Health of Indigenous Peoples Essay

This essay seeks to demonstrate that whilst Indigenous health policy may have been on the Australian public policy agenda since the1960s, the gap between Indigenous and non-Indigenous health has remained. A brief description of the lives of Indigenous Australians prior to the colonisation of Australia is given, followed by a description of various policies that have been introduced by the Australian government to combat these inequalities. This essay demonstrates why these policies have been inadequate, in turn highlighting why the incorporation of Indigenous knowledge in creating Indigenous health policies is important. This essay closes with a brief examination of the Closing the Gap policy, which is utilising the knowledge of Indigenous Australians in creating culturally sensitive Indigenous health policies. In conclusion, this essay demonstrates that by including Indigenous Australians in the policymaking process, we might be starting to close the gap. The health inequality of Indigenous Australians has long been a concern for Australia and the world. Whilst the overall health of Australia has continued to improve, the health of Indigenous Australians remains at levels below those of non-indigenous Australians. Whilst it may seem that there is a lot being done to address these issues, the statistics demonstrate that policies implemented to address these issues have not been effective (Australian Indigenous HealthInfoNet 2010; Australian Institute of Health and Welfare 2010, p. 29). The thesis of this essay is that whilst the government has been seen as attempting to address the issues of health inequalities of Indigenous Australians, it is only in recent times that the government has implemented programs that are anywhere near close to closing the gap between Indigenous and non-indigenous Australians. To demonstrate this thesis, this essay will firstly discuss the history of Indigenous health prior to colonisation. This will be done to highlight how Indigenous health has declined dramatically since colonisation. This essay will then discuss what the government has been doing since the 1967 referendum, in which Indigenous Australians were formally recognised in the Constitution, to address issues of health inequalities (Australian Indigenous HealthInfoNet 2010). In the next section, a discussion on the reasons why there is a large gap between Indigenous and non-indigenous health will occur. This will be followed by a discussion on the utilisation of Indigenous knowledge to provide adequate health services. This essay will finally discuss the current Closing The Gap policy (Australian Human Rights Commission 2011), which has been introduced to address issues that previous policies have failed to. This will be done to highlight the fact that whilst it may seem that as the Indigenous population require the knowledge and assistance of its non-indigenous counter parts, what is evident is that health of Indigenous populations has in fact declined since the colonisation of Australia. Failing to recognise the correlation between colonisation and declining health of Indigenous people, will only see a continuation of the problem rather than seeing a positive change. Whilst the information pertaining to the health of Indigenous Australians prior to colonisation in 1788 appears to be scarce, what is known is that Indigenous health has been on the decline since the arrival of European settlers. Indigenous Australians were considered to be healthier than those of their colonisers (Flood 2006, p. 120). Prior to colonisation, there was no contact with the outside world and therefore infectious diseases were minimal. Due to the introduction of new illnesses from colonisation, the population of Indigenous Australians declined (Carson 2007, p. 43). It was also common for Indigenous women to contract sexual diseases from the often non-consensual contact with the colonisers (Carson 2007, p. 44). Health was also impacted upon by change in diet. Prior to colonisation, Indigenous Australians maintained a diet of protein and vegetables due to the animals and plants available to them (Flood 2006, p.120), as well as the exercise they maintained from hunting and gathering (Flood 2006, p. 122). After colonisation, the Indigenous diet included many foods which saw an increase in obesity, diabetes and heart disease (O’Dea 1991, p. 233). It was not just the introduction of disease and change in die that impacted upon Indigenous Australians’ health. Anthropological studies surrounding Indigenous culture have shown that Indigenous populations have close ties to the land, as the land is incorporated into their sense of being. Pieces of land belonged to particular groups of individuals, and the objects from the natural landscape were considered to be part of their history (Carson 2007, p. 180). It was the failure of colonisers to understand this worldview that has contributed to the deterioration of mental health amongst Indigenous Australians, as they were forced off their lands and into settlements and reserves (Carson 2007, p. 49). This contributed to the feeling of being disconnected from land and family, exacerbating feelings of not be longing, lack of identity and low self-esteem (Ypinazar et al.2007,p. 474). As one can see, the issue of health amongst Indigenous Australians is a complex one, complicated by the differing world views of Indigenous and non-indigenous Australians. It is due to this lack of understanding that has resulted in a myriad of health policies that have attempted to address the issue of health inequality of Indigenous Australians. The first health policy to address the health issues of Indigenous Australians was implemented in 1968, with thirty five adjustments made between then and 2006. Without going into the details of every amendment or new policy, what was common throughout this timeline, was that there were various bodies and institutions created to address the issues that had not been adequately addressed previously, responsibilities were allocated by the government to the states and territories, and programs were implemented to address health issues. Change in governments also meant that policies were constantly changing, which meant that the ways in which health issues were seen and therefore addressed also changed (Australian Indigenous Health InfoNet 2010). When attempting to implement a policy that will adequately address the issue, what has been found is that comparative analysis has been used to determine how health issues have been addressed in other countries. Whilst this kind of analysis may be sufficient in some circumstances, it does not suit such a situation where our Indigenous population’s culture and worldview is unlike that of any other. For example, whilst health issues may be similar to those of Indigenous populations elsewhere, worldviews which impact upon health and wellbeing will vary and may not be able to be applied from one culture to another (Tsey et al.2003, p. 36). One event that highlights the differing views on how issues should be addressed, was the closing down of Aboriginal and Torres Strait Islander Commission (ATSIC) by the John Howard Government in 2004 (Australian Indigenous Health InfoNet2010). What was significant about this was that Indigenous health policy had been the responsibility of ATSIC. This action effectively removed the responsibility of Indigenous health from the Indigenous people and placed the responsibility with mainstream departments that were also responsible for non-indigenous health. By doing this, the government had  wound back many years of work to address the health inequalities of Indigenous Australians, perceiving Indigenous Australians as a culture that could not look after themselves and needed instead the knowledge and expertise of the superior colonialists (Kay & Perrin 2007, p. 19). By removing the responsibility of Indigenous health from ATSIC and placing it in the hands of a body that was also responsible for non-indigenous health, the government failed to understand the intricacies of Indigenous Australian culture and the implications that this kind of action can have on Indigenous health. Whilst the overall health of Australians is amongst the top third of Organisation for Economic Cooperation and Development (OECD) countries (Australian Institute of Health and Welfare 2010, p. 8). There is a clear disparity between Indigenous and non-indigenous health, when one considers that even in this day and age of modern medicine, Indigenous Australians are expected to live twelve years less than their non-indigenous counterparts for males, and ten years less for females (Australian Institute of Health and Welfare 2010, p. 29). So what are considered to be the reasons for this inequality? What has already been highlighted, is that Indigenous health has suffered from the introduction to changes in diet, introduction of diseases both airborne and venereal, and the impact upon mental health due to dispossession of land and loss of kinship. Mental health issues can also be connected to the economic and social disadvantage of many Indigenous individuals, which can lead to substance abuse and other issues (Australian Institute of Health and Welfare 2010, p. 33). The failure to adequately address mental health issues has resulted in deaths by suicide being the second biggest reason for deaths by injury (Australian Institute of Health and Welfare 2010, p. 30). These figures demonstrate that policies have clearly not been working. A salient point to note is that Indigenous Australians are the least likely group of the whole population, to access important health services. So what are the reasons behind this lack of access to services? It can be as simple as the kind of service that an individual receives. From personal experience of serving Indigenous customers, tone of voice can be misinterpreted. What may be considered polite in most circumstances, can be misconstrued as being conceited by others. Use of language can also be a barrier. For example, (again from personal experience), language has to be altered to manoeuvre these barriers, such as replacing the term ‘bank account’ with the word ‘kitty’. Other barriers may include the fact that in remote communities, health professionals may also be the town judge, which may deter Indigenous people from accessing the services from a person who might have also been responsible for sentencing an individual or a member of their family (Paul 1998, p.67). Barriers such as the remote locations of individuals in comparison to the services, and the cost of services also have to be taken into account. For example, if a service is some distance away from an individual, the cost of travelling may be too high. The cost of services close by may also be too expensive for individuals, or individuals may receive poor treatment due to either being turned away from services, or mistreatment due to racialist beliefs. This may result in individuals travelling long distances due to this very mistreatment in their own communities (Paul 1998, pp.67-68). The misconception that all Indigenous Australians are one group of people can also result in culturally inadequate services, deterring individuals from accessing important health services (Paul 1998, p. 68). This lack of understanding about Indigenous cultures when providing health services has resulted in a rise in the provision of health services that are either run by Indigenous individuals, or have been created in consultation with Indigenous individuals, to ensure that the services being provided are culturally adequate. An example that highlights this can be seen in the creation of a program in 1998in the Northern Territory that was attempting to address the health inequalities of Indigenous children (Campbell et al 2005, p. 153). There were many problems with this programme because the people that were overseeing the programme did not have cultural knowledge that was a factor in the health and wellbeing of the children. What resulted was a program which was implemented in an Indigenous remote community, which utilised the knowledge of Indigenous people from the community itself. This allowed for the programme to be altered when issues were addressed and individuals within the community were able to provide solutions to issues, rather than being told what was going to happen by an outside authority (Campbell etal. 2005, p. 155). Whilst this programme realised that a bottom-up approach was more beneficial than a top-down one which usually occurs in policy implementation, there were issues because the programme also involved people from the outside that were there to manage the programme, who were unwilling to give total control to the community, generating feelings of disempowerment, resentment and marginalisation (Campbell et al. 2005, p. 156). Whilst there are many examples of programs that have been implemented to address the health inequalities of Indigenous Australians, one that deserves mentioning because of success that it has had are the men’s groups in Yaba Bimbie and Ma’Ddaimba Balas (McCalman et al. 2010, p. 160). What was found was that these programs were successful because they were run by Indigenous men who had direct knowledge of the cultural issues and needs of the community as they also lived there. They were also successful because the men felt included in their communities by having control, rather than being controlled by an outside source. Due to these men’s groups, individuals were able to come together and share their concerns about their community, and as the others also were from the same community, they were able to contribute to solutions to the problems by feeling able to speak freely about their concerns. One such concern was anger management issues, which were exacerbated by the social issues that the individuals faced (McCalman et al. 2010, p. 163). Whilst, issues like this may seem to be separate, they in fact contribute to other areas, as has been mentioned earlier in regards to mental health and suicide, which flow on to other members of the community, when there may be no one in the family who is able to earn an income, which contributes to poverty. This may in turn, render an individual unable to access services as previously mentioned. As one can see, when individuals who are directly impacted by issues, are included in finding solutions to address these issues, there is more success than when they are not included. It is the understanding of this that has seen the implementation of the Close The Gap policy (Australian Human Rights Commission 2011). This policy is based on the understanding that the concept of health is different in the eyes of Indigenous Australians than that of non-Indigenous Australians (Australian Institute of Health and Welfare2009). This policy has sought to reduce the gap of inequality between Indigenous and non-indigenous Australians by reducing the gap in life expectancy by 2031, halving mortality rates of children by2018, ensuring equal access to early childhood education by 2013, halving the gap in the area of inability to read and write by 2018, halving the gap of individuals who attain their Year 12 education by 2020 and halving the gap of unemployment rates by 2018 (Gillard2011, p. 2). Various programmes have been implemented to address these issues, with a common theme of inclusion. That is, the programs all involve Indigenous Australians who have a better cultural understanding than non-indigenous Australians. This has allowed for individuals to work with their own communities, various levels of government, non-government organisations and businesses (Gillard 2011, p. 6). By doing so, it has provided individuals with a sense of control and purpose over their own lives, which has seen a decrease in the mortality rates of Indigenous Australians (Gillard2011, p. 12), as well as a reduction in the rates of reading and writing problems (Gillard 2011, p. 14). There has also been a significant increase in the numbers of Indigenous Australians aiming towards their Year 12 qualifications (Gillard 2011, p. 16), as well as a decrease in the number of unemployed in the Indigenous population (Gillard 2011, p. 17). Whilst these figures are promising, one has to look at some of the programs that have been implemented as a result of this policy, to see if lessons have been learned from past mistakes, or if similar mistakes are being made. One such program that is deemed to be addressing issues of inequality is the Welfare Payment Reform act, which allowed the government to withhold portions of welfare payments (Gruenstein 2008, p. 468). This was to ensure that portions of the payment were going to required living expenses before going to things such as alcohol. Whilst this may seem as though it is an important step in addressing issues within communities, what is important to note is that policies such as these are in direct violation of the Racial Discrimination Convention because they directly target Indigenous individuals solely because they are Indigenous and are not necessarily in need of intervention (Gruenstein, 2008, p. 469). Whilst the Closing the Gap policy has good intentions, it can result in actions that treat Indigenous Australians as a homogenous group, rather than recognising the variation of issues. In conclusion, this essay has demonstrated that Australia has come a long way in addressing the issues of inequality amongst Indigenous Australians. It has been demonstrated that Indigenous Australians were in good health prior to colonisation, and only since colonisation has the health of Indigenous Australians has declined. This essay has also shown that the different governments have varied between allowing Indigenous Australians self-determination, or be included in the process of policy making, to the government seizing control of the issues, excluding the Indigenous community from decision making. Whilst it has been shown that the government has been addressing issues for well over 40 years, it has only been in recent times that issues of inequality have begun to be adequately addressed. By understanding that it is Indigenous Australians who are better able to understand their issues, which stem from the actions of non-indigenous peoples and allowing Indigenous Australians to take control of their own lives, will we start to close the gap of health inequality between Indigenous and non-indigenous Australians.