Factors Resulting to Health Disparity Between Indigenous Communities

This report examines the significant health disparities between indigenous and non-indigenous communities in Australia. It investigates various contributing factors, including social determinants, cultural practices, historical events like colonization and discrimination, and socioeconomic disparities such as income, poverty, and education levels. The study explores how cultural obligations, risky health behaviors (e.g., tobacco and alcohol use), and perceptions of control impact the health outcomes of indigenous populations. It utilizes an inductive research approach with qualitative methods, including interviews and questionnaires, to gather data from the Aboriginal and Torres Strait Islander communities. The research questions address the influence of culture, colonization, social factors, income, and education on health outcomes, aiming to identify the key drivers of these disparities. The findings are analyzed using content analysis to categorize and compare data, with ethical considerations to ensure adherence to scientific research standards. The report aims to highlight the challenges faced by indigenous communities and inform strategies to reduce the health gap, considering past research and interventions.

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Project Title: Factors resulting to health disparity between indigenous and non-
indigenous communities

Background of the study
There is huge disparity in health of indigenous people and the non-indigenous people
of Australia (Steenkamp, Rumbold, Barclay & Kildea,2012). Data from the ministry
of health shows that indigenous Australian shave a shorter life expectancy compared
to non-indigenous Australians. Males from indigenous communities have a life
expectancy of 10 years lesser than non-indigenous communities while the life
expectancy for indigenous females is less by 9.5 years when compared to that of other
communities in Australia. Statistics also indicate that indigenous communities have
worse general health outcomes as compared to non-indigenous populations. The
burden of disease among the Aboriginal and Torres Strait Islanders is 2.4 times more
than the average burden of disease in other communities (Hill, Sarfati, Robson &
Blakely,2013). Child mortality rates among the indigenous people is also twice as
high as compared to the non-indigenous communities. Despite the decline in child
mortality rate among the indigenous communities, there still remains a huge gap
between the health of the children in indigenous communities and those from non-
indigenous communities. Additionally, research shows that people from the
indigenous communities are 2.7 times more likely to experience psychological
distress and mental related illnesses compared to the rest of Australians (Aspin,
Brown,Jowsey,Yen & Leeder, 2012). Children of the Aboriginal and Torres Strait
Islanders are two times more likely to be born with low birth rate. Statistics also
indicates that instances of clinical diseases among the Aboriginals are more than two
times higher compared to non-indigenous communities. From the above statistics, it is
very clear that there is a huge disparity in health of the indigenous population and that
of non-indigenous populations. This study therefore aims at establishing the factors

that contribute to the huge difference in health of these two components of the
population.
According to Aspin et al (2012) , the disparity in health between these two groups of
populations is as a result of social determinants. Research indicates that Indigenous
Australians highly engage in detrimental and highly risk health behaviors. One of
such risky behavior is use of tobacco. A survey conducted by Aspin et al
(2012)indicated that approximately43.9% of Indigenous Australians were reported to
be daily smokers as opposed to a mere 15.5% of non-indigenous daily smokers. This
information indicates that the proportion of indigenous people who are daily smokers
is almost three times more than the percentage of non-indigenous Australians who
smoke daily. The use of alcohol and other drugs is also 1.8 times more than the use of
the same among non-indigenous communities. This therefore explains the high
instances of chronic respiratory diseases among this population. Merrick et al.,
(2012)indicates that there are several factors which influence the health behavior of
the indigenous people. These factors are both social, economic and cultural. Some of
these behaviour cannot be completely controlled by the indigenous people. Historical
events are identified as some of the factors that contributed to the health behavior
associated with the Aboriginal and Torres Strait Islanders. Merrick et al.,(2012) also
indicates that colonization of Australia also impacted greatly on social health
behaviors which impact on the indigenous population to date. During colonization,
the indigenous people were forced to live in reserves and missions where most of their
freedoms were restricted. This loss of liberty resulted to complete change in social
and cultural behavior and hence impacting on their healthcare.
(Mitrou et al., 2014) in his research identified culture as one of the major factors
contributing to disparity in health between the indigenous community and the non-

indigenous people. There is a strong cultural obligation towards family members
among the indigenous communities. The people in these communities consider it a
cultural obligation to provide basic commodities such as food, accommodation and
money irregardless of a person’s own situation (Mitrou et al., 2014). Many indigenous
people stated that these obligations impacted on their health since they were taking
care of a huge network of family members. This put a strain on their resources and
hence impacting their quality of life and health. The desire of the community to
preserve their cultural has sometimes interfered with the health of the indigenous
people. These is because some of their cultural practices expose the community
members to risks which leads to diseases such as diabetes and some sexually
transmitted diseases.
Lawrence,Hancock & Kisely, (2013) indicates in his research that there is a linkage
between perceptions of control and chronic stress among the indigenous communities.
The research indicated that the controls that people have over their physical
environment, dignity and their self esteem determine the health of the people. He
states that health outcomes are not merely about the availability of health facilities,
doctors and medicines (Durey & Thompson, 2012). The community needs to be
empowered and given control over their resources in order to improve their health. An
individual’s lack of control of contributed to stress and mental health issues among
the indigenous communities (Paradies & Cunningham, 2012). The people have felt
discriminated over the years and they do not have control of any resources despite the
fact that they were the first people to occupy Australia.
Despite the past atrocities committed during the colonial times, continued
discrimination even after colonization has impacted on the health care of the
indigenous communities (Gracey, 2014). Indigenous Australians have not been able to

access education as compared to non-indigenous Australians. Most of the indigenous
people do not have sufficient education because they have not had opportunities to go
to school like other communities (Paradies, 2016). This has impacted their knowledge
on how to take care of their health as well as hygiene. Discrimination and poverty has
also resulted to high levels of unemployment among indigenous people.
Unemployment among indigenous people stands at 17% while it is at 5% among the
non-indigenous communities (Ewen, Mazel & Knoche, 2012). These social and
economic disadvantages have greatly impacted the healthcare of the indigenous
people (Jorm, Bourchier, Cvetkovski & Stewart, 2012). This is because
unemployment means that most people in this community will not afford quality
healthcare services. This is because they do not have much disposable income which
they can spend on healthcare. Economic disadvantage of the Aboriginal and Torres
Strait Islanders means that there are fewer health facilities in the region. This makes it
difficult for the people to access high quality healthcare.
Research Questions
Does culture contribute to disparity in health between the Indigenous communities
and non-indigenous communities?
Does colonization and discrimination contribute to disparity in health?
How does a social factor impact on the health of the indigenous people?
Does the difference in income and poverty level contribute to disparity in health
between indigenous and non-indigenous communities?

Does education contribute to the gap in health outcomes between the indigenous and
non-indigenous communities?
Aims and objectives of the study
 To identify the impact that colonization and discrimination has on the health of
the indigenous people
 To determine whether culture of the indigenous communities contributes to the
disparity in health between the indigenous and non-indigenous communities.
 To discover if education has an impact on the differences in health outcomes
between the indigenous communities and non-indigenous communities
 To determine whether high levels of poverty contributes in the disparity in health
between the indigenous and non-indigenous communities.
Significance and innovation of the proposed study
Since colonialism, there has existed a huge difference in health between indigenous
communities living in Australia and non-indigenous communities. The indigenous
communities have been discriminated against for many years and they have suffered
racism for so long. This discrimination has been reflected in the health of the
Aboriginal and Torres Strait Islanders. People living in these communities have high
prevalence and incidences of many diseases when compared to other communities
living in Australia. Research conducted over the years has also indicated that as a
result of poor health in this community, child mortality rate is more than three times
higher among the Aboriginal than among non-indigenous communities. Life
expectancy of the Aboriginal is on average less by 10 years when compared to life
expectancy of non-indigenous communities living in Australia. Chronic diseases are

also more common among the indigenous people and they have contributed to the
death and suffering of many people in this community. The government and the non-
governmental organizations have carried out various programs over the decades with
the aim of reducing this disparity. Major efforts have been made in improving the
health of the indigenous communities but there still remains a very huge difference in
health outcomes between the two populations under review. This research is therefore
conducted to identify the factors that still contribute to the high disparity in health
between the indigenous and non-indigenous communities despite the research and
investment that has been put in place to close this gap.
Research outcomes/hypothesis
Culture of the indigenous communities increases disparity in health between the
indigenous and non-indigenous communities
Colonization and discrimination is one of the factors contributing to huge differences
in health of the indigenous and non-indigenous people.
Low levels of income and poverty among the Aboriginal and Torres Strait Islanders
contributes to differences in health between the indigenous and non-indigenous
communities.
Research plan/methodology
Research approach
This research uses inductive research approach. The research begins with a particular
observation which is used to make general observations on the theory. This approach
is important because it takes into account the context where there is active research
effort.This research is carried out using qualitative research methods. This means that

the data presented in this study is description in nature and there is less of numerical
values in this research.
Data collection methods and tools
The data collection for this study was done by interviewing people from the
Aboriginal and Torres Island with a value of determining whether the hypothesis
listed above are true. In depth interviews are personal and unstructured and they help
to identify the emotions, views, feelings, and opinions of a person about a particular
subject. Data for this study was also collected using the sample size used for this
study is 30 representative from different social and economic backgrounds in the
Aboriginal community (Moore et al., 2012). The research also used semi-structured
questionnaires to collect data from participants. Some questions are prepared were
help in fulfilling the objectives of study. The following are the sample questions for
the research:
1. What do you feel about your level of healthcare as a person from the Aboriginal
community compared to other people in Australia?
2. How do you think colonization and discrimination has impacted on your health as a
community over the years?
3. Do you think that social factors impact on your health behavior?
4. In what way do you think that your health behavior impacts upon your health?
5. What is the impact of income level and economic status on your health as an
individual?
6. Is there easy access of healthcare services in your region?

Sample selection
The sample for this study was chosen using sample random sampling. Members of the
indigenous community were selected and grouped together. After this, the population
sample was selected using simple random sampling.
Data analysis
Content analysis is the method of data analysis used for this research. This method is
very effective for analyzing data collected using interviews and questionnaires. The
data is categorized into themes and sub-themes and then it is analyzed and compared.
The advantage of content analysis is that it helps in data collected being reduced and
simplified while at the same time producing amazing results (Möller, Falster, Ivers &
Jorm, 2015). Content analysis also helps researchers to structure the data collected in
a manner that helps the researcher accomplish research objectives.
Ethical consideration
This study is subjected to ethics in order to ensure that it adheres to all the standards
of scientific research. Before the participants were interviewed, they were required to
write and sign an acceptance letter to confirm that they were willing to participate in
the study. This was to ensure that the participants felt that the participation was
completely voluntary. The culture and social factors that are dear to the indigenous
community were respected. The communities use of traditional medicine was
respected and acknowledged when carrying out this study (Jamieson et al.,
2012).Additionally, permissions for conducting the study were sought before the
commencement of the study.

Study limitations
The following are the limitations encountered during this research:
 The sample size of the study is not so big given that the population under research
is so huge. Using a bigger sample size would have enhanced reliability of the
data.
 Qualitative research makes it difficult to accurately measure some variables.
 There was a challenge in translation since there may be some information which
was lost during translation
Study Administration
The following was the budget for the study:
Expenditure description Cost($)
Research assistant 2000
Practitioner 1800
Transcriber 1560
Digital voice recorder 240
Laptop and projector 1530
Telephone 1100

Venue hiring fee 200
Travelling 1900
Accommodation 4500
Stationery 680
Total 15,510
Time Schedule
Duration Activity
Jan2019-Feb 2019 Acceptance of the research proposal
Feb 2019-June 2019 Meeting and communicating with local
representatives
July 2019-Oct 2019 Development of Research tools
Oct 2019-Jan 2020 Sample selection and community
engagement
Jan 2020-Feb 2020 Training and enumerator
Feb 2020-March 2020 Validation of equipment
April 2020-Aug 2020 Data collection
Sep 2020- Oct 2020 Data entry and analysis

Nov 2020-Feb 2020 Thesis and report writing
March 2020 Report presentation
References

Aspin, C., Brown, N., Jowsey, T., Yen, L., & Leeder, S. (2012). Strategic approaches
to enhanced health service delivery for Aboriginal and Torres Strait Islander
people with chronic illness: a qualitative study. BMC health services research,
12(1), 143.
Durey, A., & Thompson, S. C. (2012). Reducing the health disparities of Indigenous
Australians: time to change focus. BMC health services research, 12(1), 151.
Ewen, S., Mazel, O., & Knoche, D. (2012). Exposing the hidden curriculum
influencing medical education on the health of Indigenous people in Australia
and New Zealand: the role of the critical reflection tool. Academic Medicine,
87(2), 200-205.
Gracey, M. (2014). Why closing the Aboriginal health gap is so elusive. Internal
medicine journal, 44(11), 1141-1143.
Hill, S., Sarfati, D., Robson, B., & Blakely, T. (2013). Indigenous inequalities in
cancer: what role for health care?. ANZ journal of surgery, 83(1-2), 36-41.
Jamieson, L. M., Paradies, Y. C., Eades, S., Chong, A., Maple-Brown, L. J., Morris,
P. S., ... & Brown, A. (2012). Ten principles relevant to health research among
Indigenous Australian populations. Medical Journal of Australia, 197(1), 16-
18.
Jorm, A. F., Bourchier, S. J., Cvetkovski, S., & Stewart, G. (2012). Mental health of
Indigenous Australians: a review of findings from community surveys.
Medical Journal of Australia, 196(2), 118-121.

Lawrence, D., Hancock, K. J., & Kisely, S. (2013). The gap in life expectancy from
preventable physical illness in psychiatric patients in Western Australia:
retrospective analysis of population based registers. Bmj, 346, f2539.
Merrick, J., Chong, A., Parker, E., Roberts-Thomson, K., Misan, G., Spencer, J., ... &
Jamieson, L. (2012). Reducing disease burden and health inequalities arising
from chronic disease among Indigenous children: an early childhood caries
intervention. BMC Public Health, 12(1), 323.
Mitrou, F., Cooke, M., Lawrence, D., Povah, D., Mobilia, E., Guimond, E., &
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), 201.
Möller, H., Falster, K., Ivers, R., & Jorm, L. (2015). Inequalities in unintentional
injuries between indigenous and non-indigenous children: a systematic review.
Injury prevention, 21(e1), e144-e152.
Moore, H. C., Lehmann, D., de Klerk, N., Jacoby, P., & Richmond, P. C. (2012).
Reduction in disparity for pneumonia hospitalisations between Australian
Indigenous and non-Indigenous children. J Epidemiol Community Health,
66(6), 489-494.
Paradies, Y. (2016). Colonisation, racism and indigenous health. Journal of
Population Research, 33(1), 83-96.
Paradies, Y. C., & Cunningham, J. (2012). The DRUID study: Exploring mediating
pathways between racism and depressive symptoms among Indigenous
Australians. Social psychiatry and psychiatric epidemiology, 47(2), 165-173.

Steenkamp, M., Rumbold, A., Barclay, L., & Kildea, S. (2012). A population-based
investigation into inequalities amongst Indigenous mothers and newborns by
place of residence in the Northern Territory, Australia. BMC pregnancy and
childbirth, 12(1), 44.