Social, Behavioural and Cultural Factors in Public Health 

Introduction to Health Inequities between Indigenous and Non- Indigenous Australians

Inequalities among Indigenous and non-Indigenous health isunacceptably wide in Australia.Indigenous Australians face major health issues compare to non-Indigenous Australians. These disadvantages refer to shorter life span, poor health, infant mortality, lack of education and unemployment. From birth of child, Indigenous Australians have short life span than others. This may also cause social, cultural and economic issues related to health (Taylor&Guerin, 2019). Social determinants which have negative impact on Indigenous Australians includes racism, stolen generations (children eliminated from their own families), Indigenous women as criminals, and reconciliation. Mental health issues and suicide are the major concern to health of Indigenous Australians. The factors that affect the indigenous Australians health mainly depends on the social disruption, political forces, behaviour, and economic conditions. Due to these issues of Indigenous health inequities, Australia is behind other developed colonial countries. However, Aboriginal Community Controlled Health Services (ACCHS) were introduced for the distribution of holistic primary health care (PHC) to indigenous Australians. ACCHS is proved to increase positive outcomes of Australians health issues, by providing them models of care. These services include the consistent meeting to the individual, providing services to people of outer region areas, and record superior performance. ACCHS provides a general practice model to deal with health issues of Indigenous Australians, called as patient-centred medical home (PCMH) model. This service delivers people quality care, workforce education and training when they are in need of health care and take responsibility of their PHCservices(Waterworth et al., 2015).

Part 1: Social, Economic, Political Forces Contributing to Health Disadvantages Experienced by Indigenous Australians

The factors that contribute towards the health difficultypracticed by Indigenous Australians are poorly understood. However, according to a research the health behaviour is influenced by those factors which are beyond the control of individual, such as social disruption, economic and political forces (Taylor and Guerin, 2019). Indigenous Australians health is majorly affected by different factors such as social networks, racism, psychological stress, culture and tradition, socioeconomic issues and political factors.The health disparity among Australian Indigenous and non-Indigenous people include low health standard and absence of primary health care, such as access to healthy behaviour, sanitation and food compare to other people of Australia (Davy et al., 2016). Economic status of individual is also decreasing due to unemployment and poverty, which is also associated with poor health of an individual.When people started living in Australia, differences based on their religion is prevalent. Indigenous Australians were forced to stay in the area where they have no freedom to get socialise, even marriage is also restricted for them. They are not free to teach their children about history and traditions, or practice traditional language and cultures. The change in social and cultural behaviour during colonisation leads to loss of freedom and life of individuals. The socio-economic behaviour is also influenced due to unemployment and financial crisis, which thoroughly affects the health behaviour because of psychological stress. These issues rise the suicide or alcohol consumption among people to cop-up with the situation (Harrison et al., 2019).Chronic stress among people have severe adverse effects on person’s immune system and circulatory system. The inequality and discrimination among citizens reflect their health status. Health problems arise due to improper functioning of metabolic pathways, or mental disbalance (Boffa et al., 2018).Inequality of policies distribution among Indigenous Australians are the major political issue emerging which affect health of people over there. Indigenous Australians have asubstantial gap in life, short life expectancyand higher rates of chronic disorders. Cardiovascular disorders contribute majorly (23%) in health issues among Australian Indigenous and non-Indigenous people, corresponding to other diseases like diabetes (12%), psychological illness (10%), and longer breathing disorders (9%). From 2008-2012 studies, it has been concluded that there are three main reason of death in Indigenous Australians, they are cardiovascular disorders (25%), cancer (20%), and external injuries or poisoning or suicide (15%)(Guillemin et al., 2016).

Social and economic issues such as unemployment destroy the available financial resources for funding those who are in need of health care. Health behaviour of an individual can also be affected by living in an overcrowded area or with improper housing facilities. This may adversely affect their nutrition and health. The economic crisis or unemployment risks their health by increasing stress among people. This will further lead the person to make use of alcohol and smoke for overwhelming the situation (Freeman et al., 2019).Political issues are the inequalities in health policies, which cause unequal distribution of resources between Indigenous and non-Indigenous Australians. This shows the failure of political forces as they are not able to provide equal health policies for well-being of Indigenous Australians. It is high time to change the governance or make them aware about health policies and leadership in Australia (Lee, 2017). However,reports indicate that interactions among Indigenous and non-Indigenous Australians will affect the health behaviour positively. By getting more interactions, people will get practical support, information and encouragement that will help improving their health issues (Australian Institute of Health and Welfare, 2016).

Part 2: The Role of ACCHS in Reducing Health Inequities 

Australia has poor health records with its past history of colonisation.Australian history suggest that the Indigenous health is used by non-Indigenous people to explain the racism and exploiting working conditions. Indigenous Australians people are considered to be the poorest health people. To maintain their health status, healthcare and action on socio-economic determinants are needed. Around 40 years ago, Aboriginal Community Controlled Health Services (ACCHS) model comes in Australia. ACCHSs provides comprehensive and cultural primary health care (PHC) services to Indigenous Australians to encounter their requirements of health services. This approach will further improve the health of Indigenous Australians by providing them employment, training, community-controlled governance, appropriate health system and PHC (Campbell et al., 2018). ACCHS helps to solve the socio-political and economic issues addressed by the aboriginal people of Australia.The PHC model is critical to Australia’s health system with several advantages like comprehensive multidisciplinary service, options for community involvement, greater scope of cultural respect, intersectoral collaboration on social determinants, and accessibilitystrategies (Coombs, 2018).

The differences created between Indigenous and non-Indigenous Australians is the core business of ACCHS sectors. The reason of development of ACCHS are the Indigenous people of Australia who have health issues due to colonisation. ACCHS provides primary health care for Indigenous Australians to access high quality care delivered by health professionals. There are 3 major goals of PHC, that is to progress healthcare services, excellence of services and health of the individual.ACCHS is developed for indigenous individuals because their health status is more complex than non-Indigenous people. The role of ACCHSs isto reduce health disparities by providing them training and knowledge. There are several benefits of ACCHSs for Indigenous Australians including anti-racism, models of care, and accountability to translate healthcare services to practice. Evidence suggests that ACCHSs offer significant advantages over mainstream PHC in regard to accessibility and quality of care for indigenous Australians (Freeman et al., 2016). ACCHSs contribute towards better results among Indigenous Australians health, by providing them proper healthcare services.These improved health outcomes by ACCHSs can contribute towards reducing health inequities. Although, there are some barriers for ACCHSs in reducing health inequities and limitations for health services on taking action to address a range of broad ‘upstream’ determinants of health. The Government funding for ACCHSs, high cost of healthcare, poor communication, and experiences of racism, are the barriers for Indigenous Australians healthcarefacilities (Panaretto et al.,2014).

Conclusion on Health Inequities between Indigenous and Non- Indigenous Australians

Overall, this essay points out on the differences and racism between Indigenous and non-Indigenous Australians. It highlights the challenges faced by Indigenous and Non- Indigenous Australians due to these culture intersections. Health of Indigenous Australians is affected by the social, economic and political forces as discussed earlier. Social factors include the behaviour among people of Indigenous society of Australia, economic issues like unemployment and poverty. Political forces include the inequality in policies for Indigenous and non-Indigenous Australians.Conversely, this report also highlights about the benefits of ACCHSs as a model of PHC delivery for Indigenous Australians.This model helps the Indigenous Australian community to improve health behaviour and reduce the empowerment and inequities among people of Australia. The data collected by ACCHS is used to ensure the best possible evidence-based services. They also maintain electronic health records for better services and outcomes.Although, there are several limitations faced by ACCHSs in being able to reduce health inequities.The potential barriers for Indigenous Australians health care services are the Government funding for ACCHSs, high cost of healthcare, poor communication, and experiences of racism. The government have to be awake regarding this concern and acknowledge and support ACCHS for primary health care of Indigenous Australians.

References for Health Inequities between Indigenous and Non- Indigenous Australians

Australian Institute of Health and Welfare (2016). Healthy Futures—Aboriginal Community Controlled Health Services: Report Card. Cat. no. IHW 171. Canberra: AIHW

Boffa, J., Tilton, E., & Chee, D. A. (2018). Preventing alcohol-related harm in Aboriginal and Torres Strait Islander communities: The experience of an Aboriginal Community Controlled Health Service in Central Australia. Australian Journal of General Practice,47(12), 851-854. DOI:10.31128/ajgp-08-18-4661

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 evidencereview. Australian Health Review,42(2), 218. DOI:10.1071/ah16149

Coombs, D. (2018). Primary Health Networks’ impact on Aboriginal Community Controlled Health Services. Australian Journal of Public Administration,77(S1). DOI:10.1111/1467-8500.12357

Davy, C., Harfield, S., Mcarthur, A., Munn, Z., & Brown, A. (2016). Access to primary health care services for Indigenous peoples: A framework synthesis. International Journal for Equity in Health,15(1). DOI:10.1186/s12939-016-0450-5

Freeman, T., Baum, F., Lawless, A., Labonté, R., Sanders, D., Boffa, J., Edwards, T., &Javanparast, S. (2016). Case Study of an Aboriginal Community-Controlled Health Service in Australia: Universal, Rights-Based, Publicly Funded Comprehensive Primary Health Care in Action. Health and human rights18(2), 93–108.

Freeman, T., Baum, F.,Mackean, T., Ziersch, A., Sherwood, J., Edwards, T., &Boffa, J. (2019). Case study of a decolonising Aboriginal community controlled comprehensive primary health care response to alcohol‐related harm. Australian and New Zealand Journal of Public Health,43(6), 532-537. DOI:10.1111/1753-6405.12938

Guillemin, M., Gillam, L., Barnard, E., Stewart, P., Walker, H., & Rosenthal, D. (2016). “We’re checking them out”: Indigenous and non-Indigenous research participants’ accounts of deciding to be involved in research. International Journal for Equity in Health,15(1). DOI:10.1186/s12939-016-0301-4

Harrison, K. H., Lee, K. K., Dobbins, T., Wilson, S., Hayman, N., Ivers, R., . . . Conigrave, K. (2019). Supporting Aboriginal Community Controlled Health Services to deliver alcohol care: Protocol for a cluster randomised controlled trial. BMJ Open,9(11). DOI:10.1136/bmjopen-2019-030909

Lee, V.S. Political determinants and Aboriginal and Torres Strait Islander women: don’tleave your integrity at the political gate. (2017). Journal of Public Health Policy, 38,387–393. DOI: 10.1057/s41271-017-0075-y

Panaretto, K. S., Wenitong, M., Button, S., & Ring, I. T. (2014). Aboriginal community-controlled health services: Leading the way in primary care. Medical Journal of Australia,201(2), 91-91. DOI:10.5694/mjac13.00005

Taylor, K., & Guerin, P. (2019). Health care and Indigenous Australians: Cultural safety in practice. London: Red Globe Press.

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). DOI:10.1371/journal.pone.0142323

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