Indigenous Health and Wellbeing: CTG Policy and Judy's Case Study

This essay examines the Closing the Gap (CTG) policy implemented by the Australian government to address health inequalities among Aboriginal and Torres Strait Islander populations. It begins with a brief overview of the CTG policy, its aims, and the data that influenced its creation, including statistics on health disparities. The essay then analyzes the case of Judy, an Aboriginal woman with a diabetic foot ulcer, exploring her social determinants of health (SDHs), such as lack of health literacy, limited healthcare access, and insufficient social support, and how the CTG policy addresses these issues. The benefits of Judy's registration under the CTG policy are discussed, including increased healthcare access, financial support, and improved disease self-management skills. The roles of the Aboriginal Medical Service (AMS) and Aboriginal Liaison Officer (ALO) are defined, highlighting their contributions to Judy's care and the relationship between these services and community health. The essay concludes by summarizing the key SDHs affecting Judy and how the CTG policy provides support to mitigate these challenges, promoting better health outcomes and access to culturally appropriate healthcare.

Running head: INDIGENOUS HEALTH AND WELLBEING
Indigenous Health and Wellbeing
Name of the Student
Name of the University
Author Note

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A significant portion of the Australian population constitutes Aboriginals and Torres
Strait Islanders and is popularly known as indigenous population of Australia. At least
787,000 Australians are indigenous as per the 2016 statistics. Of them 7.7% resides in the
remote areas and 14% resides in the very remote areas. The percentages of indigenous
population residing in remote and very remote areas are the victim of health inequalities or
health disparities. In order to address this health inequality, “Closing the Gap” (CTG) policy
was implemented by Australian Government in the year 2008 (Australian Institute of Health
and Welfare 2018). The following essay is based on the case study of Judy, an Aboriginal
woman with diabetic foot ulcer. The essay will begin with brief description of CTG policy
followed by Judy’s social determinants of health (SDHs) and how it is being addressed by
CTG. The role of ALO, AMS and community health will also be highlighted at the end of the
essay.
CTG policy aims to reduce the health inequalities among the indigenous population in
Australia. The main aim of the policy is increase the life expectancy of the overall indigenous
population, decrease in rate of childhood mortality, increase access to education for the
children and improved employment outcomes (Australian Government 2019). The policy was
implemented during 2008 under the approval of two important stakeholder, Government of
Australia and indigenous people through signing of the Indigenous health quality summit of
intent. The timeline for achieving the proposed aim was 25 years. The need for the CTG
policy evolved from several reports of health inequalities among indigenous population
coming from national and international bodies. The reports of World Health Organization
[WHO] (2019) revealed that there is a significant health disparity between indigenous
populations in Australia than that of the non-indigenous population. Australian Bureau of
Statistics (2006) reported that average life-expectancy of indigenous people is 17 years less in
comparison to non-indigenous population. High rate of infant mortality, increase rate of

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substance abuse, unhealthy yet unhygienic living conditions and high rate of occurrence of
non-communicable disease like diabetes and cardiovascular disease among the indigenous
population. On the basis of both national findings and internal criticism, the government of
Australia implemented CTG policy for its indigenous population. According to Young et al.
(2017) reduction in health disparity is important in any human race in order to up-help the
concept of comprehensive healthcare. According to Australian Parliament on behalf of Prime
minister (2019) post implementation of CTG, a significant improvement have recorded in
childhood mortality and education however, there is still a gap in achieving rest of the targets
proposed by CTG.
The long-term consequence of Judy’s health includes increase in severity of Type 2
Diabetes (T2DM), manifested by macro and microvascular complications (Zheng, Ley & Hu
2018).The SDH that is primarily responsible for Judy case is lack of health literacy. Proper
lifestyle interventions and periodic monitoring of blood glucose level (BGL) helps in
reducing the severity of T2DM however, not abiding the same leads to increase severity of
T2DM manifested by micro and macrovascular complications like in this case, it is diabetic
foot ulcer. The gap in health literacy is addressed in CTG under the aim of increased of life
expectancy of indigenous population. Amery (2017) stated that indigenous population suffers
from poor health literacy and thus lack the disease self-management skills. Arranging
community based health literacy program under the funding of CTG will help to increase the
level of health literacy and thus improving overall quality of self-care (Parliament of
Australia 2019). Judy has financial constrains as she is unemployed at present. She also has
no car of her own. Due to mobility issues she is unable to avail public transport in order to
avail healthcare service that is 10 kilo-meter away from her house. The SDH affected her is
lack of healthcare access. CTG addresses this concern by setting up local small health check-
up centres in order to conduct periodic assessment for the indigenous population (Parliament

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of Australia 2019). Third SDH is lack of social support as Judy lives alone and her son
frequently visits her. Social support of companion is important to her in order to meet her
needs of activities of daily living and proper wound dressing and management. The SDH that
is affected is lack of social support and copings kills CTG has no direct aim in order to
improve social support for indigenous population. However, getting registered under CTG
helps to provide access of AMS and ALO helping to increase the healthcare access and
thereby increasing the coping skills (Parliament of Australia 2019).
The main benefits of getting registered under CTG are increase in the provision of
healthcare access, proper financial funding for managing the healthcare needs (Fisher et al.
2017). Getting registered under CTG will help Judy to conduct routine health assessment
under the funding of CTG or under subsidised cost. This will be extremely helpful for Judy
as she is currently unemployed as since she has no car of her own, she is unable to take public
transport to healthcare because both the finance and foot ulcer create a barrier. Routine health
check-up will help Judy to track her BGL and at the same time conduct other physical
assessment. This will help in early identification of healthcare concern and helping to avoid
disease complications (Bus et al. 2016). Getting proper financial support will help Judy to
manage her diet proper along with effective management of other medication expenses.
Proper healthcare access will also help to manage her periodic wound dressing and to conduct
proper medication management (Magny-Normilus, Mawn & Dalton 2019). Getting registered
under CTG would help Judy to improve her health literacy. Development of diabetic foot
ulcer occurs during unmanaged T2DM condition and this indicates that Judy’s diabetes
management is poor. Increase in health literacy will help in improving diabetes self-
management skills (Magny-Normilus, Mawn & Dalton 2019). Moreover getting registered
under CTG will help Judy to receive culturally safe care and thus helping to increase her
overall healthcare access. This is because role of CTG is to design culturally competent care

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by working closely with the aboriginal and international and culturally competent trans-
cultural nurses (Medical Board of Australia 2019).
Aboriginal Medical Service (AMS) is special health service funded for delivering
subsidized healthcare services to the indigenous population residing in Australia. AMS is not
a community operated healthcare service and thus all AMS are not eligible to register as a
member of National Aboriginal Community Controlled Health Organisation (NACCHO) and
its other associated affiliates. Non-community operated AMS are main controlled by the state
of territory government like the one present in the Northern Territory of Australia and in the
northern part of Queensland (NACCHO 2019). Aboriginal Liaison Officer (ALO) delivers
social emotional and cultural support to the indigenous population Australia. The support is
extended for both the patients and their family members. The role of ALO mainly includes
extending their hands towards the indigenous population in order to manage their mental
health condition while they are hospitalized or suffering from severe illness. The main issues
include management of stress, anxiety, depression, sadness, isolation along with home-
sickness. ALO also assist in developing culturally safe plan for the indigenous population
(Australian Government Department of Health 2019). ALO also assists multidisciplinary
teams in order to provide primary and clinical healthcare for patients and their family
members (NSW Health Government 2019).
AMS will be important for Judy, as currently she is unemployed. Involvement of
AMS will help Judy to manage her healthcare expenses with ease and thus helping to
promote effective management of T2DM along with managing the wound dressing of foot
ulcer. Judy, an older adult, stays alone with both her son visiting frequently. Staying alone is
a threat for Judy as she is experiencing foot ulcer along with immobility and this further
increases the chance of developing accidental fall (Magny-Normilus, Mawn & Dalton 2019).
The mental support from ALO will help Judy to take proactive approach towards managing

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her own health. It will also help Judy to come across the source of several non-governmental
organizations that provide home-based care to the aboriginal older adults suffering from
physical alignments (Australian Government Department of Health 2019). ALO will also
help to design person-centered care plan for Judy via taking help from the members of
multidisciplinary team and thus increasing the access to primary care. The community-based
service that will be experienced by Judy by getting register under AMS will also help Judy to
earn social support and mental strength (Australian Government Department of Health 2019).
Thus from the above discussion it can be concluded that the mail social determinants
of health that is being affected in Judy’s case is poor health literacy, inadequate healthcare
access and minimal social support and development of coping skills. By being enrolled under
the scheme of CTG policy for the indigenous population in Australia, Judy will gain access to
proper healthcare service by mitigating the chances of financial constraints. It will also help
Judy will to increase her proper disease self-management skills. Increasing disease
management skills will help to mitigate the chance of increasing complexcity of T2DM.

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References
Amery, R., 2017, ‘Recognising the communication gap in Indigenous health care’, Medical
Journal of Australia, vol. 207, no. 1, pp.13-15.
Australian Bureau of Statistics. 2006. The People of Australia Statistics from the 2006
Census. Access date: 18th august 2019. Retrieved from:
https://www.dss.gov.au/sites/default/files/documents/01_2014/poa-2008.pdf
Australian Government Department of Health. 2019. Aboriginal Liaison Officer
(ALO).Access date: 18th august 2019. Retrieved from:
http://www.gvhealth.org.au/wp-content/uploads/Aboriginal-Liaison-Officers-
Brochure.pdf
Australian Government Department of the Prime Minister and Cabinet. 2019. Closing the
Gap. Access date: 18th august 2019. Retrieved from:
https://closingthegap.pmc.gov.au/
Australian Institute of Health and Welfare. 2018. Profile of Indigenous Australians. Viewed
on 18th August 2019: https://www.aihw.gov.au/getmedia/f29b7dd4-695a-4f9f-a508-
ecdacc52beca/aihw-aus-221-chapter-6-1.pdf.aspx
Bus, S.A., Van Netten, J.J., Lavery, L.A., Monteiro‐Soares, M., Rasmussen, A., Jubiz, Y.,
Price, P.E. & International Working Group on the Diabetic Foot (IWGDF), 2016,
‘IWGDF Guidance on the prevention of foot ulcers in at‐risk patients with diabetes’,
Diabetes/metabolism research and reviews, vol. 32, pp.16-24.

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Fisher, M., Baum, F., Kay, A. & Friel, S., 2017, ‘Are changes in Australian national primary
healthcare policy likely to promote or impede equity of access? A narrative review’,
Australian Journal of Primary Health, vol. 23, no. 3, pp.209-215.
Magny-Normilus, C., Mawn, B. & Dalton, J., 2019, ‘Self-Management of Type 2 Diabetes in
Adult Haitian Immigrants: A Qualitative Study’, Journal of Transcultural Nursing,
p.1043659619841586.
NSW Health Government. 2109. Aboriginal Liaison Officer. Access date: 18th august 2019.
Retrieved from: http://www.hnehealth.nsw.gov.au/Careers/Documents/Aboriginal
%20Liaison%20Officer.pdf
Parliament of Australia. 2019. Closing the Gap. Access date: 18th august 2019. Retrieved
from: https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/
Parliamentary_Library/pubs/BriefingBook44p/ClosingGap
World Health Organisation [WHO].2008.Australia’s disturbing health disparities set
Aboriginals apart. Access date: 18th august 2019. Retrieved from:
https://www.who.int/bulletin/volumes/86/4/08-020408/en/
Young, C., Tong, A., Gunasekera, H., Sherriff, S., Kalucy, D., Fernando, P. & Craig, J.C.,
2017, ‘Health professional and community perspectives on reducing barriers to
accessing specialist health care in metropolitan Aboriginal communities: A semi‐
structured interview study’, Journal of paediatrics and child health, vol. 53, no. 3,
pp.277-282.
Zheng, Y., Ley, S.H. & Hu, F.B., 2018, ‘Global aetiology and epidemiology of type 2
diabetes mellitus and its complications’, Nature Reviews Endocrinology, vol. 14, no.
2, p.88.

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