• Subject Code : NUR329
  • Subject Name : Nursing

Public Health Nursing: Prelicensure

Abstract on Systematic Literature Review

Background: The health care inequalities refers to the potential aspects that are related to health care like access and availability that fails to give health equity to the people of the nation. The health care inequalities exist between the Indigenous and non- Indigenous people of different nations on a broader levels. Aim: the main aim of this study was to analyse the health care inequalities among people of the nation. Design: the design of this study was systematic literature review in which various articles were searched using databases and selected using inclusion and exclusion criteria. The selected articles were then analysed for various aspects like risk of bias, findings of the study, design of the study and limitations that helped in better screening of the information. Results: he results were obtained on the basis of the findings from the studies that helped in shaping the topic of inequalities in the health care. Conclusion: the conclusion drawn is that there exists huge level of health care inequalities between Indigenous and non- Indigenous people of the nation mainly because of the racial discrimination and other social factors like no housing, low income, low employment rates among them and no access to affordable health care services.

Keywords- health inequalities, health care services, disadvantaged people, “Aboriginal and Torres Strait Islander people of Australia”, health disparities, discrimination

Introduction to Systematic Literature Review

Health inequality refers to the systematic difference in the health status of different population groups (World Health Organisation, 2020). This difference in the health is observed in different communities of people like Indigenous group of people and non- Indigenous groups of people. These are avoidable and preventable difference in the health of people that goes against the principle of social justice. The health inequality exists due to the social determinants of health and is also because of the socially determined by circumstances. These situations causes disadvantage in the people and also causes limit their opportunities of living longer and healthier. The inequality in the health care services is due to the low access, less availability and many more reasons. The people who have no access or limited to health care services are especially from the remote areas of the nation who does not get an advantage of the health care services (Taylor & Guerin, 2019). This makes them the victim of inequality of health care services and this has negative impact on their physical health and mental health. The inequality in the health care system is also due to income inequality that exists in the comparable groups that is in different groups of people. The health inequalities do exist for some extent in every health care system of different nations (Martinson & Reichman, 2016). There is an assumption in the medical practice that health equity can be provided when people are able to access medical care easily and quickly. The “Aboriginals and Torres Strait Islander people” are one of the most disadvantaged people in terms of health care services because they live in rural areas and they do not have access to easy and affordable medical care. There are many socio- economic factors such as housing, low employment, low education and low income that affects them to have access to affordable medical care services. There are many health care services in Australia that are not delivered through public sector like dental care services so the private sector does not make it affordable for such disadvantaged people of Australia. The inequalities in health care has been a major concern for the government of different nations so they have made some efforts like Australian government proposed ‘Closing the gap” which aims to diminish the health care disparities between “Indigenous and non- Indigenous people of Australia” (Altman, 2018).

Objectives of Systematic Literature Review

The main objective is to analyse the inequalities in health care among different groups of people.

Methods of Systematic Literature Review

The method adopted for the search on “inequalities in health care” is systematic literature review. This is a review of a clearly formulated question that makes use of systematic and explicit method that would help in identification, selection and critically appraising the relevant research (Liao et al., 2017). This also helps in the collection and analysis of the data that is collected from various studies that are a part of this review. The systematic literature review is done using different articles which has either quantitative data or qualitative data or has a mixed design that is both qualitative and quantitative data.

For this systematic literature review, the journal articles will be searched through various databases like MEDLINE, EMBASE, CINAHL and PubMed. These databases are searched thoroughly because they are the source of authentic and relevant articles that are published after thorough research. The articles from other sources like WHO website and other websites for relevant articles on this topic. The search strategy adopted was to use relevant keywords along with the use of the Boolean operators, truncation and wildcard. The search terms used are inequalities AND health care, health care services OR health care AND inequality, disadvantaged people AND health care access, health care AND inequality*, ATSI AND health care access, ATSI OR disadvantaged people AND health care disparity.

The selection of articles was done using inclusion and exclusion criteria. The inclusion criteria was the articles which were published from 2012- 2019 were selected and the articles that were in English language were only selected. This year bracket was selected so that recent information can be processed for the selected topic. The exclusion criteria was that the articles which did not match the topic or which contained information which was not relevant to the topic were excluded. The articles in language other than English were also not selected. After the application of exclusion criteria, inclusion criteria and removal of duplicate articles the total number of articles selected were six. These abstract of these six articles was read thoroughly for checking their relevancy. The selected articles had mixed methodology that is were both qualitative design and quantitative design. This helped in selecting the best articles that had both type of data that is qualitative data and quantitative data both. The process of article selection is explained through the PRISMA chart diagram below:

Prisma Flow Chart

Records identified through database searching
(n = 300)

Additional records identified through other sources
(n = 10)

Records after duplicates removed
(n = 200)

Records screened
(n =200 )

Full-text articles assessed for eligibility
(n = 66)

Studies included in qualitative and qualitative synthesis
(n = 6)

Studies included in qualitative and qualitative synthesis
(n = 6)

The data collection method for various journal articles was done using both inclusion and exclusion criteria. The data analysis was performed together that is the results of different articles were analysed together. The characteristics of the study were analysed along with the qualitative and quantitative information that the articles had.

Results of Systematic Literature Review

The results of different studies are presented in the form of table given below:


Paper 1

Paper 2

Paper 3

Paper 4

Paper 5

Risk of bias

The methodology is survey of people from Brazil, New Zealand and Australia for estimating health inequality of “Indigenous and non- Indigenous people”. High risk of bias because people were randomly selected

The methodology is analysis of data from the 2014 Australian General Social Survey that is used to assess the hypothesis formed. The risk of bias is medium because of the assessment of hypothesis

The methodology adopted is using nationally representative survey of New Zealand, Australia and Canada. There is a high risk of bias in the study because this concentrates on the age and sex of participants.

The methodology adopted in the national survey of Australia which is based on self- reported data on the health care utilization. This creates a high risk of bias because the data is self- reported which cannot be relied on.

The methodology adopted is review of the medical systems’ contribution to health disparities. This is a review of current knowledge on inequality and bias in the health care system that leads to inequalities in the health care.

Study design

Quantitative design

Quantitative design

Quantitative design

Cross sectional study

Qualitative design

Synthesis of results

The findings of this study states that irrespective of the country, “Indigenous people” were the victim of health inequality which was measured in terms of oral health (Schuch et al., 2017). the magnitude of inequality was great and they remain untreated for longest period of time.

The findings of this study states that one of the reason for barrier to health care which results in inequalities is racial discrimination and this was not found to be strongly associated with only low status group of people (Bastos et al., 2018). The racial inequalities contributes to health care inequalities in Australia.

The findings of this study states that the oral health of all the “Indigenous people” of all three countries was fair/ poor as self- reported by them as compared to “non- Indigenous people of all three countries”. This concludes that there exists health care inequalities between “Indigenous and non- Indigenous people of Canada”, Australia and New Zealand (Jamieson et al., 2016).

The findings of this study states that there are high rates of health care inequalities and health status inequalities in the utilization of health care services which is due to the demographic reasons and socio- economic reasons (Jankovic et al., 2018). This should have significant implications for the health policy makers as they should ensure equal care for the people living in this country.

The findings of this study states that as per the modified social ecological model there has been growth in the knowledge of cognitive and psychological processing that judge the bias and racism (Spencer & Grace, 2016). There has been decreased emphasis on the structural, organisational and social factors that contributes to inequalities in health care.


There was age restrictions for becoming the participant in Australia.

The assessment of individual level data was done that does not include all the potential aspects.

This study is secondary data analysis which does not allow them to have all the areas of interest under study.

This is a cross sectional study design that is known to limit the casual interpretation of the findings of the study and this has self- reported data on health care which affects the reliability of the data.

The limitation of this study is that it has reviewed the limited information from the secondary sources that is insufficient to draw conclusion.

Findings of Systematic Literature Review

The findings of different studies will be analysed as per the individual papers. The individual paper will be read for the findings section for drawing an appropriate conclusion. The paper 1 states that Indigenous people of almost all the countries are the victim of health care inequalities. These are the most disadvantaged people because of their social determinants of health like poor housing, poor educational opportunities, low income and discrimination due to which they are unable to access easy and affordable health care services. The ATSI people of Australia are amongst the most disadvantaged ones because of above mentioned reasons and they are also known to have health disparity measured in the terms of dental health (Yap et al., 2018). The findings of the second article reveals that racial discrimination is one of the biggest cause of health care inequalities that is majorly suffered by Indigenous people of Australia. The fear of facing racism and discrimination does not allow these people to access health care services which further leads to inequalities in the health care. The findings of the third article reveals that the there is a significant gap in health care services that are provided to “Indigenous and non- Indigenous people” of different countries and this was drawn on the basis of self- reported dental health of the participants. This study analysed the health status through dental care which represented the health care inequalities that is experienced by “Indigenous people” of different countries. This health disparities in the terms of access to services is explained by article 4 that states that the main reason for this gap in the access to health care service is the demographic reason and socio- economic reason. The findings of article five states that the low level of emphasis when talking about health care inequalities is given to structural factors, organizational factors and social factors as compared to racism. This has a direct impact on the view of inequality in the health care (Hicken et al., 2018).

Discussion on Systematic Literature Review

 The inequalities in health care is still a major concern in many of the countries like Australia despite of governmental efforts like “Closing the gap” and other movements. This is because of some factors like racism, discrimination, social factors like housing, employment opportunities, low income and educational opportunities. The health care inequality exists between “Indigenous and non- Indigenous people of different countries”. This health care disparity is highly prevalent in Australia due to the lower rates of health care access among ATSI people. They do not have access to health care services that are affordable and discrimination free which makes it impossible for them to access such services. This stud majorly analysed the national survey data and concluded that the health care inequalities needs to be addressed to diminish the health disparities between “Indigenous and non- Indigenous people” of the nation.

References for Systematic Literature Review

Altman, J. (2018). Beyond closing the gap: Valuing diversity in Indigenous Australia. Canberra, ACT: Centre for Aboriginal Economic Policy Research (CAEPR), The Australian National University.

Bastos, J. L., Harnois, C. E., & Paradies, Y. C. (2018). Health care barriers, racism, and intersectionality in Australia. Social Science & Medicine199, 209-218.

Hicken, M. T., Kravitz-Wirtz, N., Durkee, M., & Jackson, J. S. (2018). Racial inequalities in health: framing future research. Social Science & Medicine (1982)199, 11.

Jamieson, L. M., Elani, H. W., Mejia, G. C., Ju, X., Kawachi, I., Harper, S., & Kaufman, J. S. (2016). Inequalities in indigenous oral health: findings from Australia, New Zealand, and Canada. Journal of Dental Research95(12), 1375-1380.

Janković, J., Šiljak, S., Erić, M., Marinković, J., & Janković, S. (2018). Inequalities in the utilization of health care services in a transition European country: results from the national population health survey. International Journal of Public Health63(2), 261-272.

Liao, Y., Deschamps, F., Loures, E. D. F. R., & Ramos, L. F. P. (2017). Past, present and future of Industry 4.0-a systematic literature review and research agenda proposal. International Journal of Production Research55(12), 3609-3629.

Martinson, M. L., & Reichman, N. E. (2016). Socioeconomic inequalities in low birth weight in the United States, the United Kingdom, Canada, and Australia. American Journal of Public Health106(4), 748-754.

Schuch, H. S., Haag, D. G., Kapellas, K., Arantes, R., Peres, M. A., Thomson, W. M., & 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), 434-441.

Spencer, K. L., & Grace, M. (2016). Social foundations of health care inequality and treatment bias. Annual Review of Sociology42, 101-120.

Taylor, K., & Guerin, P. (2019). Health care and Indigenous Australians: cultural safety in practice. London: Macmillan International Higher Education.

World Health Organisation. (2020). Health inequality. Retrieved from https://www.who.int/hia/about/glos/en/index1.html

Yap, M., Kok, M. R., Nanda, S., Vickery, A., & Whyatt, D. (2018). Hospital admissions and emergency department presentations for dental conditions indicate access to hospital, rather than poor access to dental health care in the community. Australian Journal of Primary Health24(1), 74-81.

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