Health Inequity: Impacts on Indigenous Australian Communities

This essay examines the significant health inequities experienced by indigenous populations, particularly in Australia, providing a comprehensive overview of the historical context and current challenges. It delves into the lasting impacts of colonization, including the forced removal of children, land dispossession, and the introduction of diseases, which have resulted in intergenerational trauma and social disadvantages. The essay highlights key issues such as poor education, low income, unemployment, discrimination, and inadequate housing, which serve as social determinants of health, directly and indirectly impacting the well-being of indigenous communities. It discusses the marked health gap, including lower life expectancy and higher rates of chronic diseases, and explores the failures of government initiatives. Furthermore, the essay applies conflict theory and social constructionism to analyze power dynamics and the creation of knowledge, shedding light on the root causes of health inequity. The essay emphasizes the need for addressing social injustices to ensure a healthier and more equitable future for indigenous populations.

Running head: HEALTH INEQUITY FACED BY INDIGENOUS PEOPLE
HEALTH INEQUITY FACED BY INDIGENOUS PEOPLE
Name of the student:
Name of the university:
Author note:

1
HEALTH INEQUITY FACED BY INDIGENOUS PEOPLE
History and current context:
Health gap between the Aboriginals and the non-native people in the nation is one of
the main concerns faced by the nation in the present years. Indigenous Australians generally
experience worse health than that of their non-native counterparts. Although the health gap as
well as the likely causes have been well documented, but less progress could have been made
in helping the indigenous people overcome the gap and live better quality lives like that of the
non natives (Azzopardi et al., 2018). In order to initiate the understanding, one must need to
reflect the historic impacts that colonisation had resulted on the physical, mental as well as
emotional well-being of the native people. This would be followed by discussion on the
present context of the issue.
The social as well as economic impact of invasion as well as control of the British
colonisers over the indigenous people has accumulated across generations. The same was
found to have been amplified by different policies as well as practices that used to
systematically disadvantage the indigenous people. In a large number of instances, this had
resulted in transmission of trauma as well as poverty and other forms of the disadvantage
from one generation to the next generation (Anderson et al., 2016). Therefore, many of the
researchers are of the opinion that the disadvantages faced by the indigenous people people
can actually be contributed to the long-term effects mainly the different types of lack of
opportunities in the previous generations, which included poor nutrition and also inadequate
education and healthcare. Forcible taking away of their lands affected their shelter as well as
food resources often exposing them to homelessness and lack of food to meet the body’s
nutrition (Gibson et al., 2015). The oppression gradually converted to exploitation with more
of the colonisers applying four main tactics to render the indigenous people helpless and
ensuring them to move through the path of perishing. They attacked four main core values of
the native people, which are identity, responsibilities, relationships and spirituality that

2
HEALTH INEQUITY FACED BY INDIGENOUS PEOPLE
inseparably changed the culture as well as lifestyles of the native people mainly be changing
the role of men in the families. Apart from their policies that promoted violence for the native
people and resulted in loss of culture and land, there were also policies that included forced
removal of children from their families and communities, which had devastating effects.
They were put into institutions with no education and adequate foods, their names were
changed, they were not allowed to speak their native language and meet anyone from their
communities (Armstrong et al., 2017). Exploitation even led many officers put poison in the
food resources of natives to eliminate them. Introduction of many disorders like flu, influenza
and many others by the colonisers, against which the native people were not immune,
resulted in large-scale death. No proper healthcare services were allowed and even
introduction of alcohol was also done by colonizers. Such turmoil and the effects were
carried on for generation being accumulated among the natives, which had contributed to the
health gap that they experience today. In the present context, it can be seen that there exists a
marked health gap in the nation between the Indigenous and non-Indigenous Australians. In
case of the females, it is seen that indigenous life expectancy at the birth is found to be 783.7
years when it is 83.1 years for the non-indigenous females and this inevitably reflects a gap
of 9.5 years. In case of the males, the differences are found to be quite higher with the native
men experiences 69.1 years of life expectancy when the non-native males have a life
expectancy of about 79.7 years depicting a gap of about 10.6 years (Dyer et al., 2017). This
shows the health gap and represents the health inequity that needs to be resolved to ensure
social justice in the nation.
Identified key issues and discussing political, economic as well as social issues:
The indigenous people have been found to be disadvantaged across a large number of
domains in their lives that continue to affect the health today. It has been found that
disadvantages like that of poor education, low income, unemployment, discrimination as well

3
HEALTH INEQUITY FACED BY INDIGENOUS PEOPLE
as poor quality housing are some of the social determinants of health that have affected their
health conditions indirectly and directly. Social determinants of health are the living
conditions where people take birth, grow, survive and live their lives. These have humungous
impact on the quality of health and well-being of people. This can be illustrated with the help
of an example (Ralph & Ryan, 2017). A direct effect that might be where a person with low
income is not able to afford and thereby benefit from the healthcare services because of high
out of pocket costs. Again, indirectly social factors might also increase the likelihood of
engaging in different risky behaviours in people like that of smoking or excessive alcohol
consumption, which increases the health disorder prevalence among the native people. The
report as published by the World Health Organization had shown that 517200 Aboriginals in
the nation make up to about 2.5% of the population but they are also found to be the most
disadvantaged groups in the nation. Their communities are seen to have higher rates of infant
mortality as well as more drug and alcoholism. They are also seen to suffer from disorders
like poor living conditions like that of scabies and pneumonia. Lack of education and
employment opportunities are making the native community more prone to develop poor
quality health in comparison to non-natives. About 62% of the indigenous students are seen
to finish year 12 or equivalent in the year 2014-2015 when comparison are done to 86% of
the non-indigenous people (Jamieson et al., 2016). This shows that native people are not able
to complete their education, which is affecting their healthcare knowledge and health literacy,
and hence they are getting engaged in poor healthcare behaviours of healthcare decisions that
are affecting their well-being. Another data shows that the proportion of 20 to 64 year old
people working in the year 2014 to 2015 is seen to be only 42% while rest 58% of the native
people are still unemployed. The employment rate of the population is found to be 48% in the
year 2014-2015 for the native people while that of non-native people is 75%. Therefore, it
can also reflect that economic crisis as well as financial instability is affecting the native

4
HEALTH INEQUITY FACED BY INDIGENOUS PEOPLE
community to afford quality healthcare services, but organic nutrient rich foods, live in
hygienic houses with good sanitation and becoming a part of the national economy. All such
factors are making them develop poor quality health, obesity, diabetes, cardiovascular
disorder, depression suicide tendency, injury rates and many others. These numbers are quite
higher among the natives as access to healthcare services also remain obstructed for them
because of stigmatisation, discrimination as well as prejudices and culturally incompetent
services by western healthcare services (Short, 2016). Even failures of policies and
government initiatives like “Close the gap” and many others have also resulted in asking
questions about the real intention about the government – whether the government is really
trying to bridge the gap. This debate is still continuing between concerned cohorts. Hence,
above-mentioned key issues are resulting in health inequity and health gap among the native
and non-natives and needs to be resolved to ensure a happier and fitter nation (Paradies,
2016).
Major theories underpinning work in the field:
On close analysis, it can be understood that the situation of social injustice faced by
the native people of the nation can be well linked to the conflict theory. This theory mainly
determines the sociological perspective explaining how power structures as well as power
disparities affect lives of people. Researchers have described this theory stating that all
societies perpetuate some forms of oppressions as well as injustice and structural inequities
(Marnmot, 2017). Power is always found to be unequally divided and there are some groups
who are always seen to dominate the others. In fact the dominant groups have based the
social order on manipulation as well as control. Here, the social change is mainly found to be
driven by conflicts with periods of change that are driven by conflicts with periods of change
interrupting periods of stability. This theory reveals that life is characterised by conflict but
not consensus. It can be found that social position of the Aboriginals is found to be quite low

5
HEALTH INEQUITY FACED BY INDIGENOUS PEOPLE
with many of the communities sharing the “disadvantaged status”. They are always found to
be receiving end with most the social opportunities are aimed at the non-indigenous people
with the indigenous people being at the receiving end. Employment, education, food
distribution, housing opportunities, access to healthcare are not easily and abundantly
available to the native communities as that are available to the non-indigenous people
(Axelsson et al., 2016). Moreover, the different health initiatives that had been taken for the
native people had been found to be half-hearted as most of them had failed to meet the set
agendas or most of them have been so slow to achieve the mission that it had lost the zeal
midway. Aboriginals are still seen to voice for their right to self-determination which gives us
the view that although the present day nation had been able to understand the importance of
including the native communities as part of the national heritage but they have yet not hand
over the power and the rights that should be enjoyed by the Aboriginal communities.
Although, the national initiative to stop discrimination as well as stigmatisation had been
initiated in the nation, still the native people are seen to face the similar level of humiliations
and discrimination at the hands of the native people (Le Grande et al, 2017). They are still
categorised to be of the low socio-economic status with the various initiatives taken for their
welfare had failed to reach their goals.
Another theory that can be also applied to dissect the present social condition of the
natives in the nation is the social construction-ism theory. This theory mainly describes how
socio-cultural as well as historical contexts are seen to shape individuals along with the
creation of the knowledge. This theory mainly describes how individuals create themselves.
To shed more light on the context, all experiences of people is found to be subjective and
human beings are found to recreate themselves through on-going as well as never-static
processes (Sarnyai et al., 2016). The knowledge can be found to be created through an
interplay of multiple historical and social forces. In order to analyse the conditions of health

6
HEALTH INEQUITY FACED BY INDIGENOUS PEOPLE
inequity faced by the indigenous people in the nation, it can be found that exploitation and
oppression by the colonisers along with severe mental and emotional torture conducted by the
government in the past had been passed through generations resulted in development of
intergenerational trauma. This had culminated to what the Aboriginals are today. Apart from
this, the severe stigmatisation and discrimination by the non-indigenous society in the present
generations along with the lack of access to social opportunities like job, employment,
education, food housing and lack of healthcare services had contributed to development of
native communities who suffer from ill health and chronic disorders (Laycock et al., 2016).
Yet again, the questions stating that native people are careless about their health, their habits
of smoking and alcoholism, their tendency to be lazy – all show that people have yet not
acknowledged of that they are not aware about the struggles of the native communities.
Hence, the initiatives that need to be taken for the native communities to bridge the gap and
to help them lead better quality lives should undermine an in-depth research and should
implement evidence-based strategies that help them overcome all the aspects discussed.
Brief overview of current policy:
A number of national and local initiatives and policies have been published over the
years out of which the some of the most important ones would be discussed under the present
topic. Two very similar named project that had been initiated are the “Close the Gap” and
that of the “Closing the Gap”. Close the Gap can be described as the public awareness
campaign that had been mainly focused on closing the health gap between the two cohorts
and is mainly run by NGOs as well as Indigenous health bodies and human rights
organisations (Griffiths et al, 2016). Even the Australian Human Rights Commission
(AHRC) is also an active stakeholder taking part in the program successfully. This campaign
had been formally launched in the year mainly after Dr. Tom Calma had published the Social
Justice Report. He is the Aboriginal and Torres Strait Islander social justice commissioner.

7
HEALTH INEQUITY FACED BY INDIGENOUS PEOPLE
Detailed analysis had shown that this campaign had gained support from that of the state as
well as the federal governments when the Council of Australian Governments (Coag) had
been found to set two health aims among the six targets in the year. The main two such aims
that the campaign mainly worked for are the achievement of the health equality within a
generation as well as halving the gap in the different mortality rates for children who are
under five within the decade. It was found in the year 2008 when the Prime Minister Kevin
Rudd as well as the then opposition leader Brenden Nelson supported the cause and had
signed the Close the Gap statement of intent (Amery, 2017). Another policy had been also
published with the name “Closing the gap” and had been mainly based on Coag’s 2008
national strategy. This policy mainly wanted to tackle the indigenous inequalities. This was
seen to include the indigenous Reform Agreement, which is actually a commitment in closing
the gap between that of the indigenous as well as the non-indigenous Australians within a
very specific timeframes. Six important key targets were aimed to be met for overcoming the
health gap and develop the social position of the native community. These were closing the
life-expectancy gap within the generation along with halving the gap in the mortality rates for
the different indigenous children under five within the decade (Scott, 2015). The other
aspects would be to include access to the people in the community to have early childhood
education for all the four year old in the different remote communities within the five years
and to halve the gap on the wiring, reading as well as numeracy achievements of the children
within the decades. This policy also aimed to halve the gap in the Indigenous Year 12
achievement by 2020 and to have the gap in the different types of the employment status like
that between the Indigenous and non-Indigenous Australians within the ten years. On the
other hand, the Australian government had been also seen to put forward the National
Aboriginal and Torres Islander Health plan 2013-2023. This had been based on similar
principles of Close the Gap and had the aim of making the Australian Health system free

8
HEALTH INEQUITY FACED BY INDIGENOUS PEOPLE
from racism as well as inequality and all aboriginal and Torres Islander people should be
provided the access to healthcare services that would be “effective, high quality, appropriate
and affordable” (Brown et al., 2015). The vision was to address the social inequalities as well
as determinants of health and thereby provide the necessary platform so that health equality
can be achieved by the year 2013.
Analyzing current policies and practices:
As per the review reports published by the Huffington post put forward in the year
2016, 10 years had been already past and they had noticed certain improvements mainly in
the fields like child mortality was seen to be closing. However, the overall picture had shown
marginal improvements across the board and this had given them the idea that it indeed
would require a larger time to achieve the set targets in the campaigns (Fisher et al., 2019). A
struggle had been noticed while transitioning the verbal commitment into maintaining as well
as investing more into the Aboriginal health sector. This shows that restricted funding could
have been one of the barriers that have slowed the process and have affected the phase with
which the campaigns had initiated in the early phase. Reports that had been out forward by
Prime Minister Malcolm Turnbull contained the annual Closing the Gap Report in February.
He was indeed seen to acknowledge the fact that progress had not been made in the important
and critical arenas like one of those being the development of the indigenous life expectancy.
However, gain had been noticed in the 12 attainment rates and there had been also found to
be a significant decline in the child mortality rates. The progress was noticed to be also slow
in the other critical areas like that of the employment areas as well. Even after the
implementation of the projects, policies and the campaigns, there had been still a ten year gap
among the native and non-natives and even in some places, it has been seen to rise up to
about 20 years (Parter et al., 2019). Even stubbornly high levels of chronic ailments had been
found in the chronic disorders like that of the type 2 diabetes, rheumatic heart disease, kidney

9
HEALTH INEQUITY FACED BY INDIGENOUS PEOPLE
disease, and other life-shortening conditions. However, progresses had been found in the
reduction of the smoking rates and increase the number of health check-ups and higher access
to the medicines because of the higher levels of resourcing to the indigenous health sectors.
The strengths that had been observed are that the health promotion programs arranged by the
different concerned authorities are indeed bringing put positive impact by developing their
health literacy. Strength is that the healthcare centre is educating professionals to provide
culturally competent care thereby helping more native people to access the healthcare
services. Strength is that the native indigenous health sectors are doing great holds in
providing services to the native people that are helping them to live better quality lives. The
weakness is consistent funding issues, lack of maintaining the pace of the campaigns and
continuous evaluation to find out the loopholes in the action strategies (Cashman et al.,
2016). Many researchers are also of the opinion those policy makers and the government
professionals and concerned others need to work in partnership with Aboriginal and Torres
Islander people. This would help to identify their concerns, receive feedback and suggestions
from them and include them in the project developments so that better achievements can be
made as per their demands through partnership with First Nations Leaders. Lack of adequate
funding is another weakness of the projects. Such issues need to be tackled with care so that
the health gap between the indigenous and non-indigenous people can be bridged.

10
HEALTH INEQUITY FACED BY INDIGENOUS PEOPLE
References:
Amery, R. (2017). Recognising the communication gap in Indigenous health care. Medical
Journal of Australia, 207(1), 13-15.
https://www.mja.com.au/system/files/issues/207_01/10.5694mja17.00042.pdf
Anderson, I., Robson, B., Connolly, M., Al-Yaman, F., Bjertness, E., King, A., ... & Pesantes,
M. A. (2016). Indigenous and tribal peoples' health (The Lancet–Lowitja Institute
Global Collaboration): a population study. The Lancet, 388(10040), 131-157.
https://doi.org/10.1016/S0140-6736(16)00345-7
Armstrong, G., Pirkis, J., Arabena, K., Currier, D., Spittal, M. J., & Jorm, A. F. (2017).
Suicidal behaviour in indigenous compared to non-indigenous males in urban and
regional Australia: prevalence data suggest disparities increase across age
groups. Australian & New Zealand Journal of Psychiatry, 51(12), 1240-1248.
https://doi.org/10.1177/0004867417704059
Axelsson, P., Kukutai, T., & Kippen, R. (2016). The field of Indigenous health and the role of
colonisation and history. Journal of Population Research, 33(1), 1-7.
https://link.springer.com/article/10.1007/s12546-016-9163-2
Azzopardi, P. S., Sawyer, S. M., Carlin, J. B., Degenhardt, L., Brown, N., Brown, A. D., &
Patton, G. C. (2018). Health and wellbeing of Indigenous adolescents in Australia: a
systematic synthesis of population data. The Lancet, 391(10122), 766-782.
https://doi.org/10.1016/S0140-6736(17)32141-4
Bailie, C., Matthews, V., Bailie, J., Burgess, P., Copley, K., Kennedy, C., ... & Bailie, R. S.
(2016). Determinants and gaps in preventive care delivery for Indigenous Australians:

11
HEALTH INEQUITY FACED BY INDIGENOUS PEOPLE
a cross-sectional analysis. Frontiers in public health, 4, 34.
https://www.frontiersin.org/articles/10.3389/fpubh.2016.00034/full
Brown, A., O'Shea, R. L., Mott, K., McBride, K. F., Lawson, T., & Jennings, G. L. (2015). A
strategy for translating evidence into policy and practice to close the gap-developing
essential service standards for Aboriginal and Torres Strait Islander cardiovascular
care. Heart, Lung and Circulation, 24(2), 119-125.
https://doi.org/10.1016/j.hlc.2014.09.020
Cashman, P. M., Allan, N. A., Clark, K. K., Butler, M. T., Massey, P. D., & Durrheim, D. N.
(2016). Closing the gap in Australian Aboriginal infant immunisation rates--the
development and review of a pre-call strategy. BMC public health, 16(1), 514.
https://doi.org/10.1186/s12889-016-3086-x
Dyer, S. M., Gomersall, J. S., Smithers, L. G., Davy, C., Coleman, D. T., & Street, J. M.
(2017). Prevalence and characteristics of overweight and obesity in indigenous
Australian children: a systematic review. Critical reviews in food science and
nutrition, 57(7), 1365-1376. https://doi.org/10.1080/10408398.2014.991816
Fisher, M., Battams, S., Mcdermott, D., Baum, F., & Macdougall, C. (2019). How the Social
Determinants of Indigenous Health became Policy Reality for Australia's National
Aboriginal and Torres Strait Islander Health Plan. Journal of Social Policy, 48(1),
169-189. https://www.cambridge.org/core/journals/journal-of-social-policy/article/
how-the-social-determinants-of-indigenous-health-became-policy-reality-for-
australias-national-aboriginal-and-torres-strait-islander-health-plan/
D8A74CAA7651CC6732B598D0466A7691

12
HEALTH INEQUITY FACED BY INDIGENOUS PEOPLE
Gibson, O., Lisy, K., Davy, C., Aromataris, E., Kite, E., Lockwood, C., ... & Brown, A.
(2015). Enablers and barriers to the implementation of primary health care
interventions for Indigenous people with chronic diseases: a systematic
review. Implementation Science, 10(1), 71. https://doi.org/10.1186/s13012-015-0261-
x
Griffiths, K., Coleman, C., Lee, V., & Madden, R. (2016). How colonisation determines
social justice and Indigenous health—a review of the literature. Journal of Population
Research, 33(1), 9-30. https://link.springer.com/article/10.1007/s12546-016-9164-1
Jamieson, L. M., Elani, H. W., Mejia, G. C., Ju, X., Kawachi, I., Harper, S., ... & Kaufman, J.
S. (2016). Inequalities in indigenous oral health: findings from Australia, New
Zealand, and Canada. Journal of dental research, 95(12), 1375-1380.
https://doi.org/10.1177/0022034516658233
Laycock, A., Bailie, J., Matthews, V., & Bailie, R. (2016). Interactive dissemination:
engaging stakeholders in the use of aggregated quality improvement data for system-
wide change in Australian Indigenous primary health care. Frontiers in public
health, 4, 84. https://www.frontiersin.org/articles/10.3389/fpubh.2016.00084/full
Le Grande, M., Ski, C. F., Thompson, D. R., Scuffham, P., Kularatna, S., Jackson, A. C., &
Brown, A. (2017). Social and emotional wellbeing assessment instruments for use
with Indigenous Australians: A critical review. Social Science & Medicine, 187, 164-
173. https://doi.org/10.1016/j.socscimed.2017.06.046
Marmot, M. G. (2017). Dignity, social investment and the Indigenous health gap. Medical
Journal of Australia, 207(1), 20-21.
https://www.mja.com.au/system/files/issues/207_01/10.5694mja17.00297.pdf

13
HEALTH INEQUITY FACED BY INDIGENOUS PEOPLE
Paradies, Y. (2016). Colonisation, racism and indigenous health. Journal of Population
Research, 33(1), 83-96. https://link.springer.com/article/10.1007/s12546-016-9159-y
Parter, C., Wilson, S., & Hartz, D. L. (2019). The Closing the Gap (CTG) Refresh: Should
Aboriginal and Torres Strait Islander culture be incorporated in the CTG framework?
How?. Australian and New Zealand journal of public health, 43(1), 5-7.
https://www.catsinam.org.au/static/uploads/files/6dec18-onlinerelease-closing-the-
gap-anzjph-paper-wfmkewhpwemy.pdf
Ralph, S., & Ryan, K. (2017). Addressing the Mental Health Gap in Working with
Indigenous Youth: Some Considerations for Non‐Indigenous Psychologists Working
with Indigenous Youth. Australian Psychologist, 52(4), 288-298.
https://doi.org/10.1111/ap.12287
Sarnyai, Z., Berger, M., & Jawan, I. (2016). Allostatic load mediates the impact of stress and
trauma on physical and mental health in Indigenous Australians. Australasian
Psychiatry, 24(1), 72-75. https://doi.org/10.1177/1039856215620025
Scott, G. (2015). Close the gap: Don't just do something! The Indigenous affairs budget. AQ-
Australian Quarterly, 86(1), 20.
https://search.informit.com.au/documentSummary;dn=776086015825358;res=IELHS
S
Short, D. (2016). Reconciliation and colonial power: Indigenous rights in Australia.
Routledge. https://www.taylorfrancis.com/books/9781315603933

14
HEALTH INEQUITY FACED BY INDIGENOUS PEOPLE