What are the key factors contributing to the Australian Aboriginal health crisis?
In Australia, aboriginal people are still having a considerably shorter life expectancy and experience a significantly higher burden of ill-health and disability throughout their life course (Tsey, Whiteside, Haswell-Elkins, Bainbridge, Cadet-James & Wilson, 2010). In Australian, just like every other developed nation, on average the population enjoys a longer life expectancy and live healthier lives, but this is only for the non-indigenous people. The difference in health situation between the indigenous (Aboriginal and Torres Strait Islander) and the non-indigenous has been attributed to various factors which include socio-political, historical, intermediate, and distal. Literature on the topic in replete with materials from various authors and almost each has used a different categorization of the factors contributing to the health crisis for the Australian indigenous people. This essay seeks to discuss the key factors that are contributing to the Australian aboriginal health crisis. The essay will be focussed on socio-political factors based on the argument that, the majority of the factors related to aboriginal health crisis fall into this category (World Health Organization (WHO) 2003). This will be done through review of various available literature materials on the topic.
Background on aboriginal health situation
According to Scrimgeour and Scrimgeour (2007), the start and the most of socio-political factors contributing to the aboriginal health crisis is partly attributed to the historical effects of colonization that caused the erosion of traditional ways of life, culture, and self determination of the aboriginal population. Some of these acts perpetuated by the colonial administration whose consequences affect the current health situation of the aborigines include racism, marginalization from the society, discrimination, and ongoing forced removal of children from their aboriginal families (Lee, Griffiths, Glossop and Eapen, 2010). The effects of these acts are on the emotional, social, and physical wellbeing of aboriginal people. According to the Australian Bureau of Statistics (ABS) (2010a), data shows that the life expectancy of aboriginal people at birth is 67.2 years for males and 72.9 years for females; and this is short by 11.5 years and 9.7 years respectively for the average life expectancy at birth for the non-aboriginal population.
According to Vos, Baker, Stanley and Lopez (2007), the if disease and injury burden for the aboriginal people was at the same rate as that of the non-aboriginal people, then 59% of the total disease and injury burden among the aboriginal population could be eliminated. The evident health gap between the aborigines and the non-aborigines is primarily from non-communicable diseases and they occurred mainly among the middle aged generation (35-54 years) (Begg, Vos, Barker, Stevenson, Stanley & Lopez, 2007). The health gap is as a result of certain risk factors and according to Vos et al. (2007); they include tobacco, high body mass index (BMI), high blood cholesterol, physical inactivity, and consuming alcohol.
According to Tsey et al. (2010), in 2002, the aboriginal people in Australia were less than half as likely a non-aboriginal person to have attended and successfully completed a post-secondary educational qualification of certificate level 3 and above. This level includes a post-graduate degree, graduate diploma or certificate, a bachelors degree, advanced diploma, certificate and diploma levels 3 and 4. At the national level, in 2004, aboriginal students on average were half as likely as a non-aboriginal student to continue to year 12 (Hallett, Chandler & Lalonde, 2007). It is therefore evident that the aboriginal population has a small percentage in the mainstream education. Compared to the non-aboriginal population, the aboriginal people are less educated, and this is considered to be one of the factors contributing to the aboriginal health crisis.
Education according to Couzos (2004) is a component of the social economic status and it determines health through various ways. For example, for the uneducated aboriginal people, they experience poor literacy which then affects their ability to acquire information on the appropriate and proper nutrition or the right preparation of healthy food. The other effect of low and inadequate education is that it greatly reduces the skills of human resource therefore making it hard for one to secure a vacancy in the labour market and if they do, they often get low paying jobs. As a result of inadequate or low education, one is plunged into poverty and experiences social exclusion, and these are both experienced disproportionately by the aboriginal people and they increase family instability (Lee, Griffiths, Glossop & Eapen, 2010). This has a high probability of resulting to a vicious cycle of poverty which further causes school dropout, further diminishes the literacy level, and employability of aboriginal people.
The entire medical process from diagnosis to treatment of diseases in the mainstream healthcare system requires a literate person. The inadequate education levels among the aboriginal, especially the rural and elderly members of the aboriginal community is a major factors causing the aboriginal health crisis (AHMAC, 2012). The majority of these people don’t understand early diagnosis and may avoid seeking health care not until diseases are at critical levels. Moreover, due to the knowledge and communication gap due to low literary level, it is hard to communicate the symptoms with healthcare providers. In addition to this, the lack of many aboriginal healthcare practitioners in the healthcare system, has lead the aboriginal community to regard the system as foreign and therefore, not for them hence, some will shun healthcare interventions and prefer the native medicine provided by native doctors (Centre for Epidemiology and Research, 2010).
- Employment and income
As per the 2001 census, on average, the generalised gross household income for aboriginal people was $364 per week, which is 62% of the non-indigenous weekly income of $585 (Andrews & Slade, 2001). According to AIHW (2004), the levels of income broadly decline with increasing geographic remoteness; at 70% of the corresponding income for non-aboriginal people in major urban areas to 60% in remote areas, and about 40% at the very remote and areas. In terms of employment, in 2001 52% of aboriginal people with the age of 15 years and above were active in the labour market. The rates of participation in the labour market for aboriginal communities declined with remoteness with 57% in the major cities, and 46% in the very remote areas of the commonwealth. At the same period, the unemployment rate for aboriginal people was at 20%. This was three times higher than the unemployment rate of the non-aboriginal Australians (Gubhaju, McNamara, Banks, Joshy, Raphael, Williamson & Eades, 2013). Moreover, one in every six aboriginal people who are classified as employed is working in Community Development Employment Projects (EDEP).
Employment and income for the Australian aboriginal population is a socio-economic element that has been affected through colonization, systemic racisms and discrimination where aboriginal people are denied access to resources and conditions that are necessary for improvement of their social economic status. Based on the statistics presented above, it is clear and convincing that aboriginal communities are ranked lower in the economic ladder (Clelland, Gould & Parker, 2007). The direct effect of low income is poor housing, low literacy, and meagre community economic resources. The main consequence of poverty to the aboriginal health crisis is lack or insufficiency of material resources which include nutritious foods, continuous consumption of the appropriate foods, and inhibited access to high quality care.
Poverty is also linked to low social cohesion, social exclusion, and increased crime which are a combination for health crisis and injury. More importantly, poverty creates lack of control due anxiety, a feeling of hopelessness, insecurity, and low self esteem that results. The combination of these factors, mainly psychological stresses, have been linked to violence, poor parenting, lack of social support, and addictions, all which an accumulation that often leads to poor health especially in mental health and increased vulnerability to such ailments like high blood pressure, depression, and suicide (Nagel, Robinson, Condon & Trauer, 2009). Poverty also been attributed to being the major cause of substance abuse among the aboriginal population.
- Remoteness and health of indigenous Australians
According to studies (AIHW, 2004; Australian Bureau of Statistics and the Australian Institute of Health and Welfare, 1997; Australian Bureau of Statistics, 2010b; De Leo, Milner & Sveticic, 2012), aboriginal Australians living in the remote areas of the commonwealth have a higher risk to ill health behaviour for example smoking, poor access to healthcare, and experience health compared to persons living in regional and metropolitan areas. According to De Leo et al. (2012), poor health conditions increase with increasing remoteness and these may be linked to geographical or environmental facts which may include long distances from healthcare centres, aboriginal communities being cut off on occasional basis because of flooding. As stated by Galloway & Moylan (2005), the differences in the health situation between aboriginal and non-aboriginal communities are also attributed to the characteristics of the populations in the very remote areas. For instance, the association between socioeconomic status and health is strong, i.e. the lower an individual’s socioeconomic status is, the worse their health is and vice versa.
Remoteness and health is more pronounced for aboriginal people as the majority of indigenous Australians live outside the metropolitan areas as compared to the non-indigenous Australian population (Andrews Slade, 2001). In 2011, the number of indigenous Australians living in the major cities was just about a-third (34.8%) compared to the 70% of non-indigenous Australians. On the other hand, only 1.7% of non-indigenous Australians lived in remote areas of the commonwealth compared to the about a fifth of indigenous Australians (7.7% in remote areas and 13.7% in very remote areas) (AHMAC, 2012; Gubhaju et al., 2013). According to statistics, indigenous Australians living in remote and very remote areas of the country are 16% and 45% respectively of the population living in these areas.
- Access to health care
As argued by World Health Organization (WHO) (2003), the health gap between aboriginal and non-aboriginal populations is as a consequence of poor access to effective heath serves on a timely manner. According to AHMAC (2012), the reason that are given by aboriginal people for not using the mainstream healthcare include long waiting time, care not being available at the time requested, unavailability of health services in their local areas, long distance and transport issued, being unable to afford health services, and health care provided in hospitals being not in line with their culture. These factors therefore contribute by restricting aboriginal people from accessing health services, for example, aboriginal people in the very remote areas where there are no hospitals are restricted to seek and access healthcare in a timely and effective manner.
Poorer access to health services by aboriginal people has been indicated as being a factor underlying the relatively high rate of hospitalizations that are potentially preventable (AIHW, 2004; Centre for Epidemiology and Research, 2010). From 2010 to 2012, aboriginal people were 3.5 times more likely to be hospitalised for potential preventable scenario as compared to the non-aboriginal population (Gubhaju et al., 2013). In addition, aboriginal Australians are less likely to get a medical procedure recorded during a visit to a healthcare facility.
Access to health care is also affected by other factors that are not restrictive, but rather diverging. Among these in access to traditionally right conditions, for example access to traditional land that has food, shelter, and water (Tsey et al., 2010). This is common among aboriginal people who are living in the very remote areas, are illiterate, and are highly sceptical of the mainstream health care system. Ordinarily and as argued by Galloway & Moylan (2005), aboriginal people believe that they are responsible of their health and that, whenever they suffer from a disease, they need to rectify their living or visit a traditional healer. An example of this belief is in the behaviour of elderly persons seeking to be returned to their homes during their last days.
Aboriginal people in Australia are less than half as likely a non-aboriginal people to have attended and successfully completed a post-secondary educational qualification of certificate level 3 and above. Poor literacy affects ability to acquire information on the appropriate and proper nutrition or the right preparation of healthy food and unawareness of the medical procedure from diagnosis to treatment. Employment and income for the Australian aboriginal population is low and it is the main consequence of poverty to the aboriginal health crisis is lack or insufficiency of material resources which include nutritious foods, continuous consumption of the appropriate foods, and inhibited access to high quality care. Aboriginal Australians living in the remote areas of the commonwealth have a higher risk to ill health behaviour for example smoking, poor access to healthcare, and experience health compared to persons living in regional and metropolitan areas. Poor access to effective heath serves on a timely manner is the reason given by aboriginal people for not using the mainstream healthcare. Poorer access to health services by aboriginal people has been indicated as being a factor underlying the relatively high rate of hospitalizations that are potentially preventable.
- AHMAC (Australian Health Ministers’ Advisory Council), (2012). Aboriginal and Torres Strait Islander Health Performance Framework 2012 Report. Canberra: AHMAC.
- Andrews, G. & Slade, T. (2001). Interpreting scores on the Kessler Psychological Distress Scale (K10). Aust N Z J Public Health, 25(6):494–497.
- Australian Bureau of Statistics (ABS), (2010a). Demographic, social and economic characteristics overview: life expectancy, No. 4704. Canberra.
- Australian Bureau of Statistics and the Australian Institute of Health and Welfare, (1997). The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples. Canberra: Australian Bureau of Statistics. Report No. Cat. No. 4704.0.
- Australian Bureau of Statistics, (2010b). The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples, Oct 2010. (ABS Catalogue no 4704.0) Canberra: Australian Bureau of Statistics
- Australian Institute of Health and Welfare (AIHW) (2004). Rural, regional and remote health: a guide to remoteness classification, Cat. no. PHE 53. Canberra: AIHW.
- Begg, S., Vos, T., Barker, B., Stevenson, C., Stanley, L. & Lopez, A. (2007). The burden of disease and injury in Australia 2003. (AIHW cat. no. PHE 82) Canberra: Australian Institute of Health and Welfare
- Centre for Epidemiology and Research, (2010). 2006–2009 Report on Adult Aboriginal Health from the New South Wales Population Health Survey. Sydney: NSW Department of Health.
- Clelland, N.A., Gould, P.M. & Parker, E.A. (2007). Searching for evidence: what works in Indigenous mental health promotion? Health Promotion Journal of Australia 18(3):208–16.
- Couzos, S. (2004). Practical measures that improve human rights -Towards health equity for Aboriginal children. Health Promotion Journal of Australia. 15:186-92
- De Leo, D., Milner, A. & Sveticic, J. (2012). Mental disorders and communication of intent to die in Indigenous suicide cases, Queensland, Australia. Suicide and Life-Threatening Behavior 42(2):136–46.
- Galloway, G. & Moylan, R. (2005). Mungalli Falls indigenous women’s healing camp. International Journal of Narrative Therapy and Community Work 2(3–4):77–88.
- Gubhaju, L., McNamara, B. J., Banks, E., Joshy, G., Raphael, B., Williamson, A., & Eades, S. J. (2013). The overall health and risk factor profile of Australian Aboriginal and Torres Strait Islander participants from the 45 and up study.BMC Public Health, 13(1), 1-14. doi:10.1186/1471-2458-13-661
- Hallett, D., Chandler, M.J. & Lalonde, C.E. (2007). Aboriginal language knowledge and youth suicide. Cognitive Development 22(3):392–9.
- Lee, L., Griffiths, C., Glossop, P. & Eapen, V. (2010). The Boomerangs Parenting Program for Aboriginal parents and their young children. Australasian Psychiatry 18(6):527–33.
- Nagel, T., Robinson, G., Condon, J. & Trauer, T. (2009). Approach to treatment of mental illness and substance dependence in remote Indigenous communities: results of a mixed methods study. Australian Journal of Rural Health 17:174–82.
- Scrimgeour, M. & Scrimgeour, D. (2007). Health Care Access for Aboriginal and Torres Strait Islander People Living in Urban Areas, and Related Research Issues: A Review of the Literature. Cooperative Research Centre for Aboriginal Health, Darwin.
- Tsey, K., Whiteside, M., Haswell-Elkins, M., Bainbridge, R., Cadet-James, Y. & Wilson, A. (2010). Empowerment and Indigenous Australian health: a synthesis of findings from Family Wellbeing formative research. Health and Social Care in the Community 18(2):169–79.
- Vos, T., Baker, B., Stanley, L. & Lopez, A. (2007). The burden of disease and injury in Aboriginal and Torres Strait Islander peoples 2003. Brisbane: School of Population Health, The University of Queensland.
- WHO (World Health Organization) (2003). Social determinants of health, the solid facts. 2nd Geneva: WHO.