TOPIC
Good health is the right of
all Australians. How does the state of Aboriginal health care relate to that of
non-Indigenous Australians? Why is this so and how can this situation be addressed so that
there is parity across all segments of Australian society? Discuss.
'Good health is not just the physical wellbeing of an
individual, but the social, emotional, and cultural wellbeing of the whole community in
which each individual is able to achieve their full potential as a human being thereby
bringing about the total wellbeing of their community'. (Anderson, 2000, para. 6)
If we take Anderson's view as the definition of good
health, then the fact that an Indigenous baby raised in an Aboriginal community can expect
to live 20 years less than other babies strongly indicates that the relative health status
of Australia's Indigenous population is indeed much poorer than that of the rest of the
Australian population (Merston, 1999, p.32). This is largely due to inadequate living
conditions, lifestyle, lack of education and employment, and historical conditions. To
improve the health status of Australia's Indigenous population, the government not only
needs to allocate more funds to health services and the improvement of overall living
conditions, but also to investigate ways in which health services can be offered to better
reflect the cultural needs of this group.
Indigenous Australians suffer a higher amount of illness
and die at a younger age than non-Indigenous Australians. Available data shows that life
expectancies in 1992-94 for Aboriginal and Torres Strait Islander men and women were 15 to
20 years below those of other Australians. This lower life expectancy is, in large part, a
consequence of the mortality rates of Aboriginal people aged 25 to 54 years. These rates
are five to seven times higher than for other Australians within the same age category.
The major causes of excess mortality are circulatory conditions which in 1997 accounted
for 26 percent of deaths, injury and poisoning (6 percent), respiratory conditions (15
percent), and endocrine conditions, largely diabetes, (10 percent) (AMA Report, 1997,
p.78). Similarly, despite significant declines over the past two to three decades,
Aboriginal infant mortality rates remain typically about three times higher than the rates
for non-Aboriginal infants. Also recorded deaths from diabetes rose rapidly in men in the
late 1980s. Aboriginal and Torres Strait Islander death rates from diabetes in 1992-94
were 12 times higher for men and nearly 17 times higher for women than rates for other
Australians. Indigenous people are also 15-18 times more likely to die from infectious
diseases than their non-Indigenous counterparts (Merton, 1999, p31). Respiratory disease
and injuries resulting from violence are significantly higher, and problems associated
with drinking and smoking are responsible for one in three hospital admissions for
Indigenous men. Indigenous people suffer significantly more illnesses and infectious
diseases than the rest of Australians. There is no doubt that the health status of
Aboriginal people is far lower than that of other Australians.
Poverty, coupled with living in remote locations,
contributes significantly to the poor health of the Indigenous population. Making healthy
food choices is more difficult in remote areas than in other areas of Australia because of
the limited availability of fresh food and the high costs. Food costs in remote areas may
range from150-180 percent of capital city prices. High costs of food are due primarily to
high transport costs - in some places, freight charges may add more than $2 per kilogram
to the price of the food. The availability and affordability of nutritious foods in remote
areas of Australia is a problem for both Indigenous and non-Indigenous people. However,
the social and economic status of many Indigenous people means that they are even more
likely than non-Indigenous people to be affected. Expensive foods and low incomes mean
that the food budget can represent from 56 percent to 89 percent of total household income
among Indigenous people in remote areas, compared with a national average of 18 percent
(George, 1996, para. 6).
The food choices of Indigenous people are heavily
influenced by problems with (or a lack of) electricity, gas, water supply, cooking
appliances and refrigeration. Thus, convenience foods are often chosen over fruits and
vegetables, as they require little or no preparation and many do not require refrigerated
storage. McKenzie (1997) cited in George (1999) states that a diet based heavily on
convenience foods impacts significantly on the health of Aboriginal and Torres Strait
Islander people, predisposing many of them to diet-related conditions such as obesity,
diabetes, cardiovascular disease and stroke (George, 1999, para. 9).
Poverty also results in poor living conditions that further
contribute to the poor health of Indigenous people. Thirty percent of Indigenous people
are living in private dwellings that are unacceptable due to overcrowding, lack of repairs
and the poor state of basic facilities (Smail, Jullen, Magee, and Temple 1998, pp.6-7). In
rural areas, there is a lack of toilets, absence of gas or electricity, and no running
water for baths or showers. Sixty nine percent of Indigenous households live in rented
premises compared with 27 percent of all Australians. (AMA Report, 1997, p.80). Many
Indigenous people share a house - 4.1 percent of Indigenous people compared to 2.6 percent
of non-Indigenous people (Smail et al, 1998, p.10). Such conditions lead to more illness
and infectious disease in Aboriginal communities.
Another contributing factor to poor health is the major
changes in the lives of Indigenous people after colonisation. Australia's colonial
administrators separated Indigenous people from their land. They were forced to live on
reserves, missions and government settlements. As well as losing contact with their
families, they were precluded from living their traditional way of life, including
learning about and accessing their natural healing practices. This, coupled with resulting
low self-esteem and a sense of hopelessness, contributed to their taking up threatening
lifestyle practices (NHMRC, Dec, 1996, p.4).
Larger proportions of Indigenous people take up
life-threatening habits such as smoking at a younger age (Ferrari, April 1999, p11).
Almost three-fifths (58 percent) of Indigenous people aged 13 years and older reported
alcohol use as one of the main health problems in their local area. The next most
frequently perceived health problems were drugs (30 percent), diabetes (22 percent),
diet/nutrition (19 percent) and heart problems (14 percent) (ABS, 1966). The risks
associated with smoking are not well understood by Indigenous people. Ferrari (Ferrari,
April 1999, p12) found that one in three Aborigines surveyed believed it was safe to smoke
a packet of cigarettes a day. According to Ferrari's studies, Indigenous people also take
up drinking at an earlier age than non-Indigenous people. Contrary to popular opinion, by
comparison, fewer Aborigines drink alcohol than non-Indigenous people with one in three
being drinkers compared to 45 percent of non-Indigenous people (ibid). However, those
Indigenous people who do drink are more likely to drink in hazardous quantities.
If it is so apparent that there is such a disparity between
Indigenous and non-Indigenous Australians' health then health monies need to be
apportioned accordingly. Despite popular opinion, 30 percent less is spent on Aboriginal
health per capita than on the health of the non-Indigenous populations (Ferrari, April
1999, p 15). But the far greater reason for the seemingly ineffective efforts of
government at all levels to redress the health issue is the way that the money is managed.
This is one of the underlying causes for continued poor health of Aborigines. Stephenie
Bell (Acting Director, Central Australian Aboriginal Congress) in a paper presented to the
'Aboriginal Health: social and cultural transitions' Conference, Darwin, spoke on behalf
of Indigenous people stating that the non-Aboriginal bureaucratic culture is a very
'top-down' model of problem solving and as such has failed the Aboriginal people:
The decision-making power lies not with communities, the
traditional and preferred arbitrators and proponents of change, but instead with distant
and so inherently irrelevant government bureaucracies. This is seen to be true even if the
bureaucracy is (was) ASTIC (1995, para. 8).
To address the problems of poor health in our Indigenous
population, we need to attack the underlying causes of poverty, address the lack of health
education and promotion, and restructure the administration of funds in a targeted and
culturally relevant manner. Successive governments have grappled with the task of
providing adequate health services to Indigenous people where the culture and lifestyles
are often so different from non-Indigenous people. Effective provision of services in
remote communities adds an additional geographic challenge. During the 1970s, Aboriginal
community-controlled health services emerged as an Aboriginal community response to this
problem. These services created a model for primary health care delivery that embedded the
principles of self-determination within health care delivery structures.
Self-determination remains a central plank within the framework for Aboriginal health
policy and strategy. It is also crucial that commitment to self-determination is not seen
as an excuse for the mainstream health system to abdicate its responsibility in Aboriginal
health. 'Self-determination and shared responsibility are not mutually incompatible'
(Bell, 1995, para. 14).
Short term and long term targets need to be set. The
immediate targets need to be designed to tackle the main diseases and conditions causing
untimely death among Aboriginal people including: reducing the prevalence of the main
causes of excess Aboriginal mortality - diabetes, cardiovascular disease, respiratory
disease, cervical cancer and injury/poisoning; increasing immunisation and vaccination
coverage for key conditions; and reducing the prevalence of smoking, obesity and dangerous
levels of alcohol consumption. In the long term, the problems of under-employment, lower
educational levels and low self esteem need to be targeted by government policy, through
greater allocation of funds to specific, relevant and proven successful programs, and by
the national recognition of the past to enable the growth of self determination and
cultural pride. Likewise, we must invest in human resources to make this strategy happen.
A well trained, culturally sensitive, financially rewarded workforce, complemented by
linkages with specialist medical services, is essential if this plan is to work. The need
for a skilled workforce is the way to long-term sustainability. Primary health care
services need to continually be aware of what needs to happen and be equipped to respond
(Anderson, 2000, para.12).
The structure to best effect this is one that incorporates
a bottom up approach. Bell points out that the Commonwealth Health Department bureaucracy
is not the authority on matters of the health of Aboriginal people and, if there are any
such things as "experts" in Aboriginal health, they are the Aboriginal
community-controlled health services:
These services are intimately linked to the community they
serve, by history, by culture, and by management. Staffed by, and under the day-to-day
control of their community, they have been recognised by the National Aboriginal Health
Strategy and the Royal Commission into Aboriginal Deaths In Custody as the voices of our
people. They are the only organisations that can effectively address the health problems
of our people. (Sept 1995, para. 5)
To build effective Aboriginal health organisations means
putting the emphasis on local and regional structures first, national ones second.
The low health status of Indigenous people,
especially compared to the health of the wider Australian community, is a national and
international disgrace. There are no quick fixes - it may take years to see appreciable
improvements - but the framework needs to be laid to make change happen. Addressing the
issues underpinning this situation is fundamental not only to achieving equity in health
outcomes for Aboriginal people but is central to achieving a sustainable quality of life
within all our Australian communities.
References
Australian Medical Association 1999, AMA Report, Aus Med
Volume 13, Number 21
Anderson, I. Sept 24, 1977, Overview of Indigenous
health status in Australia.
Shortened version of speech given by Dr Ian Anderson, Medical Adviser to the Office for
Aboriginal and Torres Strait Islander Health Services, Commonwealth Department of Health
and Family Services, to the World Health Organisation's Regional Committee for the Western
Pacific. Retrieved November 2001 from the World Wide Web: www.healthinfonet.ecu.edu.au
Australian Bureau of Statistics 1996, National
Aboriginal and Torres Strait Islander survey 1994: health of Indigenous Australians (Catalogue
No. 4395.0). Australian Bureau of Statistics, Canberra.
Bell, S. September 1995, Building Aboriginal Health from
the ground upwa rds.Paper presented to the "Aboriginal Health: social and
cultural transitions" Conference, Darwin. Retrieved November 2001 from the World Wide
Web: www.healthinfonet.ecu.edu.au
Ferreri, J. (April 1999), Distributing the health wealth, The
Medical Journal ofAustralia, 176, 743-746.
George K L (1996), Community stores and the promotion of
health: an assessment of community stores and their functions in the promotion of health
in Aboriginal communities, Health Department of Western Australia, Perth (Nanga
Services Pty Ltd.).
Merston, J. 1999, Bad Health, Bad Practice, Collins,
Sydney.
National Health and Medical Research Council Dec.1999 NHMRC
Report1999, Vol 34 No 7, 31 - 39
Smail P., Jullen, S., Magee, T. & Temple, M. B. 1998, Factors
underpinning Indigenous Health (2nd Ed.) Rodin, Melbourne.