1 INDIGENOUS HEALTH AND WELL-BEING There is a significant health equalities prevailing in Australian indigenous population. In order to address this health inequality government of Australia has issued policy name “Closing the Gap” (CTG)(Australian Institute of Health and Welfare 2018). The following essay is based on the case study of a Aboriginal woman named Judy who suffering from Type 2 diabetes along with foot ulcer. The essay will initiate with a brief over-view of the CTG policy followed by poor social determinants of health of Judy and how CTG is addressing those issues. At the end the essay will highlight the role of ALO and AMS and community health service in managing the health of Judy. “Closing the Gap” CTG policyis a government strategy that aim to decrease the disadvantage prevailing among the Aboriginals and Torres Strait Islanders people residing in Australia (Australian Government 2019). The main parameters of inequalities that are taken into in CTG policy include life expectancy, childhood mortality, and access to education for the children, improved educational achievement and employment outcomes (Australian Government 2019).The policy was implemented on 2008under the joint collaboration of the Australian Government and Aboriginals and Torres Strait Islander people via signing theIndigenous health quality summit of intent, with an aim to close the gap within next 25 years (Australian Government 2019).. The implementation of the policy is based on several reports published by international and national organizations(Australian Government 2019). For example, the reports published by theWorld Health Organization (WHO) in 2007stated that there is a significant disparity between health of the indigenous Australian population in comparison to the rest to the population residing in Australia and the condition is astonishing under the context of such affluent country(WHO 2007). The report ofAustralian Bureau of Statistics (2006)highlighted that average life-expectancy of indigenous population is 17 years lower than the total population.
2 INDIGENOUS HEALTH AND WELL-BEING The indigenous population also has high rate of infant mortality, increased substance abuse and poor living condition with increased rate of occurrence of diabetes and heart attack. This significanthealthdisparityreportandrepeatedcriticismexperiencedintheinternational conference led to the foundation of CTG policy(WHO 2007).The significance of CTG policy is it aimed towards reducing the prevailing health inequalities among the indigenous population in Australia and thereby helping Australia to recover from health disparity(Whitty&Littlejohns 2015).Moore et al. (2015) stated thatreducing the health-inequalities will help in promoting effective development in early childhood education and thereby helping the indigenous people to improve the social determinants of health(REFERENCE).The report published by Australian Parliament on behalf of Prime minister (2019)about the follow up of CTG policy,showed there is a good process in childhood mortality and education but there is a gap in achieving targets like life expectancy, academic achievement and employment outcome(REFERENCE). Thepossible might includeunequal channelization of funds, food sanitation and gap in health literacy and educational opportunities(Australian Parliament 2019). The long term consequence of Judy’s diabetes is include increase in the severity of diabeteslikeincreasetendencyofheartattack,diabeticretinopathyandrenal malfunction(Lefebvre et al. 2018). The first social determinant of health (SDH) is responsible for the present condition of Judy is lack of health literacy.Lefebvre et al. (2018)stated that uncontrolled or unmanaged diabetes for a prolong period of time increases the tendency of developing diabetic foot ulcer. Judy’s, diabetic foot ulcer is an outcome of her unmanaged type 2 diabetes for this she has to left her job. The gap in health literacy is managed CTG under the goal of increase in the life-expectancy of indigenous population.Aboriginal population of Australia suffers from poor health literacy and thus lack disease self-management skills(De Wit et al.
3 INDIGENOUS HEALTH AND WELL-BEING 2018). CTG helps to address this gap in health literacy by arranging community based health educational campaign. Increase in health literacy will help to improve diabetes self-management skills and preventing the chances of negative disease prognosis (Parliament of Australia 2019). The case study also highlights that Judy has to leave her job due to mobility issue, and is a widow. In the absence of the proper financial support, she is unable to go for a regular health check-up in-spite of staying with 10 kilometres from the healthcare facilities. Thus the SDH that is being affected in this case is lack of proper healthcare access. The main aim of the CTG policy is reduce the gap in life expectancy and the government is trying of achieve the same by increasing the provision of the healthcare access among the indigenous people residing in remote areas(Parliament of Australia 2019). The third SDH affected in case of Judy is lack of social support, Judy lives alone her two sons only visit her. There is no one look after her and to manage her wound dressing. Moreover, due to her mobility issues she might experience difficulty in conducting her activities of daily living.The CTG has no specific aim in order to improve the social support and coping skills but unviability of ALO indicates gap in healthcare access.Here increasing healthcare support might help to increase her coping skills(Parliament of Australia 2019). The potential benefits of being registered with CTG are increase in the healthcare access, increase in financial support to manage health and increase in health literacy(Altman, Biddle & Hunter 2018). Registering under CTG will help Judy to conduct periodic health check without imposing a significant financial burden. Judy is unemployed and does not own and travels by public transport. This is a reason why she is unable to go for health checkup that is 20 kilometer away from her home. Periodic health checkup will help Judy to track her blood glucose level and thus reducing the chances of developing micro-vascular complication of diabetes(Lefebvre et a;.
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4 INDIGENOUS HEALTH AND WELL-BEING 2018). Improved healthcare access will help her to manage the wound dressing. CTG will helps to provide financial support to the Aboriginal people and thus helping to over-come health inequalities. Judy is unemployed and thus might be exhibiting financial constraints and difficulty in disease management like medication management and diet management. Getting registered under CTG will help in effective management disease. CTG also promotes health literacy by educating the Aboriginalsand Torres Strait Islanders in about self-management skillsof diabetes. Health literacy helps to promote disease awareness and helping to decrease the gap in life expectancy and health inequalities(Altman, Biddle & Hunter 2018). Additionally registering under closing the gap will help Judy to receive culturally safe care. CTG works closely with the culturally competent healthcare professionals from Aboriginal origin. This help in designing culturally competent care plan that is free from racism and helping the Aboriginals to live strong in dignity (Medical Board of Australia 2019). Aboriginal Medical Service (AMS)is a health service funded mainly in order to deliver healthcare services to the Aboriginals and Torres Strait Islander population. AMS is not a community operated service and thus all AMS are not eligible to become members of National Aboriginal Community Controlled Health Organisation (NACCHO) and its other affiliates. Non- community controlled AMS are run by government (state of territory government). The non- community controlled AMS is present in Northern Territory of Australia and in northern part of Queensland (NACCHO 2019). Aboriginal Liaison Officer (ALO) provides social, emotional and cultural support to Aboriginal and Torres Strait Islander patients and their family members in hospital. Staying in hospital increases the tendency of developing stress and anxiety along with fear, sadness, isolation, and home-sickness. ALO mainly helps to overcome such complex mental issues by the routine counselling with the use of effective communication skills. They
5 INDIGENOUS HEALTH AND WELL-BEING also help to develop culturally safe care plan (Australian Government Department of Health 2019). AMS will be involved in Judy’s case as currently she is unemployed. Involvement of AMS will help Judy to meet her healthcare expenses and thus promoting effective management of type 2 diabetes along with daily dressing of leg ulcer(Australian Government Department of Health 2019). AMS though not eligible for attend the need to management of wound but they funding Judy will receive through AMS will help her execute this healthcare needs. Judy also stays alone and her sons only visit her often. Referral to ALO will help Judy will recover from her loneliness. Moreover, losing her job due to mobility issues, developing of leg ulcer might create a barrier in executing activities of daily living along with additional burden of hospital visit. The counselling done by ALO will help Judy to improve her mental state of mind. ALO and AMS will promote increased access of healthcare by referring to community health centre. Community health centre will help to promote Judy’s health literacy, effective monitoring of blood glucose level and disease self-management skills (Australian Government Department of Health 2019). Thus from the above discussion, it can be concluded that the main social determinants of health that is affected in case of Judy is lack of health literacy, gap in healthcare access and social support or coping skills of disease. By getting enrolled under the CTG gap policy will help Judy to recover from her poor health status. Moreover, taking assistance from the ALO and AMS will help Judy to avail help from community healthcare service and thus promoting effective management of the disease(REFERENCE).
6 INDIGENOUS HEALTH AND WELL-BEING References Altman, J., Biddle, N. & Hunter, B., 2018.How realistic are the prospects for'closing the gaps' in socioeconomic outcomes for Indigenous Australians?. Canberra, ACT: Centre for Aboriginal Economic Policy Research (CAEPR), The Australian National University. Australian Bureau of Statistics. 2006.The People of Australia Statistics from the 2006 Census. Accessdate:18thaugust2019.Retrievedfrom: https://www.dss.gov.au/sites/default/files/documents/01_2014/poa-2008.pdf Australian Government Department of Health. 2019.Aboriginal Liaison Officer (ALO).Access date:18thaugust2019.Retrievedfrom: http://www.gvhealth.org.au/wp-content/uploads/Aboriginal-Liaison-Officers- Brochure.pdf Australian Government Department of the Prime Minister and Cabinet. 2019.Closing the Gap. Access date: 18thaugust 2019. Retrieved from:https://closingthegap.pmc.gov.au/ Australian Institute of Health and Welfare. 2018.Closing the Gap targets: 2017 analysis of progress and key drivers of change.Access date: 18thaugust 2019. Retrieved from: https://www.aihw.gov.au/reports/indigenous-australians/closing-the-gap-targets-2017- analysis-of-progress/contents/summary De Wit, L., Fenenga, C., Giammarchi, C., Di Furia, L., Hutter, I., de Winter, A. &Meijering, L., 2018, ‘Community-based initiativesimproving criticalhealthliteracy:a systematic review and meta-synthesis of qualitative evidence’,BMC public health,vol.18, no. 1, p.40.
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7 INDIGENOUS HEALTH AND WELL-BEING Lefebvre, A.L., Zullo, A.R., Dapaah‐Afriyie, R., Collins, C.M. and Elsaid, K.A., (2018), ‘Outcomes of a pharmacist‐managed clinic for underserved persons with unmanaged type 2 diabetes mellitus’,Journal of Pharmacy Practice and Research,vol.48, no. 1, pp.65- 71. Medical Board of Australia.2019. Closing the gap by 2031: A shared commitment.Access date: 18thaugust 2019. Retrieved from:https://www.medicalboard.gov.au/News/2018-07-04- closing-the-gap-by-2031-a-shared-commitment.aspx Moore, T.G., McDonald, M., Carlon, L. & O'Rourke, K., 2015, ‘Early childhood development and the social determinants of health inequities’,Health promotion international,vol.30, no.suppl_2, pp.ii102-ii115. NationalAboriginalCommunityControlledHealthOrganisation(NACCHO).2019. Aboriginality.Accessdate:18thaugust2019.Retrievedfrom: https://www.naccho.org.au/about/aboriginal-health/definitions/ Parliament of Australia. 2019.Closing the Gap. Access date: 18thaugust 2019. Retrieved from: https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/ Parliamentary_Library/pubs/BriefingBook44p/ClosingGap Whitty, J.A. &Littlejohns, P., 2015, ‘Social values and health priority setting in Australia: an analysis applied to the context of health technology assessment’,Health Policy,vol.119, no. 2, pp.127-136.
8 INDIGENOUS HEALTH AND WELL-BEING WorldHealthOrganisation[WHO].2008.Australia’sdisturbinghealthdisparitiesset Aboriginalsapart.Accessdate:18thaugust2019.Retrievedfrom: https://www.who.int/bulletin/volumes/86/4/08-020408/en/