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Lack of equity in public health practice

Lack of equity in public health practice

Introduction

It would be correct to say that the coronavirus doesn’t discriminate however we know that humans and societies do. The entire world is facing the COVID19 pandemic, indigenous peoples are especially at risk because of the disparities they face in the home countries.

Indigenous Peoples are almost three times more likely to be living in severe poverty and are more likely to suffer negative results from infectious diseases. Many Indigenous groups are already impacted by issues such as malnutrition, pre-existing conditions, and lack of access to high-quality healthcare

Indigenous Australians have continually suffered from multiple obstacles in subjects of health, which puts them in a place of greater vulnerability due to ongoing pandemic as they no longer have the simple resources such as access to healthcare services.

Reports indicate that indigenous communities lack basic resources, including food which can be bought from grocery stores, food boxes provided by federal programs, and clean water, which is needed to fight the disease. The current issue of poverty in the indigenous communities also contributes to the failure of responding to the pandemic. Indigenous households are more likely to suffer from hunger than non-indigenous Australians. Unfortunately, there has been an increase in malnutrition as a result of the virus. Another important factor is racial inequality faced by indigenous people.  Indigenous societies experience high rates of heart disease, high blood pressure, diabetes, and other chronic diseases which weaken their immune system and increase the likelihood of them contracting the virus. Xafis V,2020

The pandemic risks worsen the deep-seated social, economic, and health inequities in Australia, particularly the pre-existing long-standing inequalities between Indigenous people other Australians. Irma,2020

Indigenous Australians are and may continue to be impacted by this problem in various forms than other Australians.COVID-19 's effect on First Nations citizens not only illustrate existing bad health and economic status that places populations at specific risk

The failure of public health agendas for the indigenous communities during this ongoing pandemic has revealed a governance gap that is difficult to ignore.

Health equality and health equity.

There is often confusion between understanding the meaning of health equality and health equity. the Milkin Institute School of Public Health describes equity as the lack of an unfair and avoidable economic, environmental, and social gap between different groups of people. The absence of equity is what causes inequality in society.

Lack of Access to Medical Supplies and Healthcare

Indigenous communities already have limited access to healthcare and medical supplies. There are very few Indigenous community health clinics that lack medical facilities, and now even urban clinics are not well equipped to handle the ongoing crisis. Shut down of public transportation, communities have raised a need for transportation to medical clinics and hospitals in cities.

Communities have banned outsiders to visit indigenous communities, to restrict the spread of COVID-19 in the community.

Lack of equity in public health practice

Australia is considered to be a world leader across a series of health domains, from cervical cancer to tobacco cessation. But Indigenous Australians experience a wide range of chronic conditions such as a high number of premature deaths, kidney cancer, diabetes, etc, revealing the limitation of the Australian government in protecting the health of minority communities.  

Public health has proven to be more effective in describing the existing gap in  Indigenous health vulnerability and quantifying the health inequalities rather than working to rectify it and addressing the problems faces by minor communities.

In be able to rectify this health disparities gap between indigenous Australians and the rest of the population of Australia, the underlying obstacles and problems faced by the underserved population must be addressed effectively.  

As medical doctors of Maori and academic scholar Papaarangi Reid points out, addressing COVID-19 concerning equity means to address the vulnerability in such a way that the issues are not just limited to age.

while it is important to focus on the elderly, it is also necessary to focus on the homeless, underserved population, poor working class and those in prison 

Access to Culturally and Linguistically Relevant Fact-based Information
currently there is a lack of Information regarding COVID-19 for Indigenous Peoples in their languages. Indigenous communities in rural areas are not able to access the internet and more often lack the understanding of mainstream languages. Additionally, accurate information regarding no of cases and intensity of the crisis. as well as low levels of formal education in rural communities causes the spread of misinformation. such lack of information leads to higher exposure of Indigenous communities to COVID-19.

Income and jobs

when it comes to employments Indigenous workers belonging to remote regions of  Australia are most affected by a pandemic as they in casual jobs in high numbers.

Indigenous unemployment has been a long-standing problem even before the COVID-19 pandemic and it is very likely to remain as a problem for a long time even if the government measure help contain the current pandemic spread. Diane Smith

 Food insecurity further worsens the existing inequalities and is especially problematic for families who do not have access to well-paying jobs. Those who depend upon work to afford meals and buy food and not able to do so. most of the Indigenous communities are facing such a problem. in such a scenario there is a need for delivery of basic amenities such as food and clean water to these aboriginal communities especially those in the remote locations of Australia. the need to pay for basic food for the family encourages the indigenous people to break isolation measures to work. 2020 | Markham, Smith and Morphy

Indigenous communities have a history of a lack of access to healthcare. there is a scarcity for even most basic healthcare supplies and clinics .now  in these times even the rural clinics are not well equipped to deal with the COVID-19. (Department of Health, 2020)

Public health failures in the coronavirus response

Australian public health runs on the utilitarian logic of “greatest good for the greatest number”. however the logic takes care of most of the population and not the whole and renders indigenous minority populations to be vulnerable and overlooked by the government policies. 

much of Indigenous health experts efforts are spent in appealing for a much more equitable public health response, leaving no opportunities for focusing on responding to the crisis to limit the health consequences on the communities

a recent plan for the management of The  Aboriginal and Torres Strait Islander Populations has been introduced, it is developed by the Aboriginal and Torres Strait Islander Advisory Group which focuses majorly on equity as its core principle. (Australian Department of Health, 2020)

Failure in the  implementation of  an equitable response to the pandemic will give  poor results for indigenous communities

 

government response

The introduction of public health measures like imposing fines for breaking social distancing and self-isolation rules are of little assurance to Indigenous communities. Such measures are feared to target indigenous people rather than protect them.

Already, in the Northern Territories there have been calls where  Indigenous peoples are denied access to coronavirus stimulus payments as well as cases of discrimination based on racism relating to coronavirus testing and treatment for the Indigenous groups. (Sky News, 2020)

Delay in the implementation of social isolation measures in Indigenous communities, such as no immediate actions towards restricting group activities in the community development programs (CDP) which are active in remote communities. (the guardian,2020)

 Suspending welfare quarantine programs to help vulnerable households respond better to the pandemic is yet to be seen. 

But this is the major limitation of the public health agendas that it is empathetic towards the deterioration of Indigenous health, but indifferent to equity. It calls for a need of forming transformative results. a sense of helplessness is inevitable in the ongoing pandemic

Indigenous health policymakers are blind to the abilities of Indigenous peoples, their cultures, and their communities.

For Aboriginal Australians, COVID-19 has great potential to wreak havoc in our communities.

Around 50% of indigenous people live with chronic diseases like diabetes, kidney, heart diseases, and cancers.  adult First Nations people. Most of these are chronic conditions (Markham & Biddle, 2018)

One in eight indigenous people lives in congested and overcrowding housings which elevates the chances of the rapid spread of COVID-19 First Nations people.  Isolation is such cases poses a challenge. Cases of overcrowding housings are worse in remote settings,

March 20, 2020, the Western Australian State Government released the ‘Remote Aboriginal Communities Directions’ for people living in remote indigenous communities (DPC, 2020a). The WA State of Emergency provided to the WA Police Commissioner and the Chief Health Officer to limit the access to remote Aboriginal communities and traveling out of these communities were restricted as well.

the National Cabinet provided an in-principle agreement to the Commonwealth Minister for Health taking action under the Biosecurity Act 2015 to restrict travel into remote Indigenous communities to prevent the spread of Covid-19 (Hunt & Wyatt, 2020). The previous day, on March 25, the Australian Government announced an allocation of $57.8 million to 110 communities under a new ‘Remote Community Preparedness and Retrieval Package’ primary focusing on health assessment and care initiatives (Hunt, 2020).

Governments have made these problems even worse by introducing policies that do not match the patterns of the aboriginal communities. There is a need for especially focusing on the needs of these communities and initiatives which are managed by Indigenous governments, communities, organizations, women, youth, and volunteers.

The Indigenous response

in the initial stages of the COVID-19 pandemic spread the responsibility of government towards the health of the indigenous population of Australia has not been a consistent and appropriate one. but to protect the especially vulnerable proportion of the Australian population several 

Indigenous organizations and leaders of aboriginal communities and different regions have stepped up. These organizations independently implement and proposed solutions targeting the health of their residents, these solutions can also be used outside of aboriginal communities and can be widely used. (AMSANT, 2020b)

Many of these organizations and community leaders restricted access to their communities by tourists. non-essential service delivery, government officers. peak representative and statutory agencies like NACCHO, have joined these independent organizations working for the indigenous groups to support them in their work. other such agencies joined are the regional land councils, Indigenous Business Australia, The Indigenous Land and Sea Corporation, Supply Nation, and others. (Hunt, 2020)

An example of Indigenous communities implementing decisions to limiting access and travel- Mapoon Aboriginal Shire Council imposed a ban on traveling to and from western Cape York except for health workers. (ABC, 2020b). this lockdown was commended by the Cape York Health Council as it was a very effective and decisive action (Mark Wenitong, quoted in ABC, 2020b).

The National Aboriginal Community Controlled Health Organisation (NACCHO), is a body which is a representation of  more than 140 Aboriginal community-controlled health services,

NACCHO is responsible in the current situation to run an advisory group along with the government to plan out specific protocols  to manage, contain the COVID-19 spread 

In the Aboriginal and Torres Strait Islander communities across Australia (DPC, 2020b).

what we can do

a suite of measures to help communities prepare for the pandemic, including:

  • regional COVID-19 testing services to be urgently implemented
  • support for existing Aboriginal health services to modify their structures and create respiratory clinics away from normal health services
  • urgent supplies of personal protective equipment (PPE, which includes gowns, masks, and goggles) to be made available
  • urgent identification and sourcing of appropriate housing for suspected and confirmed cases
  • existing medication supplies not to be interrupted but rather prioritized across all settings
  • for access to food and other essential items – such as sanitation supplies, cleaning products, and soaps – not to be compromised as the pandemic progresses.
  • There is a major need expressed by Indigenous communities for reliable, regular communication in Indigenous languages

Domestic violence

All women face increased levels of domestic violence during the crisis. However Indigenous women particularly those living in remote communities are at high risk. Indigenous women apart from the times of crisis are already greatly affected by violence and over-represented as victims of family, domestic, and sexual abuse (Manjoo, 2012; Our Watch, 2018; NTG, 2018).

Indigenous women during a crisis like this are left isolated with limited access to their support networks such as their friends and family, and support services. Aboriginal organizations have shown concern regarding indigenous women who are being sent back to their communities where they may face isolation and violence by their spouse  

The Northern Territory Government has shut down the most commonly used transport systems as well as banning of travel out of the communities.

Support and appropriate action are required to remove the risk of abuse toward indigenous women especially during the social distancing and lockdown. The most vital key in successfully eliminating the chances of violence is communication between the women of the indigenous communities and the support services and local and district aboriginal organizations. Violence toward women needs to be seriously discussed to raise consciousness among individuals and communities to discourage domestic violence especially now, in the times of COVID-19 when the women may find themselves vulnerable to abuse. On an average in Australia more than one woman is murdered in a week– women are not being protected from COVID-19 just so they can be killed by ignoring the issue of domestic violence (Brown, 2019b; Dawn House Women's Shelter, 2020; Women's Health West, 2019)

 

Indigenous control

It is not the first time that a highly contagious virus has struck the world. The Spanish flu greatly affected human lives. During the Spanish flu pandemic, Indigenous communities suffered greatly in Australia,  30% of all deaths in Queensland were of indigenous people (Kris Rallah-Baker, 2020).  However, the suffering and vulnerabilities of Indigenous people were given attention in about 75 years later through the work of doctor Gordon Briscoe (Brough & Mark, 2001).

In every failure of Indigenous health, the Indigenous communities appeal to be heard, not just presented as statistics in death tolls. There is a desperate need of forming new health agendas that are more equitable and human towards the health of the indigenous people.

Health commitments which target all and not just most people.  However in Australia Indigenous sovereignty is refused which has the potential to create a public health crisis for the indigenous group that might prolong even after the current pandemic.

Conclusion

Indigenous groups in either urban or rural areas are not very often prioritized in public policy. This is true especially during times of crisis, which can be seen in the ongoing COVID-19 pandemic. There are several inequalities and disparities between the Indigenous and non- indigenous population in Australia—food, health, employment, access to clean water, access to medical facilities and wealth, etc—that elevates the chances of Indigenous people contracting the virus and dying as a result of it. The Australian government has failed in appropriately responding to the pandemic keeping the indigenous group in mind however many local aboriginal communities and organizations have taken the required steps to mitigate the risk of COVID-19 among the indigenous people. If such disparities are not appropriately addressed through government policies can end up prolonging the existing exclusion, unemployment, inequality, and discrimination for a long time.

Keeping in mind the pre-existing vulnerabilities of the indigenous population in Australia,  it is quite evident that the COVID-19 pandemic would prove to be catastrophic.

 

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