Aboriginal and Torres Strait Islander Health and Cultural Safety 

It is quite an impossible task to understand the current health status of Australian indigenous people without going through the history of the Australian indigenous people before the invasion. When focusing on the pre-invasion status it has been evidently seen in the study presented by Shepherd, Li & Zubrick, (2012) that the health care systems unquestionably used to function with a social system that was totally based on the three categories of inter-relationships. The first one was between the people and the land; the second was between the people and creator beings; and the third one was between the people itself. To understand the pre-invasion better it is important to understand the hindrance created by the British contact onto the self-esteem of the Australian Indigenous people. Although the Australian Indigenous medical practices required, and maintained to seek, significant justification for the illness and to answer to the individual, family, as well as the community issues that are produced by the illnesses (Shepherd, Li & Zubrick, 2012).

Many Indigenous Australian people experience shoddier health than the non-indigenous Australians. Alcohol, smoking, and other illicit substances have been widely used by the Australians; this plays a major role in the gap between non-Indigenous and Indigenous Australians people whenever it comes to the health and life expectancy (Waterworth et al., 2015). In the current situation, The Australian Government has designed a plethora of the initiatives in order to provide improved access for the Indigenous Australian people to the health services. These services will help in increasing the life expectancy among them and will help in reducing the child mortality. The services include improved access to the medicare as well as the medicines, coordinated care for the Indigenous Australians people with chronic conditions, and free immunizations (Waterworth et al., 2015).

The assimilation policy of 1961 was a policy of engrossing the Indigenous Australians people into the white society by the means of eliminating children from their families. The eventual intent regarding this policy was the obliteration of Indigenous Australians people. From this period of time the board considerably augmented the already recognized practice of eliminating Indigenous Australian children with those that had fair skin, that were referred as the 'part Aboriginal' or 'half-caste', from their families. At that time the children were located in the institutions where they were taught to take their position in the white society (The Policy of Assimilation, 1961).

Racism could be defined as a prearranged system within the society that leads to certain unnecessary and inequitable inequalities across the racial or ethnic groups in terms of power, capacities, resources, and opportunities. Racism can manifest through beliefs, stereotypes, prejudices or discrimination. It is considered to be as a key determinant of health for the Australian Indigenous men in sport that might elucidate about the unrelenting gap in health as well as the socioeconomic outcomes (Paradies et al., 2015). People consider sport as the mirror of many other things. Sport is a field where nobody wants see any type of discrimination neither on the basis of race nor on the other. But, sport had become one of the measure of Australian racism. Any form of discrimination results into distress that often leads to the depression as well as anxiety. Racism in the field of sports also affects the mental health of the men in a similar way (Tatz, 1995). In a survey on around 755 Australian indigenous people who have been facing racism , more than 47 % of the men in sport face racial discrimination and often remain distressed about the same, The findings has also shown that almost 79 % of the Australian indigenous people that participated in the survey has revealed that they themselves avoid to take participate in some settings to limit their personal exposure to racial discrimination. This means they find themselves unable to participate equally, freely, and safely in some aspects of the community life (VicHealth, 2012). Racism is directly associated with the poor mental health as well as reduced life chances for the Australian Indigenous. When an individual does not get served what he deserve he often feel distress. Similarly, being good at sports and still not getting opportunities to participate or even if they participate somehow affects their mental health by racism. Being bullied and harassed by the other team mates, not getting equal chances to play, and being discriminated by the coaches are some of the ways racial discrimination bothers them. This places them at a high risk of mounting mental health problems (Tatz, 1995). The majority of the participants has not just experienced emotional racist attacks but has also experienced physical racist attacks. These attacks include assaults and these assaults have exposed them towards the high risk of injury as well as psychological distress. The psychological distress and even disorders faced by them includes depression, anxiety, suicidal thoughts, and bipolar disorders. However, reducing the experiences of racial discrimination is considered as one of the important approach in order to improve the health of the men in sport. There would be certain guidelines form the government that should be followed to avoid such incidences (VicHealth, 2012).

Another most vulnerable group that often face racism and this affect them adversely are the Australian Indigenous Pregnant Women. The physical health of them as well as of their unborn baby is affected because of the racism. In a study by Macedo et al., (2018) it has been stated that racism is considered to be one of the psychosocial reasons behind the poor physical and mental health among the Australian Indigenous pregnant women. The policies of Societal-level intended at both the christening as well as dropping the institutionalized racial discrimination against the Australian Indigenous pregnant women are necessary. According to Paradies et al., (2015) racism has also been linked with the deprived psychological health outcomes, such as stress, depression, suicide ideation, anxiety, and suicide attempts. It also tends to diminish the stages of self-esteem along with the sense of personal control. Along with the harmful effects to the health and wellbeing of the Australian Indigenous pregnant women and their unborn baby, the effects of the stressors during the pregnancy adversely affect the mother's health during the time of labour, delivery, and even in the development of the child. Exposure to racial discrimination during the pre-natal and post-natal period in a woman’s life is directly associated to the depressive indications and a deteriorating physical health among the expected mothers that belongs to the ethnic minority groups along with the high stress levels during pregnancy. The physical impact is also associated with the preterm birth of the babies, lesser birth weight in the infants, this can potentially impact on the long term development of an infant (Alhusen, Bower, Epstein, & Sharps, 2016). Maternal exposure to the racial discrimination can also directly affect the socioemotional development of the child. The indicators such as hyperactivity, conduct problems, peer problems, negative emotionality, and inhibition/separation problems adversely affect the child growth (Rosenthal et al., 2018). Screening for the provision of health support to the Australian Indigenous pregnant women during pregnancy and the planning and testing of the interventions as per their cultural values will help in reducing the impact of psychosocial stressors along with increasing the self-empowerment (Prandl, Rooney & Bishop, 2012). Culturally sensitive as well as culturally safe interventions could be beneficial in buffering the racism that adversely affects the mothers and their unborn babies during pregnancy (Priest, Perry, Ferdinand, Kelaher, & Paradies, 2017).

The third group of population is the Australian Indigenous children of primary school age i.e., 5-10 years of age. Racial discrimination has also been seen among the primary school age group of children and it affect their neurological health as well as their developing identity. To support this, a study was conducted by Shepherd et al., (2017) which says that the racism is directly linked with the neurological health as well as the aspects of physical health of the Australian Indigenous children. The extent of the mounting risk for the neurological health has suggested that the exposure of Australian Indigenous children to racism is directly associated with the doubling-up of the risk of developing neurological health issues. This includes a wide range of neurological health outcomes, such as depression, anxiety, low self-esteem, suicide risk, as well as overall cognitive health status. Not only this but, the children exposed to racism has also faced conduct problems such as emotional outburst, rule breaking, defiant behavior; hyperactivity such as impulsivity, inattention, restless; and certain peer problems that encompasses of the relationship of the Australian Indigenous children with other children, they often experience of being bullied. Australian Indigenous children experience considerable disadvantage even in the educational premises as compared with the Australian non-Indigenous children (Schmitt et al., 2014). This disadvantage is linked with historical racism, colonisation, contemporary racism, and oppression. The current data of the Australian population has indicated that 27% of the Australian Indigenous children aged from 5- 15 years has been reported experiencing the issues of racism in their previous 12 months. The evidences has also indicated that the difficulties with psychological health that has been developed in the early stage of life are expected to persevere and have an adverse impact on the educational, social, as well as health outcomes in the succeeding years. In addition to this, there is significant evidence that deprived parental psychological health chiefly maternal psychological health (that has been exposed to racism during pregnancy) is related with the poor developmental identity, health as well as the wellbeing outcomes for children (Shepherd et al., 2017).

Cultural safety has been established in the context of “Australian Indigenous people” and is measured to be the preferred phrase for the midwifery and nursing. It is approved by the legislative body of the Australian Indigenous Nurses and Midwives, who have been highlighting that the cultural safety must be considered as significant to quality care as the clinical safety (Brooks-Cleator, Phillipps & Giles 2018). As a registered nurse I would work with the goal to achieve the cultural safety while providing the care to the Australian Indigenous young people. In order to achieve this I would first make myself aware of the patient’s culture and that will understand the cultural sensitivity of the community. By taking consideration on both of them Cultural safety could be attained. There would be three steps that I will follow to during the provision of care to the Australian Indigenous young people. The first step would be performing a cultural competence self assessment. This will include the determination of my own strengths as well as weaknesses when it comes to providing care to the Australian Indigenous young people. This would help me in improving my cultural competence. The second step I would take would be focusing on the communication with the patient in order to remove the language barrier. As the beliefs and values of a particular cultural group are entrenched within their utilization of language use; thus, language would become a key to access the patient satisfaction. It would be best if I would be able to speak patient’s language or if this won’t be possible then, I will find a translator that will help me to communicate with the patient that have limited English proficiency. Improving the communication with my patients will ultimately help me in reducing the language barriers. The third step would be engaging in the cross-cultural interactions with the Australian Indigenous young people. Understanding and acknowledging the patient’s autonomy and the significance of share-decision making would help in fostering the health of the patient. The practice of community engagement will be a major step as it has the potential to avoid the stigma among the patient, as these practices have been representing for capitulating the sustainable outcomes that will be on the basis of the potency of Australian Indigenous young. This would be a step that can be considered as a scale that begins from informing the patient, consulting him, involving him in important decisions regarding his nursing interventions, and collaborating in order to empower him (Liaw et al, 2011).Community engagement will result in collaboratively working, this will help in developing a partnership with Australian Indigenous young people by engaging them. Making commitments as well as establishing agreements will help in increasing the literacy and numeracy among the patient (Durey et al, 2016).

References for Racism as A Determinant of Health

Alhusen, J. L., Bower, K. M., Epstein, E., & Sharps, P. (2016). Racial discrimination and adverse birth outcomes: An integrative review. Journal of Midwifery & Women's Health, 61(6), 707–720. https:// doi.org/10.1111/jmwh.12490

Brooks-Cleator, L., Phillipps, B., & Giles, A. (2018). Culturally safe health initiatives for indigenous peoples in Canada: A scoping review. Canadian Journal of Nursing Research, 50(4), 202–213. https://doi.org/10.1177/0844562118770334

Durey, A., McEvoy, S., Swift-Otero, V., Taylor, K., Katzenellenbogen, J., & Bessarab, D. (2016). Improving healthcare for Aboriginal Australians through effective engagement between community and health services. BMC Health Services Research, 16, 224. https://doi.org/10.1186/s12913-016-1497-0

Liaw, S. T., Lau, P., Pyett, P., Furler, J., Burchill, M., Rowley, K., & Kelaher, M. (2011). Successful chronic disease care for Aboriginal Australians requires cultural competence. Australian and New Zealand Journal of Public Health, 35(3), 238-248. https://doi.org/10.1111/j.1753-6405.2011.00701.x

Macedo, D. M., Smithers, L. G., Roberts, R. M., & Jamieson, L. M. (2019). Racism, stress, and sense of personal control among Aboriginal Australian pregnant women. Australian Psychologist: Wiley, 55(4), 336-348. https://doi.org/10.1111/ap.12435

Paradies, Y et al., (2015). Racism as a determinant of health: A systematic review and meta-analysis. PLoS One, 10(9), e0138511. https://doi. org/10.1371/journal.pone.0138511

Paradies, Y., Ben, J., Denson, N., Elias, A., Priest, N., Pieterse, A., Gupta, A., Kelaher, M., & Gee, G. (2015). Racism as a determinant of health: A systematic review and meta-analysis. PloS One10(9), e0138511. https://doi.org/10.1371/journal.pone.0138511

Priest, N., Paradies, Y., Stewart, P., & Luke, J. (2011). Racism and health among urban Aboriginal young people. BMC Public Health, 11, 568. https://doi.org/10.1186/1471-2458-11-568

Priest, N., Thompson, L., Mackean, T., Baker, A., & Waters, E. (2017). Yarning up with Koori kids'—hearing the voices of Australian urban Indigenous children about their health and well-being. Ethnicity and Health, 22(6), 631–647. https://doi.org/10.1080/ 13557858.2016.1246418

Rosenthal, L., Earnshaw, V. A., Moore, J. M., Ferguson, D. N., Lewis, T. T., Reid, A. E., … Ickovics, J. R. (2018). Intergenerational consequences: Women's experiences of discrimination in pregnancy predict infant social-emotional development at 6 months and 1 year. Journal of Developmental and Behavioral Pediatrics, 39(3), 228–237. https://doi.org/10.1097/DBP. 0000000000000529

Schmitt, M. T., Branscombe, N. R., Postmes, T., & Garcia, A. (2014). The consequences of perceived discrimination for psychological well-being: A meta-analytic review. Psychological Bulletin. 140(4), 921–948. https://doi.org/10.1037/a0035754

Shepherd, C. C., Li, J., & Zubrick, S. R. (2012). Social gradients in the health of Indigenous Australians. American Journal of Public Health102(1), 107–117. https://doi.org/10.2105/AJPH.2011.300354

Shepherd, C. J., Li, J., Cooper, M. N., Hopkins, K. D., & Farrant, B. M. (2017). The impact of racial discrimination on the health of Australian Indigenous children aged 5–10 years: Analysis of national longitudinal data. International Journal for Equity in Health, 16. doi 10.1186/s12939-017-0612-0

Tatz, C. (1995). Racism and Sport in Australia. Race & Class, 36(4).

The Policy of Assimilation. (1961). Decisions of commonwealth and state ministers at the native welfare conference, Canberra, January 26th and 27th, 1961.

VicHealth 2007, Mental health impacts of racial discrimination in Victorian Aboriginal communities, Melbourne. Victorian Health Promotion Foundation, Australia.

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): e0142323. https://doi.org/10.1371/journal.pone.0142323

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