Indigenous Health and the Birthing on Country Project: A Conceptual Framework for Action on Social Determinants of Health

This essay discusses the conceptual framework for action on social determinants of health in relation to the Birthing on Country Project, which aims to improve birth outcomes for Aboriginal and Torres Strait Islander babies and mothers. It also highlights the impact of socioeconomic status, race, ethnicity, and psychosocial factors on health seeking behavior of the indigenous population.

Running head: ESSAY
Public health
Name of the Student
Name of the University
Author Note

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Introduction- Indigenous health is an umbrella term that generally refers to the
cultural, physical, emotional, and social wellbeing of Aboriginal and Torres Strait Islander
individuals (indigenous Australians). There is mounting evidence for the fact that numerous
indigenous Australians report inferior health outcomes, when compared to the non-
indigenous Australians, and also report increased rates of mortality younger ages (Willis,
Reynolds and Keleher 2016). Indigenous Australians also display an increased likelihood of
suffering from a plethora of disorders such as, mental health problems, respiratory diseases,
cardiovascular complication, diabetes mellitus, and chronic renal disease (Jamieson et al.
2016). Furthermore, there is a need to identify the reproductive and sexual health of
indigenous population, with a special emphasis on maternal health outcomes. It has often
been found that reproductive and sexual health of indigenous women is governed by the
cultural, socioeconomic, and political environment. This assignment will elaborate on the
conceptual framework for action on the social determinants of health, formulated by the
World Health Organization, in relation to a case study that focuses on the ‘Birthing on
Country Project’.
Historical perspective- The continuing predicament in relation to indigenous health
can be accredited to several generations of negligence and mistreatment, absence of any
unified public policy and failure of the government to create to provisions for adequate
resources, while ensuring that they are able to meet the health requirements of the
participants (Valeggia and Snodgrass 2015). The fundamental factors that are responsible for
poor indigenous health are typically accredited to the presence of economic or social
exclusion, low income, poor education, unemployment, poor sanitation, poor housing, and
absence of sufficient nutrition. Notwithstanding suffering from poor health conditions, when
compared to other Australians, the indigenous individuals usually report reduced access to
healthcare amenities (Short 2016). Historically, they have also been found to manifest little or

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no power for exerting an influence on the aforementioned factors. Hence, it can be suggested
that poor sexual and reproductive health in the target population is a direct manifestation of
their history of neglect. Nearly from the commencement of colonisation, the indigenous
populations were found to be affected by a range of diseases, in addition to the loss of living
and land. Notwithstanding the loss of their lives, and widespread poor health outcomes in the
indigenous population, there was lack of adequate medical aid (Paradies 2016).
Furthermore, in numerous states, the Aboriginal individuals were not only subjected
to less payment, but were also withheld from enrolment in trust funds that were formulated
by the government for other commitments (Bodkin-Andrews and Carlson 2016). Health was
identified as one of the major domains for development of the indigenous population in 1969,
which in turn paved the way for submission of grant to different states, in order to develop
particular Aboriginal health programs. Gradually, during the 70s, the indigenous
communities began establishing their own self-governing and community-controlled health
facilities (ACCHs), in addition to the presence of advocacy representatives that eventually led
to the establishment of the National Aboriginal Controlled Community Health Organisation
(NACCHO) in 1975 (Gwynne et al. 2016). This was followed by the initiation of first
Aboriginal Medical Service (AMS), Racial Discrimination Act, and HRSCAA’s
report Aboriginal Health (Naccho.org.au 2018).
Elements of CSDH and their relevance to the case study- The primary objective of the
‘Birthing on Country’ (BoC) project is based on taking efforts for bringing about an
improvement in the overall birth outcomes for Aboriginal and Torres Strait Islander babies
and mothers (The Lowitja Institute 2019). In addition, the project has also been formulated
with the objective of fostering collaboration between healthcare services and community
members that will facilitate establishment of Aboriginal Birthing on Country models based
on maternity care, regardless of the child delivery being carried in hospitals or stand-alone

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birth centres (Altman, Biddle and Hunter 2018). According to the CSDH, economic, social,
and political conditions are primarily responsible for giving rise to a plethora of
socioeconomic positions, which leads to stratification of populations based on educational
attainment, income, gender, occupation, race or ethnicity (WHO 2010). In addition, the
framework also illustrates the fact that the socioeconomic position of an individual is largely
responsible for shaping intermediary determinants of the health status of a population. These
determinants are in turn a direct reflection of the position of individuals within definite social
hierarchies. It can be suggested that Aboriginal and Torres Strait Islander females face a
range of issues within the existing maternity system. Furthermore, institutional discrimination
and racism is common, which in turn results in a scarcity of culturally appropriate amenities
and local services.
The BoC project aims to increase the life expectancy and health related quality of life
by reducing the rates of preterm birth, maternal and child mortality, and low birth weight
among infants (The Lowitja Institute 2019). The project fits within the upstream determinants
of socioeconomic and political context that specifically focus on public policies. Research
evidences elaborate on the fact that health public policies are typically characterised by
presence of an obvious concern for equity and health in different domains of the system, and
also hold an accountability for health consequences (Gillion 2017). Thus, alignment of the
BoC with the upstream determinant of policy can be accredited to its objective of fostering a
supportive environment, which in turn will enable pregnant women and children to lead
healthy lives. Hence, the BoC has been formulated to enhance infant and maternal health
outcomes by fostering integral association between land, birthing and the place of belonging.
The average life expectancy of indigenous people lag 20 years behind that of non-indigenous
Australians. They demonstrate an increased rate of health risk behaviour and also have

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reduced access to necessary healthcare resources, thereby predisposing the pregnant women
and their infants to poor health outcomes and increased mortality.
Furthermore, there is growing evidence for the fact that factors associated to
socioeconomic status, such as, poor education and poverty, are immensely significant in
predicting health outcomes (Tang et al. 2015). In addition, it has also been found that the
socioeconomic status of Aboriginals and Torres Strait Islander individuals significantly varies
between and within rural and urban areas. Owing to the variations in material circumstances
that commonly comprise of housing, consumption potential, neighbourhood environment and
physical working conditions, it can be suggested that the project has accurately identified the
need of providing assistance to the health departments for the formulation and
implementation of a ‘Hub and Spokes’ model of maternity care, at the local level, in
indigenous cultural framework and community engagement (Brooklyn and Sigmon 2017).
It has also been established that there exist socioeconomic health variations amid
indigenous population, under circumstances when quality of intermediary determinants are
erratically distributed between different socioeconomic categories. There is growing evidence
for the fact that higher educational attainment increases the income, which in turn improves
access to healthcare services, and enhances health behaviours (Friis et al. 2016). Furthermore,
not only does low educational attainment lead to a poor health literacy and bring about a
deterioration of health outcomes. Taking into consideration the fact that the indigenous
population report reduced access to healthcare resources that are imperative in enhancing
health outcomes of pregnant females and their children, it can be suggested that the BoC has
been effective in addressing this gap (The Lowitja Institute 2019).
This can be accredited to the focus that it places on ensuring that all practising
healthcare providers undertake incessant professional development, with the aim of

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delivering culturally compassionate maternity services for the target population (Kirmayer
and Brass 2016). Additional benefits of the BoC can be associated to its role in increasing
understanding among graduates on the delivery of culturally safe maternity services, and the
focus placed on actively recruiting and supporting midwifery and allied academics for
improving maternal health.
The project also highlights the need of fostering collaboration that will enable
indigenous females to participate in clinical decision making, by ensuring the delivery of
necessary information, based on high quality evidences (Kildea et al. 2018). Furthermore, the
BoC is also based on actions enforced by the Maternity Services Inter-jurisdictional
Committee (MSIJC) namely, developing and expanding culturally safe childbearing care for
the indigenous population (action 2.2) (Australian College of Midwives 2018). The
framework is also based on the fact that awareness and knowledge of individual status in
imbalanced communities contribute to poor health and stress (WHO 2010).
Furthermore, a range of behavioural factors such as, diet, smoking, sedentary lifestyle,
and alcohol consumption act as major health determinants. Time and again it has been found
that such unhealthy lifestyle behaviour create a significant negative impact on the health of
the mother and child, and predispose the child to different diseases like, diabetes, high
cholesterol, hypertension, and obesity (Poels et al. 2017). The project also aimed to ensure
that the indigenous pregnant women are provided with adequate opportunities for accessing
continuity of care services through birth, pregnancy, and early postnatal care. Therefore, it
can be suggested that appropriate efforts taken by the BoC to make the indigenous women
feel comfortable, at the time of accessing birth programs (The Lowitja Institute 2019).
Conclusion- To conclude, there is growing evidence that inequity trajectories for
health begin early, and birth, pregnancy, and gestation period are crucial, for both the infant

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and mother. An analysis of the BoC project suggests that is based on ‘Closing The Gap’
strategy, which in turn is based on the importance of meeting the unmet healthcare needs
among Aboriginals and Torres Strait Islanders, and increasing health outcomes. The project is
also in alignment with the CSDH framework owing to the fact that the recommendations put
forth in the project accurately recognise the impact of race, ethnicity, educational attainment,
socioeconomic status, biological factors, and psychosocial factors on health seeking
behaviour of the indigenous population.

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