UTS Contemporary Indigenous Health and Wellbeing Essay: Policy Impact

This essay analyzes the Closing the Gap (CTG) policy, a government initiative aimed at reducing health disparities among Aboriginal and Torres Strait Islander populations in Australia. The essay begins by defining cultural respect and its importance in healthcare, particularly for Indigenous communities. It then provides a comprehensive overview of the CTG policy, its targets, and its origins in the Social Justice Report 2005, focusing on the target related to life expectancy. The essay utilizes a case study of Judy, a 57-year-old Aboriginal woman with type 2 diabetes, to explore the impact of the CTG policy. It examines the social determinants of health, including unemployment, unstable housing, and low socioeconomic status, and how these factors influence Judy's health challenges and eligibility for the CTG program. The essay details the registration process for the CTG program and defines the roles of the Aboriginal Medical Service (AMS) and the Aboriginal Liaison Officer (ALO) in providing support and healthcare services to Judy. The conclusion emphasizes the influence of social and physical environmental factors, collectively known as social determinants of health, on health and wellbeing, highlighting the importance of addressing these determinants to improve health outcomes for Indigenous populations. The essay uses relevant literature and statistics throughout to support its arguments.

Running head: ESSAY
Exploring the impact of Policy on Health
Name of the Student
Name of the University
Author Note

1ESSAY
Introduction- Culture is generally defined as the combination of belief, knowledge
and behaviour. It comprises of a range of components such as, language, personal
identification, communication, customs, actions, values, and thoughts that are specific to
racial, religious, ethnic or social groups (Cai et al. 2017). The notion of cultural respect has
been found to exert a positive influence on the delivery of patient care by empowering
healthcare providers to deliver services that are reverential of and receptive to the health
principles, practices, linguistic and cultural preferences of diverse patients. This essay will
utilise the concept of cultural respect, in relation to the Aboriginal and Torres Strait Islander
population.
Closing the Gap- Closing the Gap (CTG) is a government policy that had been
formulated with the aim of decreasing the disadvantage amid Aboriginal and Torres Strait
Islander individuals, in relation to child mortality, life expectancy, and access to education
during early childhood, employment outcomes, and educational attainment. The CTG policy
can be defined as a formal commitment that has been made by the government of Australia in
order to accomplish health equality for the Australian indigenous population within the next
25 years (Altman 2018). Development of the policy was a direct consequence of the Social
justice report 2005. In March 2008, an agreement was made by the Aboriginal and Torres
Strait Islander individuals and the Australian government for working in collaboration, in
order to accomplish parity in life expectancy and health status between the indigenous and
non-indigenous population, by 2030. With the aim of monitoring changes, a plethora of
measurable targets had been set by the Council of Australian Governments (COAG) for
monitoring advancement and progress in the wellbeing and health of the indigenous
population. The targets in CTG policy are namely, (i) closing life expectancy gap, (ii) halving
child mortality rates (An Australian Government Initiative 2009), (iii) halving gap in

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numeracy, writing and reading, (iv) halving educational attainment gap, (v) closing school
attendance gap, and (vi) halving gap in employment outcomes.
On analysing the case scenario, it can be suggested that the target that focuses on closing
gap related to life expectancy within the generation is most relevant. According to data from
the Australian Bureau of Statistics, life expectancy for Aboriginal and Torres Strait Islander
population had been found to be 17 years less than the rest of the population, during 1996-
2001. Life expectancy for indigenous males and females was reported to be 59 and 65 years
compared to 77 and 82 years for non-indigenous counterparts respectively. According to An
Australian Government Initiative (2009) life expectancy is governed by a range of factors
like socioeconomic status, accessibility of health services, environmental factors and risk
behaviour. Type 2 diabetes has also been correlated with a decreased life expectancy, with
cardiovascular disease being the primary reason behind death (Huo et al. 2016). According
to Australian Bureau of Statistics (2016) diabetes accounted for an estimated 4770 deaths in
2016 in Australia and was considered the seven leading reason for the same. Additionally, it
was the second leading reason for death of the indigenous Australian population and
accounted for 7.8% of all Aboriginal and Torres Strait Islander deaths in 2016. Owing to the
fact that standardised mortality for death was 5 times greater for indigenous population, the
target of CTG policy is most pertinent to the case. Showing adherence to the target will
ensure that Judy does not suffer from comorbid conditions, and would thereby reduce her risk
of death, thus increasing life expectancy.
Social determinants- The three social determinants that have mediated the potential health
challenges faced by Judy are namely, unemployment, instable housing and poor
socioeconomic status. Research evidences have elucidated that lack of a stable housing is
detrimental to the wellbeing and health of an individual. People who do not have a good
housing typically have to encounter high morbidity, and are susceptible to an increased risk

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of mortality (Baker et al. 2016). Housing instability is a major issue in this case since Judy
resides alone and does not have any other person as her caregiver. This increases her chance
of falling behind on rent, moving frequently, or couch surfing. In addition, foreclosure is also
correlated with psychological issues like anxiety, depression, psychological distress and even
suicide (Alhenaidi and Huijts 2019). Owing to the fact that people suffering from diabetes
have an increased likelihood of developing psychological stress, the instable housing
circumstance of Judy made her eligible for the CTG campaign (Bădescu et al. 2016).
Moreover, diabetic foot ulcer has often been associated with a manifold increase in death
risk, when compared to non-ulcerated patients having diabetes (Walsh et al. 2016). Therefore,
the fact that Judy stays alone at her home increases the risk of improper dressing of the
wound site, which if not attended immediately, might threaten her health and safety. Though
Judy worked as a primary teacher part time and is currently retired, she had never been
employed full time. According to Farré, Fasani and Mueller (2018) lack of secure
employment can not only increase the likelihood of suffering from an illness, but also
influence the mental wellbeing of a person, thus causing poor self-esteem and depression.
Additionally, such people typically alienate themselves that leads to absence of the much
needed support, further aggravating their mental state. Judy’s recent employment status might
have resulted in inadequate food intake, clothing, heating, or harmful modifications in her
lifestyle. Furthermore, it might have also jeopardised the access to necessary healthcare
facilities by diminishing the monetary resources that are concomitant to loss of job (Meneton
et al. 2017). Owing to the fact that she is a retired personnel, she has been registered with
CTG in order to provide her unrestricted access to diabetes care amenities that will increase
her life expectancy.
Judy does not own any private vehicle and is mostly reliant on public transportation for
accessing nearby healthcare facilities. Absence of a private vehicle is a direct indicator of low

4ESSAY
socioeconomic status. Time and again poor socioeconomic status has been associated with
substantial decrease in life expectancy and is considered as a significant risk factor for poor
health and early death (Atal and Cheng 2016). Moreover, such people with poor
socioeconomic status have an increased likelihood of inferior self-reported health outcomes
and are diagnosed with more chronic illnesses. This socioeconomic status directly contributes
to transportation barriers that affects Judy’s access to health amenities. Remoteness, by its
core definition refers to restricted access to transportation that directly reduces the availability
and accessibility of healthcare services. Judy resides by herself, at a distance of 10 kilometres
from the healthcare facility. Hence, the barriers might lead to delayed or missed healthcare
appointment, poorer health outcome and a subsequent increase in health expenditure (Iimi
and Rajoela 2018). Owing to the fact that Judy requires regular monitoring and surveillance
for her health condition, enrolment in CTG policy is essential.
Registration and roles- The CTG PBS Co-payment Measure delivers low cost and/or free
medicines to indigenous people who are at a risk of chronic illnesses. Judy was initially
assessed and considered eligible for CTG if she would experience setback in management or
prevention of chronic disease, when the prescribed PBS medicines were not taken, and if she
is unlikely to continue treatment without support (Trivedi et al. 2017). The practitioner
initially discussed Judy’s current health condition and confirmed the ongoing healthcare
preferences and demands. This was followed by providing an explanation of the cost relief
benefits related to the measure. After outlining the requirements of registration, the patient’s
consent was taken. Following retrieval of Judy’s voluntary agreement, she was assisted with
the registration form and it was lodged with the CTG PBS Co-payment Measure. Aboriginal
Medical Service (AMS) was the foremost Aboriginal population governed health service and
aims to enhance the health and wellbeing standards in the indigenous communities. The AMS
will offer diabetes services to Judy and work towards quality improvement that will enhance

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both clinical outcome and delivery rates (Dutton, Stevens and Newman 2016). In contrast,
Aboriginal Liaison Officer (ALO) will provide social, emotional and cultural support to Judy
and her children at the time of using the diabetes services (McKenna et al. 2015). Since
accessing healthcare amenities can be troublesome and generate feelings of home sickness,
sadness, isolation and fear, the ALO will initiate discussions with the practitioner, increase
understanding of medical processes and routines, and facilitate participation in clinical
decision making. The ALO might be a direct employee of the AMS and together they will
promote patient engagement, visits to health centre, and coordination and delivery of
culturally competent care. The AMS referred Judy to the mainstream service for dressing
since Aboriginal Health Workers at specialist services might not be adequately trained in
removal and changing of dressings. Moreover, healthcare providers at mainstream service are
culturally competent and have the necessary expertise to select the correct sterile technique
and dressing type.
Conclusion- To conclude, multifaceted factors in the social and physical environment
create an impact on health and wellbeing. These factors are collectively referred to as social
determinants of health and can be considered as the best predictors and primary influencers of
health outcomes at the population and individual level. As inferred from research evidences,
social determinants like income, housing, access to nutritious food, educational attainment,
and access to healthcare amenities are indispensable to the onset and progress of type 2
diabetes. On analysing the case scenario, socioeconomic status, unemployment, and housing
were the three determinants that made Judy eligible for the CTG program.

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References
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United States after the Great Recession: a literature review’, Journal of Housing and
the Built Environment, pp.1-18.
Altman, J. 2018, Beyond closing the gap: Valuing diversity in Indigenous Australia,
Canberra, ACT: Centre for Aboriginal Economic Policy Research (CAEPR), The
Australian National University.
An Australian Government Initiative 2009, CLOSING THE GAP ON INDIGENOUS
DISADVANTAGE: THE CHALLENGE FOR AUSTRALIA, viewed 18 December
2019,
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Australian Bureau of Statistics 2016, 3303.0 - Causes of Death, Australia, 2016-
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depression’, Journal of medicine and life, vol.9, no.2, p.120.

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