Contemporary Indigenous Health and Wellbeing Essay, Semester 2, 2019

This essay examines the "Closing the Gap" (CTG) policy, a framework designed by the Australian government to address health and social disadvantages faced by Aboriginal and Torres Strait Islander peoples. The essay delves into the policy's history, including the data and events that led to its creation, while also acknowledging the challenges and barriers it has faced. The analysis focuses on a case study of Judy, a 57-year-old Aboriginal woman with type 2 diabetes and a leg ulcer. It explores how three key social determinants of health – socio-economic status, access to primary care, and access to nutritious food – impact Judy's condition and are addressed within the CTG policy. Furthermore, the essay discusses the potential benefits of Judy's registration on CTG, including access to healthcare facilities and support programs. The role of Aboriginal Medical Services (AMS) and Aboriginal Liaison Officers is also examined, emphasizing their importance in providing culturally appropriate healthcare and support. The essay concludes by highlighting the need for increased primary care services in remote communities to improve health outcomes for Indigenous Australians. The essay is supported by current and relevant evidence-based literature and health statistics.

Running head: CONTEMPORARY INDIGENOUS HEALTH AND WELLBEING
CONTEMPORARY INDIGENOUS HEALTH AND WELLBEING
Name of the Student
Name of the university
Author’s note

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“Closing the gap” is a strategically frame work designed by the Australian government for
reducing the disadvantages among the aboriginal and the Torres Strait Islander people, in
regards to health care access, life expectancy, rate of mortality in children, employment and
achievements in the field of education (Rudolph 2016).
In the Social justice report 2005, the commissioner of the Aboriginal and Torres Strait
Islanders urged the government of Australia for committing to achieve equality for the aboriginal
people with 25 years (Parliament of Australia, 2018).. Due to the validity of the report, the non-
governmental agencies responded to this appeal for the development of a National Indigenous
health equality campaign in the year 2006 and the closing the gap campaign was launched in the
year 2007 (Parliament of Australia, 2018).
The closing the gap policy aimed to close the gap in the life expectancy of the
aboriginals, to target that 90-92 percent of the babies born will be born with a healthy birth
weight (NACCHO, 2018). In terms of education, the policy aimed to increase the proportion of
the Aboriginals students in the top brands of the NAPLAN reading and numeracy (NACCHO,
2018). It aimed to half the gap in seeking the year 12 qualification by the aboriginal Australians.
The CTG policy promised that all the land and the waters should be restored by 2019 for
supporting the ownership of land by the aboriginal people. In spite of the policies made, and in
spite of the claims given by the government regarding the success of the policy, the Australian
government still failed to address the needs and the grievances of the aboriginal people. Some of
the lessons that have been learned from CTG policy is that in order to receive a better outcome,
the racism and discrimination needs to be reduced. Hence, racism can be called upon as a barrier

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in closing the gap policy. Secondly, measurement of the life expectancy target was difficult and
nothing can be understood about whether the life expectancy of the indigenous people have
actually increased or not. Thirdly, there is yearly reporting cycle, and the target for child
mortality no more appears on the track. Another thing that has to be noted is the difference in
need between the indigenous people living in the remote areas and those living in within the
urban settings.
Question 2
The three social determinants of health that can be related to Judy’s case study is the
socio-economic status, lack of access to primary care facilities and healthy food. It is evident
from the case study that Judy had been suffering from a diabetic ulcer and had been confined to
home, due to her restricted mobility. Judy had been working in a primary school, but had to retire
due to her restricted mobility. Managing people with complications related to diabetes are
generally provided n primary care settings (Zhao et al., 2014). In has already been mentioned in
the case study, that the primary care setting is about 10 Km away from the dwelling.
Unavailability of primary care facilities in close proximity to the aboriginal community is
another social determinants of health (Davy et al. 2016). One of the long term consequences that
might occur to Judy is that severe deterioration of the foot ulcer might lead to infection and
ultimately foot amputation. Providing the indigenous Australians with proper primary care
facilities is one of the aim of the CTG policy. This is because a significant of the aboriginals
suffers from chronic conditions that can have serious impact on the life expectancy and diabetes
is among those chronic conditions. Community controlled primary care in close proximity to the
aboriginal community needs to be constructed to provide an easier access to health care for
those, who have restricted mobility (Mitrou et al., 2016).

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Another social determinant of health in relation to Judy’s case study is the socio-
economic status (Zhao et al., 2014). Judy had been a primary teacher before, but had to retire due
to her inability to walk properly. Loss of employment might have taken an economic toll in her
life. Wound management of ulcers requires proper dressings and ointments, which incurs some
cost. Probably Judy cannot afford to call a private doctor for the checkup due to his/her huge
fees, although she knew special care. Again, as a way of managing diabetes, it is necessary to
maintain good and healthy food habits. Again, more money is required to buy fresh fruits and
vegetables and other nutritious food. Again, Judy has to travel 10 Km. Hence, she might face
difficulties to afford the transportation cost. In due time, Judy might at all stop visiting the
primary care clinic, this would worsen her health condition. As per the Australian government’s
target to achieve closing the gap in life expectancy, access to affordable health care facilities has
also been recoded (Zhao et al., 2014).
Another social determinant of health associated to Judy’s condition is the access to
nutritious food. A proper dietary habit needs to be followed in order to manage Judy’s diabetes.
Jud’s economic condition might not permit Judy to get access to nutritious food (Freeman et al.,
2017). Furthermore, crowded households in the aboriginal community may not permit the
growth of food crops. Improved nutrition and food security are fundamentally important in
‘Closing the gap’. This is because poor nutrition and chronic conditions related to diet are
accountable for the largest proportion of the ill health experienced by the aboriginals (Mitrou et
al., 2016).
Question 3
On being the registered to CTG, Judy would get several health care facilities like the free
check up or home visit by nurse or a general practitioners. It will subsidize the medications for

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chronic illnesses like diabetes (Gibson et al., 2017). Additionally, the Indigenous Australians
health program planning can be helpful for providing a patient centered care to the aboriginals.
Under this policy mainstream programs has been implemented like the Medicare Benefit
schedule, the Pharmaceutical Benefits Scheme that will provide health care insurance to the
aboriginals at a low premium (NACCHO, 2018). Under this policy, primary health care facilities
are given to aboriginal people at affordable or at low costs (Thomas et al,2014). The Australian
government have also introduced nutrition projects in the remote areas of Northern territory for
providing nutritious food to the local aboriginal people. There are also special provisions, for
aboriginal patients having restricted mobility. Community nurses and the GPs provide home
visits and follow ups free of cost.
Question 4
Roles of aboriginal medical service –Aboriginal Medical service (AMS) can be considered to
health care services that is funded by government in order to provide health care service to the
aboriginals. They are not usually community controlled and is generally run by a State or a
Territory government (NACCHO, 2018). The aboriginal medical service provides a list of
services like 24 hours emergency care, provision of life saving drugs, immunization, antenatal
care, management of chronic illness, immunization, proper screening of the diseases, a
pharmaceutical supply system and a comprehensive health care system.
Aboriginal Liaison officer- Aboriginal Liaison officers are responsible for providing emotional,
social and cultural support to the aboriginal people, while they use health care services at
hospitals or the other health care clinic. The officers helps out the patients to understand about
the various medical procedures as well as the routines. It helps the indigenous people to
participate in the decision making process of their own health (Australian government,

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Department of Prime minister, 2019). They can even make arrangements for admitting patients
in a hospital or at the time of discharge. They are also responsible for educating the aboriginal
patients about various policies and procedures that they are eligible to get and the process by
which they will get registered.
Question 5
An AMS needs to be involved in Judy’s care due to the reason that AMS can expose Judy to a
wide range of community care services like education regarding the self-management of
diabetes. The AMS might make arrangements, such that Judy can regularly get a glucose level
checkup, in order to do keep a track on her glucose levels. The community nurse can provide
home visit twice in a week for changing the dressing. Some of the other community based
services that can be introduced are physical education classes and spiritual training in order to
calm the body and the mind.
It is evident from the case study, that Judy is no longer employed and is probably facing
difficulties to make her two ends meet. A liaison officer can advocate for Judy about any
monetary facilities that Judy might get under an insurance scheme. Judy can be taught about the
different schemes that she can get herself registered or about the various referral services that can
be provided like a podiatrist or a dietician or an occupational therapist. Finally, they can also
provide psychological support to Judy.
In conclusion, it can be said that the primary care service in the remote communities
needs to be increased in number. So, that they do not have to travel long distances to get access
to these facilities.

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REFERENCES
Australian government, Department of Prime minister, 2019.Taking a holistic approach. Access
date: 24.8.2019. Retrieved from:https://www.pmc.gov.au/sites/default/files/reports/closing-the-
gap-2018/healthy-lives.html
Axelsson, P., Kukutai, T. and Kippen, R., 2016. The field of Indigenous health and the role of
colonisation and history. Journal of Population Research, 33(1), pp.1-7.
Davy, C., Harfield, S., McArthur, A., Munn, Z. and Brown, A., 2016. Access to primary health
care services for Indigenous peoples: A framework synthesis. International journal for equity in
health, 15(1), p.163.
Freeman, T., Edwards, T., Baum, F., Lawless, A., Jolley, G., Javanparast, S. and Francis, T.,
2014. Cultural respect strategies in Australian Aboriginal primary health care services: beyond
education and training of practitioners. Australian and New Zealand Journal of Public Health,
38(4), pp.355-361.
Gibson, O., Lisy, K., Davy, C., Aromataris, E., Kite, E., Lockwood, C., Riitano, D., McBride, K.
and 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), p.71.
Mitrou, F., Cooke, M., Lawrence, D., Povah, D., Mobilia, E., Guimond, E. and Zubrick, S.R.,
2014. Gaps in Indigenous disadvantage not closing: a census cohort study of social determinants
of health in Australia, Canada, and New Zealand from 1981–2006. BMC Public Health, 14(1),
p.201.

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NACCHO, 2018. Aboriginal Health. Access date: 24.8.2019. Retrieved from:
https://www.naccho.org.au/about/aboriginal-health/definitions/
Parliament of Australia, 2018. Closing the gap. Access date: 24.8.2019. Retrieved from:
https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/
pubs/BriefingBook44p/ClosingGap
Rudolph, S., 2016. The logic of history in ‘gap’discourse and related research. The Australian
Educational Researcher, 43(4), pp.437-451.
Thomas, S.L., Zhao, Y., Guthridge, S.L. and Wakerman, J., 2014. The cost‐effectiveness of
primary care for Indigenous Australians with diabetes living in remote Northern Territory
communities. Medical Journal of Australia, 200(11), pp.658-662.
Zhao, Y., Thomas, S. L., Guthridge, S. L., and Wakerman, J. 2014. Better health outcomes at
lower costs: the benefits of primary care utilisation for chronic disease management in remote
Indigenous communities in Australia's Northern Territory. BMC health services research, 14,
463.