The indigenous population of Australia has worse health than non-indigenous Australians. According to the World Health Organization (2010), they face many disadvantages like poverty, disparities among the distribution of resources, and low life expectancy. In access to the treatment, they face health disparities that are observed in most major illnesses including kidney disease, cardiovascular disease, cancer, and oral health. The differences between non-indigenous Australians and indigenous Australians in three key areas help explain the health gap: health risk factors, social determinants, and access to appropriate health services. According to Waterworth et al. (2015), many forces contributing to the health inequities. However, the role of Aboriginal Controlled Community Health Services (ACCHS) is to reduce the health inequities by reducing the barriers that prevent access to comprehensive, intervention, and early care for indigenous people. The sections below will discuss in brief the health inequities between indigenous and non?indigenous Australians, factors contributing to them, and the role of ACCHS in reducing the same.
The Forces Contributing To Health Disadvantages Experienced By Indigenous Australians
Many forces contributing to the health disadvantages experienced by indigenous Australians: social, economic, and political. According to the Australian Institute of Health and Welfare (2020), the social determinants are - on average, the indigenous populations in Australia have lower levels of education, poorer quality housing, income, and employment than in comparison to non-indigenous populations. The economic factors are - between 2008 and 2012–13, the unemployment rates rose for both non-indigenous and indigenous Australians but the rate for indigenous people rose more. Therefore, poor economy, low education, and employment levels ultimately result in poverty, financial hardship, family breakdown, and debt. These will impact the health access and opportunities creating a gap between indigenous and non-indigenous populations (Harfield et al., 2018).
According to Smallwood et al. (2020), the political factors – when the British implemented paternalistic policies which are evident even today in Australia. These policies restrict individuals to make choices with their consent. These policies aimed to change individual ideology in areas of alcohol, drugs, and reliance on welfare payments. These lead to the indigenous population becoming the victims of extraordinarily high levels of violence at the work-place, racism, marginalization, and disparities on health care grounds. Such inequalities in policies resulted in health inequities as there was an unequal distribution of power and resources. According to the National Aboriginal Community Controlled Health Organisation (2020), the indigenous children were removed from their families at a high rate than the non-indigenous children. Due to deplorable outcomes of such politically advantageous policies, the indigenous population started committing suicide at a high rate. It was also found in surveys that less indigenous were employed than the non-indigenous, if no education or no employment than economic strength weakens, resulting in fewer chances of getting a healthy lifestyle and ultimately health inequalities.
The Role Of ACCHS In Reducing Health Inequities
The Key Features Of Aboriginal Community Controlled Health Services (ACCHSs)
According to National Aboriginal Community Controlled Health Organisation (2020), an Aboriginal Community Controlled Health Service (ACCHS) in primary health care (PHC) service operated and initiated by the local Aboriginal community to deliver comprehensive, holistic, and culturally appropriate health care to the community. With their model of community governance and comprehensive primary health care, ACCHSs have reduced barriers to access to health care, unintentional racism, and are progressively improving individual health outcomes for indigenous Australians. According to Henderson et al. (2018), an Aboriginal Community Controlled Health Service is: initiated by a local aboriginal community, incorporated aboriginal organization, governed by an aboriginal body elected by the local aboriginal community, and based in a local aboriginal community. Across Australia, the aboriginal communities operate over 140 ACCHSs/AMSs. They range from large multi-functional services providing a wide range of services and employing several medical practitioners, to small services without medical practitioners. These rely on nurses to provide the bulk of primary care services and/or Aboriginal health workers, often with a health education focus. According to Campbell et al. (2018), there are a variety of types of services which are also known as primary (health) care services within the Australian context. The principal providers of such services are Community health services, General Practices with a general practitioner as a care provider, and Aboriginal Medical Services. The characteristics of PHC include health workers collaborating in teams, patient/family centeredness, proactive preventive focus, better management of chronic conditions. These are necessary for indigenous Australians because the indigenous populations are living below the poverty line, hence the services are unattainable for them. Moreover, due to significant cultural and language disparities, the mainstream services do not succeed to provide appropriate healthcare to aboriginal patients, therefore, the establishment of ACCHS attempts to overcome such challenges (Paradies, 2018).
The Role Can ACCHSs
According to VicHealth (2018), ACCHS are designed to provide effective cultural health care, with Aboriginal staff and culturally trained staff, to ensure that clients feel comfortable when they seek health care and to eliminate discrimination within services. ACCHSs play a significant role in employing Aboriginal people and in training the medical workforce. Its focus on prevention, comprehensive care, and early intervention have reduced barriers to unintentional racism and access, resulting in improved health outcomes of the indigenous population of Australia. It was found by the service data that the use of ACCHSs was more by indigenous populations in regional areas. According to World Health Organization (2010), based on the Australian Bureau of Statistics-estimated catchment data a high number of aboriginals were accessible to services like employment or health care access and were using the services as well. ACCHS programs have also increased Aboriginal peoples’ access to cardiac and respiratory rehabilitation programs, cervical cancer screening, eye health, mental health, sexual health, increased access to various programs like child protection, child care programs, and aged and disability care programs. These were few out of many identified benefits of ACCHSs for Indigenous Australians. Moreover, ACCHSs also contribute to better health outcomes for Indigenous Australians. According to Campbell et al. (2018), the improved health outcomes include a significant increase in smoking cessation, an increase in immunization rates, increased knowledge of healthy eating and cooking skills, a reduced oral antibiotic, and improved growth and nutritional status. Other health outcomes that increased for aboriginals in Australia are - reduction in psychiatric admissions by 58%, Reduction in vision impairment, and significant increases in mean hemoglobin. All these services and access to aboriginals show that ACCHSs contribute towards reducing health inequities.
The Barriers That Might Prevent ACCHSs
The barriers that might prevent ACCHSs are as follows:
Economic barriers – many aboriginals of Australia live life in poverty as a result they cannot afford the cost of PBS payments, doctor fees, payments for online appointments, travel costs, and many others (Paradies, 2018). Social barriers – such populations do not get easy access to offers and opportunities as in comparison to non-indigenous populations. As a result, they do not get proper education, equal access to employment offers, suffer from racism and discrimination, resulting in a big barrier for ACCHSs to reduce the health inequities for indigenous populations (Smallwood et al., 2020). Political barriers – if ACCHSs are granted autonomy and increased government funding, several political barriers like the policies that restricted aboriginals from equal health care services and opportunities, and other barriers will be removed. According to Smallwood et al. (2020), the researchers concluded that the Australian federal, state, and territory governments give inconsistent commitments for the goal of reducing health inequity. Due to Australia’s dominant ideology – neoliberalism, its policy prescriptions increase socioeconomic inequality resulting in health inequities. The neoliberal politics is acting as a roadblock for ACCHSs goals and thereby increasing the health inequities in Australia. Moreover, government funding is always important for any health care program or service. The Australian government should recognize that if the continued reduction in funds for ACCHSs will occur then the goal of reducing the health inequities between indigenous and non-indigenous populations will become very difficult to achieve. However, despite the commitment to Closing the Gap in 2008, funds have been reduced increasingly resulting that the goals of ACCHSs will not be met.
The indigenous population of Australia has worse health than non-indigenous Australians. Many forces contributing to the health disadvantages experienced by indigenous Australians: social, economic, and political. The ACCHSs in primary health care (PHC) service is operated and initiated by the local Aboriginal community to deliver comprehensive, holistic, and culturally appropriate health care to the community. With their model of community governance and comprehensive primary health care, ACCHSs have reduced barriers to access to health care, unintentional racism, and are progressively improving individual health outcomes for indigenous Australians. Moreover, ACCHSs also contribute to better health outcomes for Indigenous Australians. However, these face many barriers to achieve their goals like the government funding is getting reduced with every year resulting in difficulty to reduce the health inequities between the indigenous and non0indigebous populations.
Australian Institute of Health and Welfare. (2020). Australia’s health 2018: In brief. Retrieved from: https://www.aihw.gov.au/reports/australias-health/australias-health-2018-in-brief/contents/all-is-not-equal
Campbell, M. A., Hunt, J., Scrimgeour, D. J., Davey, M., & Jones, V. (2018). Contribution of aboriginal community-controlled health services to improving aboriginal health: An evidence review. Australian Health Review, 42(2), 218-226. Retrieved from: http://www.amsj.org/archives/3012
Harfield, S. G., Davy, C., McArthur, A., Munn, Z., Brown, A., & Brown, N. (2018). Characteristics of Indigenous primary health care service delivery models: a systematic scoping review. Globalization and Health, 14(1), 12. Retrieved from: https://doi.org/10.1186/s12992-018-0332-2
Henderson, J., Javanparast, S., MacKean, T., Freeman, T., Baum, F., & Ziersch, A. (2018). Commissioning and equity in primary care in Australia: Views from Primary Health Networks. Health & Social Care In The Community, 26(1), 80-89. Retrieved from: https://doi.org/10.1111/hsc.12464
National Aboriginal Community Controlled Health Organisation. (2020). Aboriginal health history. Retrieved from: https://www.naccho.org.au/
Paradies, Y. (2018). Racism and indigenous health. Oxford Research Encyclopedia of Global Public Health. Retrieved from: https://oxfordre.com/publichealth/view/10.1093/acrefore/9780190632366.001.0001/acrefore-9780190632366-e-86
Smallwood, R., Woods, C., Power, T., & Usher, K. (2020). Understanding the impact of historical trauma due to colonization on the health and well-being of indigenous young peoples: A systematic scoping review. Journal of Transcultural Nursing. Retrieved from: https://doi.org/10.1177%2F1043659620935955
VicHealth. (2018). A sample council strategy to reduce health inequalities. Retrieved from: https://www.vichealth.vic.gov.au/-/media/Indicators/Overview-sheets/10/VH_LG_Guides_Health-Inequalitites_web.pdf?la=en&hash=31DA3F4472AD70E5C4B7F537938B8EDD6E90B931
Waterworth, P., Pescud, M., Braham, R., Dimmock, J., & Rosenberg, M. (2015). Factors influencing the health behaviour of indigenous Australians: Perspectives from support people. PloS One, 10(11). Retrieved from: https://doi.org/10.1371/journal.pone.0142323
World Health Organization. 2010. Indigenous health. Retrieved from: https://www.who.int/healthsystems/topics/financing/healthreport/IHNo33.pdf
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