Respiratory Illness Among Indigenous Australian

This report discusses the issue of respiratory illness among Indigenous Australians, focusing on the impact of homelessness, overcrowding, and socioeconomic factors. It explores the role of organizations like the Lung Foundation Australia in advocating for respiratory health and provides policy recommendations to improve lung health in the Indigenous community.

Running head: RESPIRATORY ILLNESS AMONG INDIGENOUS AUSTRALIAN
Respiratory illness among Indigenous Australian
Name of the Student
Name of the University
Author Note

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Introduction:
Homelessness is one of the major issues in the Indigenous people of Australia and due
to the lack of proper housing, it is observed that the Indigenous Australians are suffering from
various diseases like respiratory disease and tuberculosis infection (Shepherd, Li and
Zubrick, 2012). The main factors that increase the risk of health vulnerability for homeless
people include overcrowding as this is a favourable environment for transmission of infection
and susceptibility to respiratory infections and chronic disease. Tuberculosis is the most
common respiratory disease found in elderly followed by pneumonia and influenza (Moffa et
al., 2018). The main purpose of this report is to advocate for the best possible health of
homeless indigenous people with risk of respiratory illness and critically discuss about the
rationale behind advocating for preventing respiratory illness in the group based on extent of
the health issues and the urgency of the health issue. The report will recommendations for
improvement in policy for an organization that advocates for the health issue.
Health organization:
It is reported in various studies that, the issue of respiratory disease is quite common
among the homeless Indigenous people of Australia (Andersen et al., 2016; Azzopardi et al.,
2018). The Lung Foundation Australia (LFA) is one of the organizations that is working
with the problem of respiratory disease. LFA is a government funded organization. This
organization is a patient advocacy organization in Australia that are responsible for dealing
with lung diseases. It is reported that, this organization is taking care of all the lung related
researches in order to provide maximum support to the Australians (Prasad et al., 2018). The
main of this organization is to ensure lung health and along with this they are promoting early
diagnosis of lung disease and providing care in a priority basis. In addition to this, they are
also conducting training programs to help the health care professionals in delivery of care.

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Due to the loud presence of lung disease in Australia, this organization is aiming to provide
care to the lung disease patients (Lung Foundation Australia, 2019).
Background:
Lung health has received little attention worldwide and based on national data for
Indigenous Australians, respiratory disorders has been identified to be the most common
reason for visiting health service (Chang et al., 2015) The term respiratory diseases cover a
number of conditions that affect the lungs and causes impairment of lungs. Indigenous
Australians are disproportionately affected the respiratory disease condition (Baird, Moses &
Davies, 2019). It is the second most common cause of hospitalization for indigenous youths.
In 2012-13, it was reported that, 1/5th of the total Aboriginal and Torres Strait Islander
children within the age group of 0-14 years were suffering from long term respiratory
disease. In 2014-15, the rate of hospitalization due to respiratory disease like asthma, upper
and lower respiratory conditions, were 2 times greater among the Indigenous people than that
of the Non-Indigenous children (O’Grady et al., 2018). Hence, considering the disparities in
relation to respiratory health outcome for indigenous people, understanding the contextual
and cultural cause behind such health disadvantage in the group is important.
In various studies, it is mentioned that overcrowding is one of the major risk factors of
respiratory disease and due to the problem of homelessness and low socio economic status,
the Indigenous people have this problem of overcrowding in their home (Moffa et al., 2018;
Clifford et al., 2015). According to the report of Australian Government, it is reported that
lower respiratory tract infections (LRTI) are major cause of poor health among the children in
world. In a study is reported that, 33% of total sample population (n=180) had visited the
primary health care centre for any reason and they were diagnosed with acute respiratory
diseases and 22% of children visited the centre due to acute respiratory diseases (O’Grady et

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al., 2018). In a cross-sectional study conducted with 561 children showed that 39% had the
problem of cough which is a symptom of respiratory disease. In another study it was reported
that, the hospitalization rate was also higher among the Aboriginal and Torres Strait Islander
people in comparison with the non-Indigenous people (78 per 1,000 population and 48 per
1000 for non-Indigenous people) (O’Grady et al., 2018).
Indigenous people have poor health compared to the non-indigenous counterparts
because of challenges in poverty, housing, poor education, employment and disconnection
from the ancestral land (Wilson & Neville, 2017). In the context of respiratory health, the
evaluation of the risk factors of poor lung heath in indigenous Australians revealed that
homelessness and poor housing are some social disadvantages experienced by the group that
predispose them to poor physical health (Strobel et al., 2017). The extent of homelessness
and its impact of respiratory health of indigenous people is understood from the review of the
report by Australian Institute of Health and Welfare (AIHW). According to the AIHW (2014)
report, at least one in every 20 indigenous people were homeless in the year between 2011-
2015 compared to non-indigenous people. Housing is a secondary determinant of health and
well-being and battle to access housing has increased worsening respiratory health for the
target group (Moffa et al., 2018). Therefore, this justifies the rationale behind establishment
of organizations like Lung Foundation Australia and the need to advocate for health of
indigenous people.
The high prevalence rate of respiratory diseases among the Indigenous people is a
collaborative result of various factors such as genetic, socioeconomic , environmental, and
causative agents such as , bacteria, viruses, toxins, chemicals and pollution of the
environment (Clifford et al., 2015). By the investigation regarding the perception of
Aboriginal people in Australia regarding housing and their relationship with health, it has
been found that Aboriginal community suffer from major problems with housing quality and

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availability of decent housing. The interview with this group of people revealed that this
population group have limited housing option and they struggle with housing availability too.
Another major disadvantage identified for the group was that majority of indigenous family
live in overcrowded homes (Williamson et al., 2016). It clarifies the reason behind high rate
of respiratory disease for Aboriginal and Torres Strait Islander Children compared to rest of
the population and assigning respiratory conditions as the top ten burden to total disease.
Hence, addressing disadvantage related to housing and poor housing condition is critical to
reduce the burden of respiratory disease among the population group (Adler, Glymour &
Fielding, 2016).
Poor conditions of housing like mould, damp roof, fault wires and poor temperature
control further increase vulnerability to respiratory disease for the group (Chen, Ho & Yu,
2017). Presence of mould and dampness were found to be highly linked with exacerbation of
asthma and respiratory conditions in the group. It negatively affects not only just physical and
mental health, but also child development and social and economic participation for the group
(Williamson et al., 2015; Knibbs et al., 2018). These evidences clearly justifies that policy
makers have not paid attention to provide affordable housing and reduce the impact of poor
housing, homelessness and overcrowding on overall health of the group (Andersen et al.,
2018). The discussion clearly justified why advocating for the respiratory health and overall
well-being of the target population group is necessary. Public health approach to housing is
an urgent need to promote health of the group and recommending LFA regarding the lack of
attention to affordable housing is critical to ensure that they achieve and sustain optimal lung
health for a long term period (Stewart et al., 2016).
Socioeconomic disadvantage is also the primary cause behind vulnerability to
homelessness and risk of respiratory disease for indigenous people. Although a virus or
bacteria is needed for transmission of respiratory infection, however the method by which

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people get sick from infection is dependent on many factors such as poor education,
unemployment, low income and poverty. This is said because access to proper income,
education, transport and quality of housing is critical for prevention and management of
respiratory illess in children (Strobel et al., 2017). However, there is great gap in the
socioeconomic health status between indigenous and non-indigenous people in Australia and
this contributes to high burden of respiratory disease in this population group (). Therefore, to
target optimal lung and respiratory health for the group, there is a need to improve
socioeconomic factors and circumstances for the group too.
Moreover, it is also observed that the traditional belief and cultural factors also
increases risk of respiratory disease among the Aboriginals and Torres Strait Islander
(Waterworth et al., 2016). For example, the effect of colonisation had adverse impact on
quality living, access to housing and health outcomes for the group. Their traditional life was
suppressed after colonization and their physical, social and emotional well-being has been
disrupted by political marginalisation and racial prejudices. All this factors lead to
dispossession of land, poverty, and unemployment creating the condition for homelessness
and the need to live in overcrowded housing (Shepherd et al., 2017; Fisher et al., 2016).
Hence, it cannot be denied that transgenerational trauma has adversely affected the group
leading to poor access to safe housing as well as burden of respiratory disorders in the group.
von Mutius (2016) gives the evidence that some of the factors that is linked to respiratory
disease in the group is the home environment. The exposure to moisture, dust-mites, mould,
tobacco smoke and overcrowding is high for indigenous group and these conditions are
strongly associated with development of asthma and development of severe respiratory
infections. Crowding is common among indigenous people and it increases the opportunity of
cross-infection among family by the transmission of respiratory pathogens through air
droplets and aerosols in ill-ventilated and crowded rooms (Andersen et al., 2018). This

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justifies the need to create an advocacy policy for improving access to affordable housing and
promote lung health for the target group.
Aim and objectives:
The main aim of the policy for advocacy of the indigenous Australians is to take
relevant action to promote respiratory health outcomes for the group. The main objectives of
the policy for advocacy are as follows:
 Take action to reduce risk factors of respiratory illness such as homelessness, poor
socioeconomic factors and other social factors
 Take action to improve existing health service for respiratory illness
 Take action to increase the accessibility of health care service for indigenous
Australians
Policy recommendations:
Based on the review of respiratory disease prevalence and high rate of hospitalization
among Indigenous Australians, there are three policy recommendations to improve
respiratory and lung health of the target population group:
1. Economic stability and housing policy should be developed to promote health of
indigenous people in Australia:
Since the rate of transmission of respiratory infection increases with poverty and quality
of housing, the Australian government needs to develop economic stability policy so that
appropriate opportunities for employment are given to the Indigenous Australians (Australian
Government, 2014). This would the group to afford decent housing options and reduce
possibility of infection due to overcrowding. To close the employment gap for indigenous
and non-indigenous Australians, the economic stability policy should focus on increasing

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capabilities of indigenous Australia via basic education and job training (Basnayake, Morgan
& Chang, 2017). Customized training arrangement needs to be done so that multiple barriers
to finding employment are addressed and the economic capability of the group is
strengthened. A system should also be established to implement support mechanisms that
enhance retention of indigenous employees (Stevenson et al., 2017). Some examples of this
form of support include mentoring support, introduction of flexible work arrangement and
addressing racism in work place. This form of action is necessary by the Australian
government because the closure of the gap in burden of respiratory illness in the Aboriginal
and Torres Strait Islander people is dependent on change in socioeconomic factor and
modifiable risk factors of the disease (Australian Government, 2014).
There is also a need for the LFA organization to focus on housing policy for the
indigenous group so that appropriate housing support and affordable housing is provided to
indigenous people. This form of housing related support is critical because unmaintained
housing and poor housing conditions like structural problems, dampness, crowding and
unaffordability are the common factors that increase risk of respiratory illness and health
disadvantage for the group (Andersen et al., 2018). Therefore, implementation of appropriate
housing policy is critical to influence affordability, condition of housing and housing
availability in remote areas. Policy related actions such as change in tenancy law and taxation
for indigenous people can play a role in increasing affordability and quality of housing and
decrease negative health outcomes for the group. The significance of this form of policy
based housing support is that spacious houses will reduce burden of respiratory disease
occurring due to dust, firewood, smoke and overcrowding.
2. Focus on developing health policy to increase resource for lung condition,
improve health services and increase accessibility of health services in remote
areas:

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To reduce the burden of respiratory illness and increasing optimal treatment options for
indigenous Australians, it is recommended to develop health promotion policy specifically
for indigenous health so that specific management guidelines are implemented to address
health needs of the group. This should focus on use of culturally appropriate risk assessment
tools to favour early detection of the disease and increasing referral centres in indigenous
communities so that early diagnosis of chronic respiratory disease and cost related to
morbidity and hospitalization is reduced (Swain & Barclay, 2015). Another advantage of
health promotion policy particularly for the group is that it will favour delivery of various
models of care to meet the health needs of the group (Binns et al., 2017). For example, this
form of policy would increase the likelihood of one-to-one health education related to lung
disease, appropriate follow up process and recruitment of indigenous health workers. Most
importantly, the focus on a policy for improved health services will improve service delivery
quality and promote sense of empowerment of indigenous community in terms of respiratory
health management (McPhail-Bell et al., 2016).
3. Increase health education to minimize burden of respiratory illness:
It is recommended that policy makers focus on health education of the indigenous
community so that different approaches are used to address impact of poor hygiene on risk of
respiratory illness. Aguirre et al. (2017) argues that rate of death and morbidity due to
respiratory illness are linked to the risk factor of poor education and education can be target
to prevent death and improve living condition of the group. As respiratory illness has a major
impact on quality of life of people, the education can be target to improve sanitation and
hygiene practices, modify living conditions and promote management of co-morbidities.
Parents need to be particularly targeted during community based education as positive
parenting behaviours can enhance physical and social environment of a child and enhance
self-efficacy in maintaining hygiene (Mckay et al., 2015). During community based health

9RESPIRATORY ILLNESS AMONG INDIGENOUS AUSTRALIAN
education, there is a also a need to target health care providers and specialist too so that all
form of education and training is implemented to support early identification of people at
risk. Increase in knowledge about risk factor disease wild contributes to improve health
practices and improve respiratory outcome.

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