Health and Society Assessment 3: Smoking and Inequity Among Indigenous Australians

This article discusses the reasons for inequity between Indigenous Australians and non-Indigenous Australians in relation to smoking. It also provides an example of a primary health care intervention that is addressing this health issue for Indigenous Australians and explains the impact this intervention is having on reducing inequity. Additionally, it discusses how cultural knowledge and sensitivity in health care may affect access to primary health care services and provides an example based on smoking.

Health and Society
Assessment 3
Extended Response Template
Choose one health issue from the list below:
 Smoking
 Coronary heart disease
Answer all of the three questions below based on this one health issue.
Each extended response should be approximately 500 words in length each.
The reference list for all three extended response should be provided under the references heading
of this template.

Question 1
Discuss two different reasons for inequity between Indigenous Australians and non-Indigenous
Australians in relation to this health issue.
Tobacco use increases the risk of many diseases including cardiovascular
disease, cancer, respiratory diseases, peripheral vascular disease and many
others. This has resulted in high mortality and morbidity rates to the Australians
In Australia, smoking has been contributed up to two-thirds of deaths on the
average age of 10 years earlier than the non-smokers. Abstaining from smoking
reduces the mortality rate. Tobacco use has greatly contributed to the disease
burden in indigenous Australian (12% of the total burden) and has created 23%
health gap between indigenous and non-indigenous Australia in 2011. The 2014-
15 Social Survey have the most recent data on indigenous smoking rates. From
the survey, 42% of the indigenous Australians aged 15 years and over, were the
current smokers. According to the survey, there is 2.7 times prevalence of smoking
higher in indigenous Australians than non-indigenous Australians (Thomas, Briggs,
Anderson & Cunningham, 2008).
Health behaviors and risk factors are found in the complexity of socioeconomic,
family and community factors. “Inequities in health, avoidable health inequalities,
arise because of the circumstances in which people grow, live, work, and age, and
the systems put in place to deal with illness. The conditions in which people live
and die are, in turn, shaped by political, social, and economic forces” (Nettleton
Woods, Burrows & Kerr, 2007).

According to 2014-15 survey on indigenous smoking rates found that 42% of the
indigenous Australians reported being the current smokers. It was found that they
are 2.7 times higher in the prevalence of smoking compared to the non-
indigenous.
The proportion of population aged 15 years and over reporting they are a current smoker, by Indigenous status and age, 2014–15
Source: ABS and AIHW analysis of 2014–15 NATSISS, 2014–15 NHS
The higher smoking rate for indigenous Australian is associated with socio-
economic factors in the most disadvantaged circumstances (Thomas, Briggs,
Anderson & Cunningham, 2008). Further studies have found that there is a higher
density of tobacco outlets in more disadvantaged districts which also record a
higher number of smokers (Marashi-Pour, Cretikos, Lyons, Rose, Jalaluddin, &
Smith, 2015)
Socio-economic factors such as education and unemployment have been
considered to be the determinants of the smoking prevalence between indigenous
and non-indigenous Australian. Their overlap may either grow or diminish
prevalences along the social gradient (Marmot, 2015). According to Hahn and
Truman (2015), those who have gone to school for more than 12 years are found
to be less prevalent in smoking. It was also found that those living in low-income

household show higher rates of smoking than high-income earners.
Question 2
Provide one example of a Primary Health Care intervention that is addressing this health issue for
Indigenous Australians. Explain the impact this intervention is having on reducing inequity.
Training healthcare professionals in smoking cessation interventions
Training of medical physicians may increase cessation of smoking rates to
patients. This training will also increase the number of smokers to undergo advice
on how to quit smoking. This is because training will increase the physician's
confidence, knowledge, skills and how to practice the smoking-related
interventions. The training also encourages referral by the health service provider
to the specialist smoking cessation services. The students who undergo the
curricula retain the skills learned, and they become more active in making smoking
interventions. Although the tobacco curricula in medical schools vary, the general
objective of the training is similar.
The major reason why some doctors may not be active in tobacco use treatments
is due to the lack of relevant training in medical schools. However, schools have
incorporated the curricula in their training. Quit Victoria developed a systematic,
comprehensive and tailored program for use in cessation training of medical
professional in Australia.
Impact of the intervention
Due to the training of medical professionals on smoking cessation and other
interventions smoking in indigenous Australian has significantly reduced. The

intervention has encouraged referrals of smoking patients to the specialist in
smoking cessation. Referrals increase the numbers of patients being helped to quit
smoking which in return increases the number of Indigenous smokers in Australia.
It has also helped doctor’s confidence in helping the patients because they have
the required knowledge and skills to help their patient.
Training of medical professionals has increased the numbers of patients seeking
smoking cessation over the few years. Patients also have confidence t the help
they seek from these physicians.
When a high number of indigenous Australian quit smoking, their health will
improve, and their economic status will also change because there will be no
wastage of money to buy tobacco. Smoking cause health problems, therefore
smoking cessation improve the health of the patient. The health burden to the
government will be reduced as a result.
Question 3
Discuss how cultural knowledge and sensitivity in health care may affect access Primary Health
Care services. Provide one example based on your chosen health issue.
Primary health care services require not only robust health system but also cultural
support. The cultural barriers exist in the provision of medical cessation services in
the indigenous Australian varying from the medical procedures and practices,
language differences, and gender issues. These barrier result to

miscommunications between the medical professional and the patient during
cessation therapy programs to the indigenous Australian. Their poor outcomes are
likely to emerge in cessation programs in areas exhibiting those cultural barriers.
These barriers also lead to inequality in health care among the indigenous
Australian. The studies have established that cultural knowledge and sensitivity
may affect the willingness of indigenous people to use the mainstream health care
centers.
Cultural identity has also affected how people perceive and seek health care. This
refers to how people feel identified to a certain group in the society. Culturally, they
tend to trust those people who hold the same beliefs, practice the same religion,
are from the same country and social class, share ethnicity and have similar
physiological characters. It has been proved difficult to deal with a person who
holds such beliefs and there offering health care services become unsuccessful.
Therefore it has come to be understood why indigenous people fail to seek
medical assistance in various circumstances.
It has also been established that the health care system medical cover in Australia
only manage to serve 40% of the population regardless of Australia having highly
regarded health care system and the government-supported community services
in the world. There is also a high number of health care centers in the metropolitan
areas than rural areas, and also a high number of medical practitioners. The
studies have found that health care system does not provide equal quality of
healthcare to indigenous people compared to non-indigenous.
Tobacco use among children from culturally diverse environments

The studies have shown that the young people are living in families where English
is spoken more likely to smoke than those living in families where there is the use
of other languages. The studies show that young people who speak a language
other than English at home shown a lower prevalence of tobacco use than those
with a background of English speaking family. The logic behind this was how the
environmental influences and cultural sensitivity has impacted on the prevalences
to this risk behavior. The lower tobacco use by children from those families is
because of the cultural attitude opposing tobacco use among children. These
children are also likely to socialize with children speaking the same language,
therefore, reducing peer influence (Larkins, Woods & Matthews, 2016).
References
Hahn, R.A., Truman, B.I. (2015) Education improves public health and promotes
health equity Int J Health Serv, 45 (2015), pp. 657-678
Larkins, S. Woods, C.E. Matthews, V., (2016) Responses of Aboriginal and Torres
Strait Islander primary health-care services to continuous quality improvement
initiatives. Front Public Health, 3 (2016), p. 288
Marashi-Pour, S., Cretikos, M., Lyons, C., Rose, N., Jalaluddin, B & Smith, J. (2015)
The association between the density of retail tobacco outlets, individual smoking
status, neighborhood socioeconomic status and school locations in New South
Wales, Australia, Spatial and Spatio-temporal Epidemiology, vol. 12, pp. 1-7.
Marmot, M., (2015) The Health Gap: The Challenge of an Unequal World,
Bloomsbury Publishing: Great Britain.
Nettleton, S., Woods, B., Burrows, R., Kerr, A.,(2007) Experiencing Food Allergy
and Food Intolerance :An Analysis of Lay Accounts. Journal of sociology, Volume: 44
issue: 2, page(s): 289-305 . Retrieved from
https://doi.org/10.1177/0038038509357208 [Accessed may 26, 2018].

Thomas, DP, Briggs, V, Anderson, IP & Cunningham, J., (2008) The social
determinants of being an Indigenous non-smoker. Australian & New Zealand Journal
of Public Health, vol. 32, no. 2, pp. 110-116.