Primary Health Care Framework: Equity Issues in Australian Healthcare

This report provides a detailed analysis of the National Primary Health Care (PHC) Strategic Framework in Australia, focusing on its strategies to improve healthcare access and address inequities, particularly within Aboriginal and Torres Strait Islander (ATSI) communities. The paper discusses the framework's commitment to comprehensive improvement, including health promotion, prevention, and management of chronic disorders. It highlights the importance of social health determinants, epidemiological factors, and the application of WHO principles to address healthcare disparities. The report compares the framework with nursing standards and global PHC recommendations, emphasizing the need for equitable access, multi-sectorial approaches, and flexible funding models. Despite the existence of the framework, the report acknowledges the ongoing healthcare inequities faced by ATSI communities, as evidenced by epidemiological data. The report concludes by emphasizing the significance of adhering to social health determinants of equity and justice, highlighting the framework's alignment with nursing standards and WHO principles.

Running head: PRIMARY HEALTH IN A GLOBAL CONTEXT
PRIMARY HEALTH IN A GLOBAL CONTEXT
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1PRIMARY HEALTH IN A GLOBAL CONTEXT
Introduction
The National Primary Health Care (PHC) Strategic Framework was developed by the
Department of Health in collaboration with the local as well as state governments for the purpose
of ensuring improved health outcomes via integration of healthcare services across all federal
and local and state territories. One of the four strategic outcomes focused upon by the
Framework is to improve healthcare access to all Australians and pave the way for reduction of
inequities in healthcare (Department of Health, 2013). The following paper will discuss this
strategy and its relation to current issues of healthcare equity in Australia, drawing comparison
from nursing standards as well as global PHC recommendations.
Discussion
National PHC Strategic Framework
The PHC Framework postulates the need to commit to comprehensive improvement of
access and inequity across a range of household as well as community based healthcare services
such as: health screening and prevention, promotion of health, preventive interventions as well as
services for the management of chronic disorders such as mental illnesses, cancer, obesity,
dietary complications and diabetes. Additionally, the PHC Framework specifically postulates the
need to address the culturally and ethnically diverse healthcare needs of socially disadvantaged,
minority populations such as Aboriginal and Torres Strait Island (ATSI) communities. The PHC
Framework considers addressing all ATSI healthcare community needs across every aspect of
the healthcare continuum such as acute care, disability care, sub-acute care, aged care, specialist
as well as early childhood services (Department of Health, 2013).

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Despite the prevalence of culturally competent strategies within the PHC, ATSI
communities in the nation continue to encounter inequities in terms of healthcare access. As per
a recent news report by The Lancet, the 11th annual report overviewing ATSI healthcare
communities as per ‘Closing the Gap’ initiatives, merely two targets addressing inequities in
healthcare, employment and education were achieved for the year 2018 (The Lancet, 2019).
Further, as per the Australian Human Rights Commission (AHRC, 2019), ATSI communities as
compared to non-ATSI communities continue to encounter inadequacies in primary and sexual
healthcare access resulting in high rates of sexually transmitted infections, cardiovascular and
renal diseases, diabetes, substance abuse and child diseases like eye and ear infections.
Social Health Determinants
Equity in healthcare implies that every individual will be able to reap positive health
outcomes if he or she has equal access to healthcare services, irrespective of caste, gender, race,
ethnicity and religion. Indeed, the importance of the social health determinant of equity is largely
evident in the form of poor health outcomes denoted across socially disadvantaged minority
groups like indigenous communities, linguistically diverse individuals and LGBTQ groups
(Artiga & Hinton, 2019). The PHC framework attempts to address the social health determinant
of health equity for disadvantaged groups, specifically ATSI communities, by establishing
longitudinal models of healthcare where health professionals like remote nurse practitioners and
general practitioners are encouraged to maintain long term therapeutic relationships with ATSI
patients as well as utilize multidisciplinary via participation by nurse assistants and anesthetists.
This will ensure lifelong management of the comprehensive healthcare needs of ATSI
communities (Department of Health, 2013).

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A healthcare organization which does not provide scope for medical insurance or
subsidized benefits for underprivileged groups will naturally be inaccessible and unjust for socio-
economically disadvantaged ATSI communities as compared to affluent non-ATSI groups
(Marmot, 2017). The PHC framework attempts to address the social determinant of justice by
encouraging the need to incorporate novel, flexible models of funding like pre-payment, mixing
fee for service and blended payment arrangements. This will ensure the availability of adequate
funds for addressing the diverse healthcare needs of ATSI communities without burdening socio-
economically disadvantaged Indigenous patients with expensive healthcare services (Department
of Health, 2013).
Epidemiological Factors
A number of epidemiological findings evidence the prevalence of healthcare inequities in
ATSI patient communities. The 11th Annual Report of ‘Closing the Gap’ demonstrate a life
expectancy of 75.6 years and 71.6 across ATSI women and men respectively, which when
compared to non-ATSI individuals highlight a gap of 7.8 years and 8.6 years (The Lancet, 2019).
Further, according to the Australian Institute of Health and Welfare (AIHW, 2018), the
‘Australia’s health 2018’ report denoted that ATSI individuals in comparison to non-ATSI
individuals as a 2.7 times risk of smoking, 1.9 times risk of low birth weight across infants, 1.7
times risk of acquiring long term illnesses, 2.7 times risk of acquiring psychologically distressing
conditions and 2.9 times risk of ear infection across children. Such recent evidence highlighting
epidemiological discrepancies between ATSI and non-ATSI communities reflect the fact that
inequities continue to exist within the Australian healthcare context, despite the prevalence of
federal and state level policies like ‘Closing the Gap’ and the PHC framework (Trivedi et al.,
2017).

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WHO Primary Health Care Principles
One of the key principles of PHC postulated by the WHO (2019) is to ensure that
healthcare services targeting healthcare issues are distributed across all individuals irrespective
of gender, age, color, class and location. Clearly, the PHC Framework’s strategy to ensure
healthcare access and equity via incorporation of longitudinal care models as well as flexible
funding policies (Department of Health, 2013). An additional primary healthcare principle
developed by the WHO (2019) is the need to follow a multi-sectorial approach in order to ensure
comprehensive health promotion and empowerment across individuals. The PHC Framework
strategy of healthcare access and equity similarly postulates the need to incorporate the roles of
additional professions like nurse assistants and anesthetists in addition to general practitioners for
the purpose of distributing the burden of disease management across socially disadvantaged
ATSI communities (Department of Health, 2013).
Reflection
A major strategy prioritized by the PHC Framework is to ensure equitable access to
healthcare services across all Australian communities irrespective of ethnicity (Department of
Health, 2013). This strategy complies well with Standard of Practice 1.3 developed by the
Nursing and Midwifery Board of Australia (NMBA, 2016) which directs Registered Nurses
(RNs) to treat all culturally diverse patients belonging to ATSI communities with respect and
equality. Additionally, this strategy also denotes the importance of collaborating with additional
professionals, which complies again with NMBA Standard 2.8 recommendations of RN
collaboration with additional health information (Department of Health, 2013; NMBA, 2016).

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Conclusion
This paper thus provides a succinct yet detailed discussion on the key aspects underlying
the PHC Framework strategy of healthcare equity and its comparison with the current issues of
healthcare inequity plaguing the nation. Despite the disparities, this strategy demonstrates sound
compliance with PHC principles of WHO as well as NMBA standards of RN practice. To
conclude, the principles of flexible funding and long term collaboration postulated in this PHC
strategy justifies the adherence to social health determinants of equity and justice.

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References
AHRC. (2019). Achieving Aboriginal and Torres Strait Islander health equality within a
generation - A human rights based approach | Australian Human Rights Commission.
Retrieved 23 December 2019, from
https://www.humanrights.gov.au/our-work/publications/achieving-aboriginal-and-torres-
strait-islander-health-equality-within.
AIHW. (2018). Australia's health 2018: in brief, all is not equal - Australian Institute of Health
and Welfare. Retrieved 23 December 2019, from
https://www.aihw.gov.au/reports/australias-health/australias-health-2018-in-brief/
contents/all-is-not-equal.
Artiga, S., & Hinton, E. (2019). Beyond health care: the role of social determinants in promoting
health and health equity. Health, 20, 10.
Department of Health. (2013). National Primary Health Care Strategic Framework. Retrieved 23
December 2019, from
https://www.health.qld.gov.au/__data/assets/pdf_file/0027/434853/nphc_strategic_frame
work_final.pdf.
Marmot, M. (2017). Social justice, epidemiology and health inequalities. European journal of
epidemiology, 32(7), 537-546.
NMBA. (2016). Nursing and Midwifery Board of Australia - Professional standards. Retrieved
23 December 2019, from https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-
Statements/Professional-standards.aspx.

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The Lancet. (2019). Closing the gap for Aboriginal health. Retrieved 23 December 2019, from
https://www.thelancet.com/action/showPdf?pii=S0140-6736%2819%2930405-2.
Trivedi, A. N., Bailie, R., Bailie, J., Brown, A., & Kelaher, M. (2017). Hospitalizations for
chronic conditions among indigenous Australians after medication copayment reductions:
the closing the gap copayment incentive. Journal of general internal medicine, 32(5),
501-507.
WHO. (2019). Primary health care. Retrieved 23 December 2019, from
https://www.who.int/health-topics/primary-health-care#tab=tab_1.