Contemporary Health Issues and Policies: Aboriginal Health

This report examines the significant health issue of chronic kidney disease (CKD) among Aboriginal Australians. It highlights the disproportionate impact of CKD, particularly end-stage kidney disease, on this population, often exacerbated by limited access to healthcare in remote areas. The report analyzes the role of the National Aboriginal Community Controlled Health Organization (NACCHO) in addressing these challenges. It explores the urgency of the issue, the impact on Aboriginal communities, and the aims of policy advocacy to improve healthcare access and outcomes. The report recommends interventions such as providing culturally appropriate education, facilitating early detection and management of CKD, and improving social support for medical services in rural and remote communities. The report underscores the need for government and healthcare providers to collaborate in developing and implementing comprehensive strategies to address the health disparities faced by Aboriginal Australians and ensure equitable access to care.

Running head: CONTEMPORARY HEALTH ISSUES AND POLICIES
Contemporary health issues and policies
Name of the Student
Name of the University
Author Note

1CONTEMPORARY HEALTH ISSUES AND POLICIES
Table of Contents
Background......................................................................................................................................2
Background of the health Organization.......................................................................................2
Health Issue.....................................................................................................................................3
Aboriginals or the Indigenous group...........................................................................................3
Health Issue- Chronic Kidney diseases.......................................................................................3
Urgency of the issue....................................................................................................................4
Impact of such issue on the Aboriginals......................................................................................5
Aims and objectives of Policy for Advocacy..................................................................................6
Recommendations (min 3)...............................................................................................................7
References......................................................................................................................................11

2CONTEMPORARY HEALTH ISSUES AND POLICIES
Background
The Australian government is responsible to ensure well-being of every Australian
citizen and undertake several measures that addresses health related issues primarily apart from
the other issues (Fredericks, Adams and Edwards 2011). This is because a healthy nation is the
foundation of a progressive nation. This paper aims at identifying one significant health issue of
the aboriginals and indigenous group and shall highlight the best possible health opportunities
for such groups by developing policies for advocacy and articulate the views to the chosen health
organization. The health organization chosen to make policies for advocacy with respect to the
aboriginals is the National Aboriginal Community Controlled Health Organization [NACCHO].
Background of the health Organization
National Aboriginal Community Controlled Health Organization [NACCHO]
Indigenous health refers to the cultural, social, emotional and physical wellbeing of the
Torres Islander or Aboriginal people. The NACCHO is a living description of the hopes of the
Aboriginal group and their effort for self-determination. This health body represents the
Aboriginal community controlled health services (ACCHSs) all over the country on health and
wellbeing issues of the indigenous community.
The ACCHS is a primary health care service where the local aboriginal community
operates and initiates the health services to deliver broad, holistic and ethnically appropriate
healthcare to the community that exercises control over such body through an elected
Management Board.

3CONTEMPORARY HEALTH ISSUES AND POLICIES
Health Issue
Aboriginals or the Indigenous group
Aboriginals or the indigenous, especially, those who dwell in remote regions are at a
greater risk of developing the chronic kidney diseases compared to other Australian citizens.
Health Issue- Chronic Kidney diseases
Several Indigenous group suffer from heart and/or circulatory disease, kidney disease and
diabetes/high sugar levels. Amongst these diseases the most common chronic diseases that often
causes death of the aboriginals is the chronic kidney diseases. Generally, the Indigenous
Australian citizens are usually vulnerable to more diseases than the non-indigenous groups of
people due to variety of reasons and chronic kidney disease is not any exception. Chronic kidney
disease has become an increasingly common health problem in Australia. People suffering from
chronic kidney diseases, especially with end-stage kidney disease usually have poor health
outcomes and a poor quality of life (Ward, Fredericks and Best 2014).
It is well known that the health conditions of the aboriginal people have undergone
changes over the past decades due to the advancement of technology and rising living standards.
Nevertheless, despite such development in place, the aboriginals are unable to enjoy the benefits
as their health conditions persist to be poor and the living standards remain to be low (Rigney
2017).
The greater prevalence of the chronic kidney diseases amongst the indigenous group is
due to the high occurrence of risk factors, which includes high blood pressure, smoking, and
diabetes along with alcohol abuse, inadequate levels of nutrition, skin infection, streptococcal
throat and poor as well as unhygienic living conditions.

4CONTEMPORARY HEALTH ISSUES AND POLICIES
Urgency of the issue
Chronic diseases are responsible for more than two-third of the total health gap and a
significant percentage of the total disease burden is seen amongst the indigenous Australians. In
remote areas in the rural regions, in particular, the occurrence of the chronic kidney diseases
especially the end-stage kidney diseases which is commonly prevalent amongst the indigenous
group of people (Hendrickx et al. 2016). Almost 18 percent of the group suffers from the end-
stage kidney diseases, which is approximately 20-time higher rate than the non-indigenous group
of eople.
Apart from the low living conditions and lack of treatment of the other diseases, which
often causes the kidney diseases, the other significant factor, which attributes to the growing
prevalence of the issue amongst the indigenous group, is the lack of accessibility to medical
services. This is evident from the fact that majority of the patients have to be relocated to cities
or regions or even countries where there are availability of appropriate medical facilities to treat
their diseases.
Presently, the indigenous and the aboriginals do not have access to sufficient support and
the patients are deprived of any medical care that is required to assist the patients during their
renal dialysis journey and by support, it implies both social and emotional. The patients who are
lucky enough to receive treatment are moved away from their families, homeland, and apart from
their health sufferings they suffer mentally as well.
The lack of a funding model in the areas where the aboriginals dwell compels patients to
move far away from their families and home. The incline in the number of people suffering from
chronic kidney diseases especially, end-stage kidney diseases are compelling the indigenous

5CONTEMPORARY HEALTH ISSUES AND POLICIES
people to travel into town centers for undergoing medical treatment away from their country,
culture and family.
Every indigenous person belonging to remote community, when they are directed to
undergo dialysis, the first thing that they ask for is if they can undergo such treatment near their
homes. This will not only help them receive family support but will also save them from
significant expenses that is incurred when they move away to towns, cities, away from their
homes (Ferguson 2015).
Impact of such issue on the Aboriginals
The aboriginals and the Torres Islanders group experience disproportionate levels of
chronic kidney diseases that too of high level irrespective of the rural, region and urban locality
compared to the general population of the country. The Islanders or the aboriginals group is four
times more vulnerable to the chronic kidney diseases out which majority of them suffer from
end-stage kidney diseases.
As mentioned above, due to lack of medical facilities within the rural regions where
majority of the aboriginals dwell, they are often shifted to other places to undergo medical
treatment. The separation of the patients from their homeland often have a psychological,
biological, socio-economic consequences on the wellbeing and health of the patients, their
communities, families, wider health as well as the welfare system.
The impact of kidney failure in almost every people, severely affects the family along
with the patients in the form of loss of job opportunities, heavy symptomatic burden, financial
hardship, real social disruption as well as ability to work (Reilly et al. 2016). Further, the
relocation of the aboriginals to other countries, regions for undergoing a dialysis often detaches

6CONTEMPORARY HEALTH ISSUES AND POLICIES
them from their families. This is one of the most significant issues that pose a threat to the health
and social support area for Aboriginals and the islanders who have accessibility to dialysis
services at places that is far from their homes. This is further very confusing, burdensome,
fragmented and isolating for the aboriginal patients.
Aims and objectives of Policy for Advocacy
The aims and objectives of policy for advocacy is not confined to the number of
decisions that are made by both non-governmental as well as governmental organizations. In the
present case, in order to bring about changes in the health related issues associated with the
aboriginals, policy advocacy is crucial to bring about such necessary changes with respect to the
aboriginals health. Policy advocacy has been proved advantageous in order to bring about
changes in other health related issues like malnutrition, diabetes, mental health, etc.
Further, it must be understood that an effective, efficient and equitable health system is a
fundamental element for government as well as for the non-governmental organizations to
address the health issues of the aboriginal and islander people (Webster et al. 2017). Despite the
commencement of the funding streams which includes child and maternal health program,
primary healthcare base funding, Aboriginals and Islander Chronic Disease Fund introduced
by the Australian Government Indigenous Australian’s Health program in 2014, shortage of
chronic fund model in the rural areas are compelling patients to move away from their family
and care to undergo medical treatment.
There are evidences of significant evidence-practice gaps in the management of pre-
dialysis of the chronic kidney diseases. As mentioned earlier that the aboriginals lack
accessibility to effective medical assistance, hence, most of the times, their health issues often go

7CONTEMPORARY HEALTH ISSUES AND POLICIES
unchecked. With an incline in the medical assessments, facilities that would ensure that every
aboriginal undergo a checkup might reduce the incidence of chronic diseases chronic kidney
diseases (Zhao et al. 2014).
The aims and objectives of this advocacy for policy can be summarized as follows:
i. to ensure that dialysis treatment is funded by the government in rural and remote areas;
ii. to ensure adequate medical facilities within such rural and remote areas;
iii. to ensure that the aboriginals living within rural and remote communities have access to
medical assistance;
iv. to provide a better understanding of how better and positive clinical results can be
achieved;
v. to establish medical facilities or programs that will provide cost-effective care to
indigenous Australians suffering from chronic kidney diseases as well as end-stage
kidney diseases;
vi. to ensure better primary healthcare services is rendered in the rural and remote areas of
the country;
vii. to make sure that a healthy workforce is adequately trained and is competent in dealing
with intricate social and health issues that are being experienced by the Aboriginal group
of people;
Recommendations (min 3)
The lack of medical facilities to conduct dialysis has made the lives of the aboriginals
more difficult leading to high mortality rate, hence, it has become a national issue, which
requires a national response of State, Federal and Territory government to develop approaches

8CONTEMPORARY HEALTH ISSUES AND POLICIES
to address the non-health as well as that of the health issues. The first and foremost objective of
such approaches must ensure effective accessibility to medical treatment. For the aboriginals
living within the rural and remote areas, lack of accessibility to the medical treatment like renal
dialysis closer to their homes which ultimately leads to the decision of relocating to other places
for treatment are essential determinants that often makes people avoid undergoing treatment.
The fear of being away from their families, carers and high expenses often causes a
significant proportion of patients not to undergo any medical treatment. Further, as stated above
those inadequate trained medical professionals who lack language competency, kidney diseases
fails to assess the disease at early stages leading to deterioration of health. Under such
circumstances, it is important to adopt measures that ensure better health outcomes for the
aboriginal group (Webster et al. 2017). In order to achieve better health standards for the
aboriginals and Islanders group, policies must be modified and following are some measures that
are recommended that the government may consider with respect to improvement in the health
standards of the Aboriginals.
I. Adequate information about chronic kidney diseases:
There is a need to develop ethnically appropriate educational resources that shall enable
the aboriginals learn about their kidney health, functions of kidney and the causes of
chronic kidney diseases. The primary target group in this respect should be the youths
and the adolescents. For patients already at the early stage of chronic kidney diseases
must also be provided with adequate information about the dialysis treatments;
II. Management of Chronic Kidney Diseases and Early Detection of the diseases

9CONTEMPORARY HEALTH ISSUES AND POLICIES
Primary healthcare services, ACCHSs and improved general practice must be facilitated
in order to detect the disease at its inception amongst the aboriginals and islanders group.
This can be achieved by establishing health checkup and health assessment sessions
which includes kidney testing, maintaining a separate register for those detected with
chronic kidney diseases so that it opens the scope for national reporting. Further, with
adequate information provided to the aboriginals about the chronic kidney diseases will
enable them to take care of their health and restrain from factors which might cause such
problems.
III. Social-Support for medical services in rural and remote communities
The lack of accessibility to renal treatment and dialysis treatment for aboriginal patients
suffering from chronic kidney diseases has an adverse impact upon the socio-economic as
well psychological factor upon several Aboriginals and Islanders groups and families.
Under such circumstances, it would be effective if a place-based model is established that
would determine the level of social support assistance required to the aboriginal kidney
patients and their families with respect to relocation of such patients for undergoing
kidney treatment. In order to provide the aboriginal patients with treatment to the
aboriginals, it is equally important to consider the huge expenses that are usually incurred
to undergo such treatment (Rigney 2017). Therefore, in order to achieve this approach, a
needs-based funding model must be established that will coordinate and address the
growing needs of the aboriginals for social support as well the model shall provide cost-
effective treatment.

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In order to implement the measures and bring a change in the policies that shall ensure a
better health outcome for the aboriginals, it is important to overcome the challenges that act as
impediments to a smooth implementation of the measures. Firstly, to maintain and develop a
knowledgeable and skilled workforce poses a significant challenge while working with the health
of the Islander and aboriginals (Hoy 2013). Further, the aboriginals not only suffer from chronic
kidney diseases but also from other chronic diseases such as diabetes, mental health, cancer,
obesity, etc. Apart from establishing models that addresses the issues of kidney diseases, it is
important, that equal strong models are established to deal with the other health issues as well
which, immediately seems to be a difficult task.
However, since chronic diseases like kidney diseases are mostly prevalent amongst the
aboriginals therefore, it is of utmost importance that the measures for addressing the kidney
disease issues. The patients suffering from kidney diseases have distinct social, economic and
cultural needs which must be fulfilled immediately as it might reduce the incidence of such
chronic diseases and result in better health outcome.

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References
Ferguson, T., 2015. The cost-effectiveness of primary screening for chronic kidney disease in
Manitoba’s rural and remote First Nations.
Fredericks, B., Adams, K. and Edwards, R., 2011. Aboriginal community control and
decolonizing health policy: a yarn from Australia. Democratizing health: consumer groups in the
policy process, pp.81-96.
Hamer, R.A. and El Nahas, A.M., 2006. The burden of chronic kidney disease: is rising rapidly
worldwide. BMJ: British Medical Journal, 332(7541), p.563.
Hendrickx, D., Stephen, A., Lehmann, D., Silva, D., Boelaert, M., Carapetis, J. and Walker, R.,
2016. A systematic review of the evidence that swimming pools improve health and wellbeing in
remote Aboriginal communities in Australia. Australian and New Zealand journal of public
health, 40(1), pp.30-36.
Hoy, W.E., 2013. Chronic disease care in remote Aboriginal Australia has been transformed.
BMJ, 347, p.f6127.
Hoy, W.E., Hughson, M.D., Singh, G.R., Douglas-Denton, R. and Bertram, J.F., 2006. Reduced
nephron number and glomerulomegaly in Australian Aborigines: a group at high risk for renal
disease and hypertension. Kidney international, 70(1), pp.104-110.
Jha, V., Garcia-Garcia, G., Iseki, K., Li, Z., Naicker, S., Plattner, B., Saran, R., Wang, A.Y.M.
and Yang, C.W., 2013. Chronic kidney disease: global dimension and perspectives. The Lancet,
382(9888), pp.260-272.