Indigenous Health & Cross Culture Care - Nursing Assessment Answer

December 29, 2018
Author : Andy Johnson

Solution Code: 1ACJE

Question: Indigenous Health & Cross Culture Care

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Assignment Task

This essay requires students to examine the concept of culture and discuss how it relates to the social determinates of health, within the Australian context and explore how a Primary Health Care approach can facilitate improved health outcomes for Aboriginal and Torres Strait Islander within the health care setting.

To achieve this students are required to:

  • Critically analyse historical events that have influenced the current health status for Indigenous Australians, including policy (i.e. protectionist, integration, assimilation, segregation, self-management, self-determination).
  • Define and discuss the concept of culture in relation to the social determinates of health
  • Identify the principles of Primary Health Care (PHC) and discuss how they are applied with Aboriginal and Torres Strait Islander specific health care settings (Aboriginal Community Controlled Health Sector).
  • Discuss how an understanding of culture and PHC principles can influence nursing practice.

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Solution:

Introduction

The provision of quality healthcare to the indigenous peoples of Australia such as the Aborigines and Torres Strait Islander has been a challenge to the authorities. There are wide gaps in the provision of healthcare between the indigenous and non-indigenous peoples in Australia. Some of the most pervasive inequalities include lack of equal access to the healthcare services and poor infrastructural standards for healthcare facilities that serve the indigenous communities amongst others.

Historical Events

One of the determinants of the nature and quality of healthcare is the prevalence of suitable physical environments. Historically, poor physical environments have been imposed to the aboriginal and Torres Strait Islander people of Australia in clearly schemed processes of dispossession of traditional territories and settlement structures. The results of these dispossessions have been poor quality housing and perennial and significant housing shortages. Also, lack of affordable housing coupled with these challenges has led to overcrowding amongst these traditional communities, especially those that reside in urban areas (Otim, Asante & Kelaher, 2015). Most of the traditional communities i.e. Aborigines and Torres Strait Islander reside in on-reserve homes that are poorly ventilated and overcrowded. It results to growth of molds in the houses that culminates to diverse health conditions such as asthma and allergies, especially amongst the children.

The traditional communities living in the rural area also face persistent food security challenges related to lack of sustainable markets and traditional foods. Due to transportation costs, healthy and nutritious foods available to other communities remain out of reach to most of the rural communities. It leads to vicious cycle of poverty coupled with other challenges such as poor sanitation and lack of clean water supplies that further places a risk on the health of these indigenous communities.

The colonization of the indigenous communities imposed a system of systemic racism and discrimination that denied the indigenous communities the resources and means to maximize their social economic status. There are pervasive rates of unemployment, poor educational standards and high illiteracy levels amongst these communities. These challenges have led to low employment and income levels amongst these communities. It has, therefore, become arduous for these communities to afford nutritious and balanced diets leading to the onset of deficiency diseases such as kwashiorkor, marasmus, and anemia amongst the children.

Other diseases such as diabetes, cardiovascular and renal illnesses are prevalent across all ages. Also, due to social exclusion and poverty, there are high rates of psychosocial stress, drug addiction, low self-esteem, anxiety and mental illnesses amongst these communities due to a general feeling of hopelessness amongst the majority. It makes the communities vulnerable to poor mental health, usually evident through depression, substance abuse and high blood pressure.

The lack of education amongst the indigenous communities of Australia has led to poor lifestyles. Inadequate education has made these communities suffer poor literacy thereby limiting their knowledge on property food nutrition due to lack of understanding of balanced diets and healthy living. The lack of education also diminishes any opportunities to access well-paying jobs thereby creating a fertile ground for family instability through divorce that leads to single parenthood and orphans due to neglect.

The adoption of various policies and laws has also shaped the current health status of the traditional communities. The protectionist policies such as the Aborigines Protection Act of 1897 and others adopted by the colonists between 1880 and 1950s entrenched a system where the Aborigines were classified and treated as minors. The welfare of the Aborigines in each state was put under a guardian (Waterworth, Pescud, Braham, Dimmock & Rosenberg, 2015). It is the guardian that was responsible of the educational and health welfare of the indigenous communities. The policy also promoted the removal of half-caste children from their aboriginal mothers so that they would be brought up by the whites. The protectionist policy meant the traditional communities had no say in their health affairs due to exclusion from decision-making.

Assimilation policy was later adopted in the 1950s to 1968 where aborigines were required to change their culture and become culturally and also socially white. The policy led to the destruction of the culture of the indigenous communities that made them disenfranchised and disconnected to their surroundings. The policy was ridden with protests since most of the aborigines were still excluded from mainstream policy and decision-making. It meant they still had no control over their health, education and other social needs. The prevalence of stereotypes on indigenous communities persisted and social exclusion remained visible as the indigenous communities could not interact with the whites.

Integration policies were implemented in 1967 up to Whitlam years through a referendum where the culture of the aborigines was recognized. However, the indigenous communities were supposed to adopt the lifestyles of the whites and maintain some of their traditional practices. However, retrogressive behaviors by the whites such as taking children away from their aboriginal mothers persisted and social exclusion was still prevalent.

Self-determination policies were adopted by the Whitlam government where the indigenous communities were expected to govern themselves. Their independence was recognized through government funding with the formation of organizations such as the Aboriginal Torres Strait Islanders Commission to advocate for their grievances. It is at this level where the indigenous communities were involved in making decisions on matters affecting their lifestyles including health.

The self-management policies were later adopted where the indigenous communities managed government projects and also their funding. However, these indigenous communities had no say on the projects to be created or prioritized. It meant key health aspects such as the development and equipping of health infrastructures for the indigenous communities was still under the control of the whites.

The Concept of Culture in Relation to the Social Determinates of Health

Some of the main social determinants of health include factors such as income levels, levels of education, the social and physical environments where people live and the availability of social support services. Amongst indigenous communities, the concept of culture facilitates a wider analysis of these factors so as to include aspects such as cultural continuity, and response to colonist ideals. It also addresses the responses to aspects such as globalization aimed at reducing the levels of diversity as it is easier and also cheaper to offer services and goods to a uniform and single market.

Cultural competence is a vital aspect in the provision of healthcare as it ensures the healthcare procedures and processes are tailor-made to suit the culture of the people being served. Such efforts enhances the levels of cultural safety where, for instance, the health services are provided in the patient’s native language and in ways that accord respect to the traditional beliefs, norms and values of the community (O'Sullivan, 2012). Such efforts ensure the social and physical environments adhere to such norms and beliefs. It increases the level of willingness of the community being served to seek healthcare services in the established institutions within the community due to low levels of apprehension.

The culture of a nation can either promote or perpetuate aspects of social exclusion or inclusion. Cultures that advocate for the exclusion of minorities lead to the prevalence of poverty and income inequalities between the minorities and the majority. Such realities limit the opportunities available to the minorities relating to access to education and employment opportunities. It becomes difficult for such minorities to access better housing and health services thereby exposing them to poor living conditions and opportunistic infections and diseases.

A stronger connection of individuals to their culture promotes the creation of collective identities, a higher sense of self-esteem and increased resilience. Cultures promoting resilience ensure their members are willing to thrive in the face of adversity. Such communities experience better outcomes in relation to most of the social determinants of health like education, income and employment levels. Resilience also promotes social cohesion and economic stability due to absence of wars and conflicts that are crucial to improved health and living standards.

A strong culture is also the foundation of the protection and preservation of traditional knowledge and kinship ties that are vital in enhancing the level of cultural continuity and cohesion. Such cultures promote policies such as child nutrition and protection, mental health, counseling and psychosocial support.

Principles of Primary Health Care (PHC) and Application amongst Aboriginal and Torres Strait Islander

One of the principles of primary healthcare is accessibility. The primary healthcare services should be available to all individuals regardless of their ethnic or racial affiliations. To enhance accessibility of primary healthcare services amongst the Aboriginal and Torres Strait Islander, the authorities have devised policies to ensure the genuine involvement of these indigenous communities. Such involvement has seen the adoption of collaborative efforts where primary healthcare providers work with other service sectors like community health organizations, housing and linkages with health specialists (Percival & O'Donoghue, 2016).

The involvement of other sectors through such collaborative relationships has also enhanced the other principle of community or public participation. There are multidisciplinary approaches that have been adopted to facilitate the employment of the local Aborigines and Torres Islander people in healthcare settings. Such programs also promote the provision of support and continuous training to enhance the levels of involvement.

Another principle is the promotion of health opportunities where focus on socio-economic conditions is critical to promoting health. The authorities devote substantial budgetary resources towards prevention and management of non-acute conditions amongst the indigenous communities. It has led to delivery of key projects such as maternal child healthcare programs.

The other principle is ensuring appropriate use of technology. There has been the development of evidence-based processes towards detection and control of health using culturally acceptable procedures. The indigenous communities are being trained on health technologies that are feasible and affordable amongst the majority thereby enhancing continuous integration.

How an Understanding of Culture and Primary Health Care Principles can Influence Nursing Practice

Cultural competency and sensitivity is vital for nurses as it enhances their sensitivity to the beliefs, norms and values exhibited by individuals from other cultures. The knowledge of other cultures, therefore, enhances the level of patient satisfaction and willingness to seek health services as they perceive the nursing services as being offered with dignity and respect (Hunt & Ramjan, 2015). Such willingness is crucial to enhancing accessibility to care since the patent perceives the nurse as one of their own due to cultural competency and sensitivity.

The knowledge of the culture and the public health principles is also vital in promoting the role of nurses as being change agents at various levels of the healthcare system. It ensures nurses can work with diverse communities across different geographical settings. They can also nurture relationships with other professionals across regions. Such relationships are crucial to the elimination of barriers that persist in most healthcare settings due to poor resource utilization amongst other factors. The understanding of culture is also necessary to the provision of a wide range of service alternatives and treatment modalities. Such modalities accord credence to the traditional worldviews and belief systems within a community and are crucial to sustaining public participation and collaboration between communities and nursing professionals.

Conclusion

The colonization of the indigenous communities in Australia led to social exclusion and dispossession of property that limited their access to basic health facilities. Their classification as second class citizens and lack of equitable access to opportunities like education and employment made these communities unable to directly control the determinants of health. Lack of access to education limited their employability and access to better incomes. It led to the prevalence of low self-esteem and poor lifestyles. Most of these lifestyles were riddled with poor housing and overcrowding where basic amenities such as clean water, sewerage and balanced diets were nonexistent. Also, most of their societies lacked support services due to poor social networks. It led to prevalence of controllable diseases caused by malnutrition and psychological stress. Most of the adults in these communities suffered depression as they witnessed most of their lands being taken away and their relegation to being homeless and destitute. However, through the current efforts to enhance inclusion of these communities in their healthcare policy development and activities, there is a hope that there will be a cultural change that will guarantee equity in access to opportunities.

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