Australia, as a developed country, generally enjoys a positive health status. However, statistics show there are a number of priority groups experiencing substantial health inequities, such as The Aboriginal and Torres Strait Islander people (ATSI). In general, they experience lower life expectancy, higher levels of preventable diseases and mental health issues and, are more likely to experience socioeconomic disadvantage.
Research by the Australian Institute of Health and Welfare in 2012 found that the mortality rate of ATSI people is 1.6 times higher than other population groups, with a high incidence of fatal endocrine, metabolic and nutritional disorders. Diabetes, being most prominent, accounted for 7.9% of all ATSI deaths, as opposed to only 2.6% of deaths for Non ATSI people.
This may be attributed to a combination of physical, social and historical factors. The colonisation of Australia disrupted the indigenous lifestyle, leading to a less nutritious diet, reduced levels of physical activity, and an increased use of drugs, alcohol and tobacco.
Infant mortality rates are also higher in Australia’s indigenous population, as indicated in this graph from the Australian institute of health and welfare. There are 6.1 infant deaths per 1,000 live births in ATSI children, compared to 3.3 for Non ATSI.
Most commonly, infant mortality arose from complications during the perinatal period. Malnutrition, tobacco and alcohol consumption during pregnancy and low levels of maternal education being contributing factors.
In addition, There is a 10 year life expectancy gap between ATSI and non-ATSI groups. ATSI people are more likely to die prematurely, as is outlined in this graph, which shows that the number of deaths between the ages of 35-44 are 4 times higher in ATSI populations. High incidence of suicide, injury and poisoning are the main reasons.
Higher Morbidity rates in the ATSI population can be linked with diseases such as Cardiovascular disease, and diabetes. However, mental illness is also a contributing cause. Studies from the Australian Health Performance Framework show that mental illnesses account for 19% of all disease within ATSI people, with twice as many Aboriginal men hospitalised for mental health issues than non Aboriginal men.
Sociocultural, socioeconomic and environmental determinants
To understand the origins of the poor health of Australia’s ATSI population, we need to examine the sociocultural, socioeconomic and environmental circumstances of people’s lives and ultimately their health.
Sociocultural
Sociocultural determinants relate to the way in which ones family and peers influence their level of health, as well as external factors such as the media.
FAMILY
Family is the first and most significant influence in anyone’s emotional and physical health. The colonisation of Australia, and the years of the ‘stolen generation’, dispossessed many indigenous people from lands and family. The trauma can still be seen in the number of mental health issues, violence and dysfunction within families.
Analysis by the Commission for Children and Young People in 2016 found that around 88% of ATSI children in out-of-home care centres were impacted by both family violence and a parent with alcohol and substance abuse issues. Exposure to family violence is categorised as ‘emotional abuse’ by child welfare agencies, and significantly impacts on the mental and social health of children. In many cases, the parents had themselves been removed from their families as children, therefore lacking an understanding of parental guidance and responsibilities.
Media
The media has a powerful role on the emotional health of a population. This is particularly evident in indigenous Australian’s, who are often represented negatively. Sydney University research showed that the most commonly published news stories about Aboriginal health regarded either petrol sniffing, alcoholism or child abuse. This negative portrayal creates a feeling of disempowerment within the indigenous population, and amounts to a feeling of shame attached to being Aboriginal. This feeling of disconnection and disempowerment can effect Indigenous peoples social health status. A recent example of this may be the racially charged abuse aimed at Adam Goodes, largely fuelled by negative media coverage.
Socioeconomic
Education
There remains a gap in HSC attainment levels. Statistics from the ABS in 2016, show only 22% of ATSI students in the Northern Territory had completed year 12. Without the opportunity to complete their education, students will be less informed about threats to their health e.g. smoking, nutrition and alcohol abuse. Therefore, they are more inclined to participate in risk behaviours.
Employment
Closing the gap statistics indicate that the number of ATSI people in the workforce declined in the period of 2006-2016, widening the employment gap by 1.5%. Unemployment, and the financial instability that comes with it, can cause increased levels of stress, anxiety and depression. This can have a negative effect on the emotional and mental health of a person, and increase the likeliness of self-harm and suicide.
Income
In 2013, more than 1/3 of ATSI households were in the lowest income quintile, as opposed to 17% of non ATSI. The higher levels of poverty in ATSI people reduce stability of life, make it harder to access health services, and can lead to rejection, social exclusion and increased levels of stress brought about by having to support a family.
Environmental
A social survey from the ABS showed that 65% of Aboriginals live in rural or remote areas, where health services and institutions are scarce. This graph, collated by the Australian Institute of Health and Welfare, shows that 56% of indigenous Australians did not access health care when in need. This can be attributed largely to the lack of diversified health services in rural and remote areas.
– The roles of individuals, communities and governments in addressing the health inequities
In order to address the health inequities of ATSI people, it is the responsibility of governments, community groups and the individual to collaboratively work together to set policies, educate, support and empower.
INDIVIDUALS
– Through the provision of health education, Aboriginal people are empowered to make informed and healthy lifestyle decisions. In ATSI communities across Australia, trained health professionals work with individuals to provide health education and information on risk behaviours.
COMMUNITIES
– The National Aboriginal Community Controlled Health Organisation (NACCHO) provides aboriginal health services in communities across the country. These are run by local Indigenous members, and aim to provide holistic and culturally appropriate responses to health issues. Ochre Day, a public event, is one such initiative:directed at men’s health in ATSI communities. A public event, Ochre day celebrates the significance of Aboriginal men in family and community life, focusing on their positive roles in society, and encouraging them to live longer and healthier lives for the benefit of themselves and their family.
GOVERNMENTS
Recent ways the government has tried to address the ATSI health inequities are:
- In 2007 the Howard Government’s ‘Northern Territory emergency response intervention’ which was an attempt to protect children from sexual abuse and family violence.
- In 2008, Kevin Rudd made the ‘sorry’ speech to Aboriginal families effected by removal in the Stolen Generation.
- The most recent Government response to ATSI health inequities is the closing the gap campaign, dedicated to reducing the inequality of health and lifestyle.
A CTG priority area is life expectancy. In the period 2006-2016, there was little to no reduction of the 10 year gap. To address this, health programs targeted specifically at the ATSI population have been implemented, e.g. Drug & alcohol intervention, prevention and treatment. As part of the Indigenous Advancement Strategy, the Australian government fund 80 organisations nationally, to provide health services which in turn, lead to longer and healthier lives.
WEBSITES
- https://www.pmc.gov.au/sites/default/files/publications/2017-health-performance-framework-report_1.pdf
- https://www.ourwatch.org.au/MediaLibraries/OurWatch/Images/ourwatch_reporting_on_a-ts_family_violence_aa_v1.pdf
- https://growingupinaustralia.gov.au/research-findings/annual-statistical-report-2016
- https://www.humanrights.gov.au/sites/default/files/document/publication/AHRC_CRR_2017.pdf
- https://www.aihw.gov.au/reports/indigenous-health-welfare/indigenous-health-welfare-2015/contents/life-expectancy-and-mortality-key-points
- https://www.aihw.gov.au/getmedia/cb719825-4e63-468a-bc91-5ba220d98254/18175-chapter6.pdf.aspx
- https://www.aihw.gov.au/getmedia/584073f7-041e-4818-9419-39f5a060b1aa/18175.pdf.aspx?inline=true
- http://www.abs.gov.au/ausstats/abs@.nsf/productsbytopic/880A750EFFDE2611CA2570BF007B1CD4?OpenDocument
- https://www.pmc.gov.au/sites/default/files/publications/indigenous/hpf-2017/tier2/216.html
- https://healthinfonet.ecu.edu.au/healthinfonet/getContent.php?linkid=591745&title=Plain+language+review+of+diabetes+among+Aboriginal+and+Torres+Strait+Islander+people
- https://www.aihw.gov.au/reports/indigenous-health-welfare/health-performance-framework/contents/tier-1/infant-and-child-mortality-measure-1-20
- https://www.pmc.gov.au/sites/default/files/publications/indigenous/Health-Performance-Framework-2014/tier-1-health-status-and-outcomes/121-perinatal-mortality.html
- https://www.uts.edu.au/sites/default/files/FinalCommunityReportBLNov10.pdf
- https://closingthegap.pmc.gov.au/healthy-lives
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