Aboriginal and Torres Strait Islander Health and Cultural Safety

Pre-Invasion Health Status of Australian Indigenous Peoples

Beginning with the clash between Indigenous people and has been a period of misfortune and disaster for them in terms of their health status (Best & Fredericks, 2018). Before the year 1788, all over the continent were 500 language groups in different places, soon after that they were termed as “Aboriginal” or “Indigenous” by the colonisers (Best & Fredericks, 2018). Before 1788, their health status was very good with each group economically independent, sustainable and had balance (Best & Fredericks, 2018). The food through hunting and gathering; wide ranging diet from seasonal farming was rich in nutrients (Best & Fredericks, 2018).

Current Health Status of Australian Indigenous Peoples

Life expectancy for male Indigenous Australian is 80.2 years and for females is 83.4 years (Australian Institute of Health and Welfare, 2020). These numbers decreases as living demographics changed, Indigenous people living in remote and very remote had a life expectancy of 65.9 years for male and 69.6 years for female; similar scenario was seen, where the Indigenous living in less developed socioeconomic areas had a reduction of 4.2 years for males and 3.8 years lower for females and death rates twice as that of non-Indigenous and highest in 65 years and above (Australian Institute of Health and Welfare, 2020).

Assimilation Policy of 1961

The policy of assimilation was enacted with the aim of providing the “Aborigines and part-aborigines” the same rights and privileges as any other Australian with the same benefits enjoyed (Hasluck, 1961). The term citizenship to them was not completely applicable according to the government as they were not able to everything as that of another Australian not protected or assisted in similar manner through the State and Territorial Native Welfare Acts (Hasluck, 1961). The assimilation policy weakened the Indigenous institutions, breaking down their cultural values, and led them into “alcohol and substance abuse” thus negatively affecting their health (Department of Health, 2020).

Australian Indigenous Men in Sport

Racism has roots from the colonial times, and is still present in the Sports world as well (Philpott, 2017). Philpott, (2017) states that most of the problem being faced by the Aboriginals come from the Non-Aboriginals who have different “beliefs and conducts”. The Australian indigenous men involved in sports believe in their own identity and want to display it proudly while playing their respective sports for Australia, even after suffering abuse from the fans as well, ex: in football (Philpott, 2017). Even though the political context has improved somewhat of late, in the earlier times, the Indigenous players had to suffer the racist abuse with no body to complain to and the perpetrators could get away with anonymity and no consequences suffered (Philpott, 2017). In addition to racist remarks, they were often the victim of “hate mail and death threats” (Philpott, 2017). The governing sporting body of Australia realised that without accepting the complaints of the Indigenous players, the notion of a nation which had reconciled with the Indigenous population was false and thus the Australian Football League’s (AFL) added Rule 30 through which the abuse could be reported (Philpott, 2017). Due to the racist remarks, Indigenous males are more likely to indulge in self-harm than their non-Indigenous counterparts, thus affecting their mental health tremendously (Hallinan & Judd, 2009).

The policies enacted hurt them mentally and had a huge impact on their cultural identity (Maynard, 2012). Facing limited opportunities, they had to severe themselves from their ancestral societies, being treated as an inferior race, alcoholic by default leading to them feeling tremendous anguish (Maynard, 2012). Racism leads to mental ill-health, placing a burden on the mental ill health care facilities (Paradies, 2018). Stress from racism leads to a reduction in cortisol levels and diminished response from cortisol which are contributable factors for mental disorders (Paradies, 2018). Racism has led to the aboriginals facing an identity crisis as they lives revolves around their culture and being one with the society (Dudgeon et al., 2010). In the face of racism, they are striving to re-establish their identity by centralizing it with a reinvigorated significance; mainly to be done by recovering, regaining and reconstructing their beliefs (Dudgeon et al., 2010). The indigenous population has a community based identity belief system, and racism through different policies have been a constant hindrance in that (Dudgeon et al., 2010).

Australian Indigenous Pregnant Women

The Australian indigenous pregnant women face racism as a tremendous burden which acts as a barrier, not letting them take proper access to the health care services in a timely and effective manner (Australian Government Department of Health, 2019). Racism leads to the misunderstanding and misinterpreting their culture and identity among the health care workforce and government agencies (Australian Government Department of Health, 2019). Due to this misunderstanding and the statistics which states that the Indigenous children are more in out-of-home care, the pregnant Indigenous mother will have observed by the child protection system and after birth their child being taken away (Australian Government Department of Health, 2019). Less representation of the Indigenous population in the workforce also leads to more misunderstanding and racial stigma (Australian Government Department of Health, 2019). 

Racism is faced by the Aboriginal women during pre and post pregnancy period has led to depression symptoms and substantially their mental health status worsening (Macedo et al., 2020). High stress levels from racism results in the baby being born pre-term, low birth weight thereby increasing the chances of its mortality (Macedo et al., 2020). Racism indirectly affects the child from the mother thorough parenting methods which are insensitive in nature and their emotional needs not getting properly addressed (Macedo et al., 2020). There is loss or decrease in personal control after facing racism, leading to mental and psychological stress during the initial phases of parenthood and leads the mothers to suffer from “depression and anxiety” (Macedo et al., 2020). Loss of personal control leads them to act in a dysfunctional manner and poor decisions which are detrimental for both the mothers and child’s health (Macedo et al., 2020).

The racist stigma faced by the pregnant Australian Indigenous women is that they have more unplanned pregnancies than the non- Indigenous women thereby causing imbalance in the population (Macedo et al., 2020). Often having less resources at their disposal, and the further they stay in remote areas, the less accessible they are to a health care centre, which leads them to be considered as a big factor in the health inequality scenarios (Macedo et al., 2020). The gap present in the difference of Indigenous and non-Indigenous population is not only due to difference in health habits but racist behaviours and attitude towards them also plays a major role (Macedo et al., 2020).

Australian Indigenous Children of Primary School Age

Children facing racism leads to increase in symptoms of high emotions, bad conduct, more hyperactivity and peer group problems (Macedo et al., 2019). “Bullying and discrimination” faced by the Indigenous children is more found in middle school up to secondary school as children younger than that might not have grasped the concept of racism (Macedo et al., 2019). Indigenous children having emotional support from their family members tend to be able to negate this in a more peaceful manner without harming the health (Macedo et al., 2019). Racism is directly associated with mental health disorders, it starts early and has a lasting effect on the Indigenous child’s future health (Shepherd et al., 2017). The Indigenous child’s chances of developing “anxiety, depression, suicide risk and low self-esteem” increase when faced with racism (Shepherd et al., 2017). The perception of racism is understood by the children as they mature, so slightly older Indigenous children have a higher risk of developing mental disorder than a younger Indigenous counterpart (Shepherd et al., 2017).

The perception of racism is high among the Indigenous children population where tin the age of 8-12 years they can grasp the context of racism (Cave et al., 2019). The children faced with racism early had a higher chance of having change in mental health as they are extremely vulnerable psychologically as well as physiologically (Cave et al., 2019). Racism form their peers also has a detrimental effect on their mental health Cave et al., 2019). The level of mental health instability suffered is directly related to how long they have suffered and how much (Cave et al., 2019). Racial discrimination has strong associations with developing health and mental issues later on in life (Cave et al., 2019).

Racism being faced in the school has led to the children doubting their heritage, ancestral culture and ignoring it for a way out of getting discriminated with (Bodkin-Andrews & Carlson, 2016). Along with the school environment, their course also doesn’t contain much information about their history which could be acknowledgeable in the class among their peers (Bodkin-Andrews & Carlson, 2016). Focusing on their own cultural identity had led the Aboriginal children develop their own self-sense, were more diverse, more perceptive in comparison to the non-Indigenous children (Bodkin-Andrews & Carlson, 2016). Epistemological racism in research context has also hampered the understanding of identity in the Aboriginal concept (Bodkin-Andrews & Carlson, 2016).

Registered Nurse, Australian Indigenous Peoples, Close the Gap

I as a working registered nurse taking care of Australian indigenous population in my health care setting will make sure that the centre has enough nurses and other health care work force to deal with population in a fair ratio without compromising on the quality (West, Usher, & Foster, 2010). To focus on “Close the Gap”, through multiple research papers, there is a lot of misunderstanding between Indigenous and Non-Indigenous people and this has severe impact on health care as well (West, Usher, & Foster, 2010). Misunderstanding their culture, identity, behaviours leads to miscommunication and can even lead to a miss-diagnosis harming the Indigenous patient (West, Usher, & Foster, 2010). My role will also be to gather more information, education knowledge and try to relay the information to the rest of the health care facility work force so they can understand how to approach such a patient in a respectful manner; as well their family members (West, Usher, & Foster, 2010).

As an added option, I will advise the hiring committee of the health care facility to hire more Indigenous nurses so the gap can be reduced (West, Usher, & Foster, 2010). Hiring Indigenous nurses in areas from health delivery to research will improve their standing academically and in the socio-economic demographic as well (West, Usher, & Foster, 2010). The poor health status of the Indigenous population is also related to them being faced with racist and discriminatory behaviour throughout their life and hence are reluctant to approach the health care centre, this I will work to ensure there are programs that can improve upon this condition and clear any doubts they have (West, Usher, & Foster, 2010).

To address the difference in low birth weight and premature birth, I will work with the Indigenous nurse who work with me to convey knowledge and information to the pregnant Indigenous women and assure them that attending the prenatal work up is beneficial to both them and their growing child (West, Usher, & Foster, 2010). I will try to establish intervention programs for indigenous children in the school making the other children and the teachers aware of what effect racism and discrimination has on their mental and physical health (West, Usher, & Foster, 2010). With the help of research done on longitudinal studies and their conclusion that early age children facing racist environment either in the family or school will be at a higher risk of developing mental health disorders, anxiety, depression and the most serious self-harm (West, Usher, & Foster, 2010).

Accessing to a health care still remains the highest priority for improving the Indigenous population and for this I will focus on the delving the care of my settings to the available Indigenous population without any racial bias which has shown to be the biggest factor for them not accessing the health care facilities (Cameron et al., 2014).

References for The Impact of Racial Discrimination

Australian Government Department of Health. 2019. Pregnancy care for Aboriginal and Torres Strait Islander Women. Australian Government Department of Health. Accessed on: https://www.health.gov.au/resources/pregnancy-care-guidelines/part-a-optimising-pregnancy-care/pregnancy-care-for-aboriginal-and-torres-strait-islander-women

Australian Institute of Health and Welfare. 2020. Indigenous Life Expectancy and Deaths. Accessed on https://www.aihw.gov.au/reports/australias-health/indigenous-life-expectancy-and-deaths

Best, O. & Fredericks, B. 2018. Yatdjuligin : Aboriginal and Torres Strait Islander Nursing and Midwifery Care. Cambridge, United Kingdom: Cambridge University Press.

Bodkin-Andrews, G., & Carlson, B. 2016. The legacy of racism and Indigenous Australian identity within education. Race Ethnicity and Education, vol. 19, no4, 784-807. doi:10.1080/13613324.2014.969224

Cameron, B. L., Plazas, M. D. P. C., Salas, A. S., Bearskin, R. L. B., & Hungler, K. 2014. Understanding inequalities in access to health care services for aboriginal people: a call for nursing action. Advances in Nursing Science, 37(3), E1-E16. doi: 10.1097/ANS.0000000000000039

Cave, L., Shepherd, C. C. J., Cooper, M. N., & Zubrick, S. R. 2019. Racial discrimination and the health and wellbeing of Aboriginal and Torres Strait Islander children: Does the timing of first exposure matter? SSM - Population Health, vol.9, no 100492. doi:https://doi.org/10.1016/j.ssmph.2019.100492

Department of Health. 2020. Community-based approaches. Accessed on https://www1.health.gov.au/internet/publications/publishing.nsf/Content/drugtreat-pubs-volatile-toc~drugtreat-pubs-volatile-pa2~drugtreat-pubs-volatile-pa2-6

Dudgeon, P., Wright, M., Paradies, Y., Garvey, D., & Walker, I. 2010. The social, cultural and historical context of Aboriginal and Torres Strait Islander Australians. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice, 25-42.

Hallinan, C., & Judd, B. 2009. Race relations, Indigenous Australia and the social impact of professional Australian football. Sport in Society, vol.12, no 9, 1220-1235. doi:10.1080/17430430903137910

Hasluck, Paul. 1961. The Policy of Assimilation: decisions of Commonwealth and state ministers at the Native Welfare Conference, Canberra.

Macedo, D. M., Smithers, L. G., Roberts, R. M., & Jamieson, L. M. 2020. Racism, stress, and sense of personal control among Aboriginal Australian pregnant women. Australian Psychologist, vol. 55, no 4, pp. 336-348. https://doi.org/10.1111/ap.12435

Macedo, D. M., Smithers, L. G., Roberts, R. M., Paradies, Y., & Jamieson, L. M. 2019. Effects of racism on the socio-emotional wellbeing of Aboriginal Australian children. International Journal for Equity in Health, vol.18, no 1, pp. 132. doi:10.1186/s12939-019-1036-9

Maynard, J. 2012. Contested space – the Australian Aboriginal sporting arena. Sport in Society, vol.15, no7, 987-996. doi:10.1080/17430437.2012.723368

Paradies, Y. 2018. Racism and indigenous health. In Oxford Research Encyclopedia of Global Public Health. DOI: 10.1093/acrefore/9780190632366.013.86

Philpott, S. 2017. Planet of the Australians: Indigenous athletes and Australian Football’s sports diplomacy. Third World Quarterly, vol. 38, no.4, 862-881. doi:10.1080/01436597.2016.1176857

Shepherd, C. 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, vol.16, no 1, pp. 116. doi:10.1186/s12939-017-0612-0

West, R., Usher, K., & Foster, K. 2010. Increased numbers of Australian Indigenous nurses would make a significant contribution to ‘closing the gap’in Indigenous health: what is getting in the way?. Contemporary Nurse, 36(1-2), 121-130.

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