• Subject Name : Nursing

Context of Aboriginal and Torres Strait Islander Peoples’ Health

Introduction to Mortality and Life Expectancy of Indigenous Australians

Indigenous groups have worse health outcomes relative to non-Indigenous peers. The care facilities derived from the fact that mainstream healthcare services that were unable to satisfactorily address the requirements of aboriginal populations and native communities. The aboriginal people are often excluded and marginalized from mainstream healthcare facilities. The colonial system and the long-term consequences of colonial have resulted in disparities in the condition of indigenous health, including emotional, physical, financial, and mental health and well-being (Paradies 2018). Culturally appropriate mental health care is not readily accessible in most countries and the lack of access to basic health and social services for Indigenous peoples is an urgent necessity. The community engagement strategy is found to be important in identifying their health-care needs of Aboriginals, transforming them into practice through regional healthcare professionals, and bringing their faith in these health services (Davy et al. 2016).

The primary health care services are more helpful to enhance the wellbeing of indigenous groups than mainstream services. The reason for this was to create and operate unique Aboriginal public health programs for indigenous peoples. Their effectiveness is attributed, in part, to the fact that they also include integrated services that include treatment and management, intervention and wellness promotion, and also addressing health social determinants (Schuch et al. 2017). In this essay, the mental health problems among the youth have been discussed along with the factors affecting the health outcomes. The aboriginal people engagement in taking care of the health of their community has been found successful.

Engagement of Aboriginals in Community Health Services

Indigenous Australians' life expectancy is ten years lesser than other Australians. Such inequality is the product of a variety of complex causes including colonialism's adverse effects, enslavement and racism, economic conditions associated with lower educational levels and jobs, and greater rates of incarceration (Australian Institute of Health and Welfare 2014). Probably the health inequalities among indigenous and non-indigenous Australians must be tackled effectively. One way to solve the issue is by including Indigenous communities in the design and provision of health care services. The purpose of the engagement was to evaluate that whether the indigenous population found the approach to community engagement to be successful in recognizing their medical needs, attempting to turn them into practice through health services, and through their confidence in those services. When it comes to accessing conventional health care services, indigenous people face many problems. Those include uncomfortable hospital conditions, lack of space, dissatisfaction with health care services provided, a sense of isolation, and inflexible choices in treatment by the health care providers (Shahid 2009).

Such reasons have tended to build a general reluctance of these people to attend services. Evidence has shown that the communication disparity between health care providers and the lack of Indigenous health services workers is exacerbating the issue. To tackle this issue, the health systems need to commit to build positive partnerships with local indigenous people and expand service capability to meet Indigenous people needs (Durey et al. 2016). The Council of Australian Governments (COAG) agreed in 2008 to the funded National Partnership Agreements (NPA) to improve Aboriginal wellbeing and life expectancy. Closing the Gap (CtG) in Indigenous health programs to lessen the gap between the aboriginals and other Australian populations. These programs are made to develop a connection between service providers, the Australian government, and local indigenous communities was a core function of the NPA (Council of Australian Governments 2009). The potential outcomes were to establish connections among health care providers and enhance access to the health care system for indigenous populations. Successful communication with the Aboriginal Community is a crucial factor to accomplish this. The factors include recognizing the importance of local Aboriginal cultural practices and awareness, learning about the culture of community and development of a local leadership network. All these will not only help to build confidence and show respect, but were required until any steps were implemented.

Mental Health of Aboriginals People

Anxiety (17 per cent) was identified as the most prevalent mental or behavioral condition which is followed by depression (13 per cent). In 2018-19, there were moderate or extremely high levels of psychological distress recorded by 31 per cent of Aboriginal people and 23 per cent of Torres Strait Islanders over 18 years of age. Mental health and education in the Indigenous community is a significant concern. Youth is a crucial transitional period in a person's life (Brijnath et al. 2020). It is a time when decisions are made on relations, education and work paths, employment, and finances. The social, cultural, environmental, and technical shifts that have taken place in recent decades mean that young people are now experiencing challenges that previous generations may not have faced. While making the transition to adulthood a success, young indigenous people face additional obstacles.

The effects of intergenerational trauma, prejudice, and inequality and socio-economic poverty are all significant in understanding contemporary Indigenous youth's experiences. The Aboriginal and Torres Strait Islander adolescent and youth mental health research produced by the Australian Institute of Health and Welfare with feedback from a specialist expert panel and young indigenous population (Carson 2020). This offers comprehensive information on health and education for Indigenous youth. A total of 241,824 aboriginal people aged 10–24 lived in Australia in 2016, comprising 5 per cent of the overall youth population in Australia. And there are facets of young Aboriginal people's health and wellbeing that need care. Smoking tobacco, alcohol and substance use, psychological problems, accidents, and incidents of abuse are some of the reported issues (Hughes et al. 2017). Many of the deaths of young Indigenous people have been due to insufficient and sufficient healthcare problems that are largely preventable. Therefore facilities must be provided and available to Aboriginal youth that promote happiness and wellbeing as well as provide comfort in times of crisis (Kwon et al. 2019).

Factors Affecting Mental Health Issue 

Indigenous youth accounted for a greater amount of the overall youth residents residing in less metropolitan centers, such as remote parts of the country. Due to social networks, culture, history, sexism, socioeconomic deprivation, and the psychological distress connected with each of these causes, the impact of poor mental health in young indigenous people is suggested to engage in a complex way to influence health-related behaviors. From an equity perspective, criticizing the culture of the Australian public health system and noting the incompetency of several modern medical services is designed to successfully approach indigenous people (Lamblin et al. 2018). The second aspect is the desire to maintain identity and culture, and distinctiveness can influence health risk behavior, both positive and negative. In addition to institutionalization and territorial constraints, separation and integration policies have been adopted. In some cases, it has prevented young Aboriginal people from speaking their native language, exercising their heritage, and teaching their customs and culture to their children. Colonization-related constraints and violence contributed to the loss of liberty and life and irreversibly changed the social and cultural actions of Australian Aboriginal youth (Freeman and Staley 2018). The increased group links that are exacerbated by societal responsibilities to family and kin occur to assert an interrupt positive health behavior patterns.

Past massacres and continuing prejudice have produced long-term physical and psychological impacts on mostly trans generational young people. This is expressed in various studies and psychosocial conditions showing that their lives are often influenced by prejudice and racism against indigenous people. The gap between Aboriginal and Non-Indigenous connection and social network that seemed to be fostered by marginalization and prejudice could affect mental health behavior. The views suggested that social relations with the non - aboriginal population may be hampered by maintaining cultural uniqueness, an authoritarian past, and prejudice (Fay 2018). It supports claims that social networks are influenced by marginalization and sexism to reduce the availability of non-Indigenous links. Interaction among aboriginal and non - aboriginal people may be disrupted by community resentment which decreases the impact of certain non-indigenous sources on native people mental health. It was mentioned that discomforting cultural confrontations and racism of the current day result to the indigenous population 's orientation to despise non - aboriginal people. Besides, the responses from aboriginal participants showed that the mental anguish and grief caused by traumatic historical incidents, such as family killings, profoundly influenced the indigenous population (Ozdowski 2017).

Primary Health Care (PHC) Services for Indigenous People

Indigenous PHC services emerged as a result of the incapacity of the contemporary health services to satisfy the requirements of indigenous communities appropriately. This was also a reaction to the truth that native communities were often exempted and disadvantaged from contemporary healthcare services. A possible solution was to establish and run Aboriginal special PHC programs for Aboriginal populations (Gomersall et al. 2017). The very first Aboriginal PHC system was launched in Australia in 1971, and there are now more than 150 Aboriginal Population-Based Health Services worldwide. Though it did not include a description of culture in the sense of Indigenous PHC services, they nevertheless illustrated how cultural elements were incorporated in services and how cultures are valued. The importance of the cultural values in the Aboriginal community is very crucial so it has to be considered in making any health care policies (Mazel 2016). Crucial community embedding strategies included the inclusion of local Aboriginal cultural values practices and beliefs, as well as spiritual healing and rituals into the model of care. The PHC focuses on the preferences of individuals and also on the wellness and health of their communities and families; recognizing the cultural interests of individuals and women, such as women-only addressing women's health services with other female or gender-specific resources and initiatives; and maintaining the engagement and management of Aboriginal health services by local populations (McCalman et al.2017).

The way culture was incorporated in service delivery models and ensured culturally relevant care delivery and made services more accessible to Aboriginal peoples. Many concrete examples about how culturally appropriate quality assurance was done have included the creation of supportive and pleasant spaces, and family-friendly environments, such as using indigenous artwork and indigenous signage, and the production of culturally appropriate resources for health promotion and prevention. Culture has promoted assessable health programs, guiding the provision of culturally suitable services and making things relevant to the population (Smith et al. 2017). Culture was essential in ensuring community involvement, encouraging indigenous responsibility and leadership through engaging the community, and participating in processes of improving quality and specifying results and measures. Culture was critical in guaranteeing a culturally effective and relevant approach to treatment.

Conclusion on Mortality and Life Expectancy of Indigenous Australians

Disparities within Australia tend to prevalent between the wellbeing of aboriginal and non - aboriginal communities. Evidence shows that native communities engage more frequently in health-risk behavior than their urban counterparts and that this activity has a significant effect on health outcomes. While this may suggest that rising health risk behavior can have a beneficial impact on people’s health, the factors influencing aboriginal health behavior are still incompletely defined as well. Culture, social networks, history, sexism, socio-economic deprivation, and the psychological suffering connected with many of such causes were assumed to influence indigenous community members' health actions endorsed by the participants participating in this research. One way to solve the issue is by including Indigenous communities in the design and provision of health care services. To tackle this issue, the health systems need to commit to build positive partnerships with local indigenous people and expand service capability to meet Indigenous people's needs. Colonization-related constraints and violence contributed to the loss of liberty and life and irreversibly changed the social and cultural actions of Australian Aboriginal youth. Crucial community embedding strategies included the inclusion of local Aboriginal cultural values practices and beliefs, as well as spiritual healing and rituals into the model of care. The way culture was incorporated in service delivery models and ensured culturally relevant care delivery and made services more accessible to Aboriginal peoples.

References for Mortality and Life Expectancy of Indigenous Australians

Australian Institute of Health and Welfare 2014. Mortality and life expectancy of Indigenous Australians: 2008 to 2012.

Brijnath, B., Antoniades, J. and Temple, J. 2020. Psychological distress among migrant groups in Australia: results from the 2015 National Health Survey. Social Psychiatry and Psychiatric Epidemiology55(4), pp.467-475.

Carson, B., Dunbar, T., Chenhall, R.D. and Bailie, R. eds. 2020. Social Determinants of Indigenous Health.London: Routledge.

Council of Australian Governments 2009. National partnership agreement on closing the gap in Indigenous health outcomes.

Davy, C., Harfield, S., McArthur, A., Munn, Z. and Brown, A. 2016. Access to primary health care services for Indigenous peoples: A framework synthesis. International Journal for Equity In Health15(1), p.163.

Durey, A., McEvoy, S., Swift-Otero, V., Taylor, K., Katzenellenbogen, J. and Bessarab, D. 2016. Improving healthcare for Aboriginal Australians through effective engagement between community and health services. BMC Health Services Research16(1), p.224.

Fay, J. 2018. Decolonising mental health services one prejudice at a time: psychological, sociological, ecological, and cultural considerations. Settler Colonial Studies8(1), pp.47-59.

Freeman, L.A. and Staley, B. 2018. The positioning of Aboriginal students and their languages within Australia’s education system: A human rights perspective. International Journal of Speech-Language Pathology20(1), pp.174-181.

Gomersall, J.S., Gibson, O., Dwyer, J., O'Donnell, K., Stephenson, M., Carter, D., Canuto, K., Munn, Z., Aromataris, E. and Brown, A. 2017. What Indigenous Australian clients value about primary health care: A systematic review of qualitative evidence. Australian and New Zealand Journal of Public Health41(4), pp.417-423.

Hughes, K., Bellis, M.A., Hardcastle, K.A., Sethi, D., Butchart, A., Mikton, C., Jones, L. and Dunne, M.P. 2017. The effect of multiple adverse childhood experiences on health: A systematic review and meta-analysis. The Lancet Public Health2(8), pp.e356-e366.

Kwon, M., Pickett, A.C., Lee, Y. and Lee, S. 2019. Neighborhood physical environments, recreational wellbeing, and psychological health. Applied Research in Quality of Life14(1), pp.253-271.

Lamblin, M., Murawski, C., Whittle, S. and Fornito, A. 2017. Social connectedness, mental health and the adolescent brain. Neuroscience & Biobehavioral Reviews80, pp.57-68.

Mazel, O. 2016. Self-determination and the right to health: Australian Aboriginal community controlled health services. Human Rights Law Review16(2), pp.323-355.

McCalman, J., Heyeres, M., Campbell, S., Bainbridge, R., Chamberlain, C., Strobel, N. and Ruben, A. 2017. Family-centred interventions by primary healthcare services for Indigenous early childhood wellbeing in Australia, Canada, New Zealand and the United States: a systematic scoping review. BMC pregnancy and childbirth17(1), p.71.

Ozdowski, S. 2017. Racism, equality and civil liberties in a multicultural Australia. In Globalisation, Human Rights Education and Reforms (pp. 187-220). Springer, Dordrecht.

Paradies, Y. 2018. Racism and indigenous health. In Oxford Research Encyclopedia of Global Public Health.

Schuch, H.S., Haag, D.G., Kapellas, K., Arantes, R., Peres, M.A., Thomson, W.M. and Jamieson, L.M. 2017. The magnitude of Indigenous and non‐Indigenous oral health inequalities in Brazil, New Zealand and Australia. Community Dentistry and Oral Epidemiology45(5), pp.434-441.

Shahid, S., Finn, L.D. and Thompson, S.C. 2009. Barriers to participation of Aboriginal people in cancer care: Communication in the hospital setting. Medical Journal of Australia190(10), pp.574-579.

Smith, K., Fatima, Y. and Knight, S. 2017. Are primary healthcare services culturally appropriate for Aboriginal people? Findings from a remote community. Australian Journal of Primary Health23(3), pp.236-242.

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