, health workers have started a
community breakfast program called cancer week and they also participate in a weekly
special health care program from a local radio broadcasting station (Cioffi, 2013).
e. Participative and evidence-based health Promotion
ACCHS health service people also provide widespread community-wide coverage
services, at even restricted area like jails and youth detention centre. They have the
opportunity to participate in different conferences and workshops to improve their
knowledge and skill base. ACCHS health workers have great expectation from their own
community. They have to take too many roles at the same time and are considered "single
window service people". However nurses who are old cannot take up so many
responsibility compared to the young generation who are active and vibrant and this
create some ill feeling among the older nurses. Instead they should support the younger
generation through sharing their experience with the younger generation.
There is another social problems faced by the nurses , their family life also get
affected as they do not find time to relax at home and people gather at their place of
residence also. (Wilson, Kelly, Magarey, Jones and Mackean, 2016). Sometimes there
may be conflict within the community and during that time nurses face the challenge to
provide necessary health service as this type of behavioral issues persist among the ethnic
groups.

Equitable Health for Indigenous population in Australia
Conclusion
Despite all these challenges, ACCHS proves that the active participation of the
indigenous community has given a new direction to the overall health scenario among the
indigenous community people. This is a step in the right direction and more and more
recruitment of nurses and doctors from this community will improve the service of
ACCHS. (Campbell, Hunt, Scrimgeour, Davey and Jones, 2018). The ACCHS training
and development was a success story of the participation process and proved the
effectiveness of the leadership quality and ability of the indigenous community. It also
strengthens the process and sorts out the concerns of the indigenous people about health
services by sending feedbacks to service providers (Panaretto, Wenitong, Button & Ring,
2014). The general feedback received after the formation of ACCHS is overwhelming
and it has created a sense of transparency, responsibility and trust that led to better
healthcare for the indigenous community.

Equitable Health for Indigenous population in Australia
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Equitable Health for Indigenous population in Australia
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