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Indigenous Health Disparities
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Introduction
According to the World Health Organisation (WHO, 2012) over 350 million people
worldwide are affected by depression. Depression often starts in youth and can impact on
person’s wellbeing for the rest of their life (WHO, 2012). Current research shows that young
women experience a high rate of depression, and that depression can be related to many
factors such as genetics, family circumstances and particularly if living with violence (Rees,
Steel, et.al. 2014; Artz, Jackson, et.al, 2014; Buzi, Smith, et.al, 2015). Domestic violence
can be prevented (Graffunder, Noonan, et al., 2004).
This report will examine the relationship between the prevalence of depression in
relation to family violence for young people and offer a school-based public health
intervention to address this issue. A socio-environmental framework will be used, and gender
will be examined using a participatory model (Baum, 2008).
Strong community partnerships will be built and developed during the planning and
delivery of this project. It is hoped that such partnerships will also build trust and
cooperation in the community (Baum, 2008).
The ‘Expect Resect’ Calendar Project for Year 6 students - A Pilot Program
The Ottawa Charter for Health Promotion (WHO, 1986) notes that health promoting
skills often already exist within communities, and this expertise can be called upon to
advance systems and thus enhance health. The WHO (2014), also state that intersectoral
action has been successful in enacting changes in perceptions of mental health. The proposed
intervention will engage many sectors of the community in order to address depression.
Depression in young women can develop as a result of living in a domestic violence
situation (Sternberg, Lamb, et. al., 1993). Furthermore, many young people experience
intimate partner violence in their early relationships. Many young people do not seek
assistance for mental health issues due to stigma (Wilson, 2007; Pinfold, Toumlin, et al.,
2003). Providing information to young people, in particular to girls, regarding how to stay
safe and avoid such potentially violent relationships can ensure their safety and thus reduce
the onset of depression (Pinfold, Toumlin, et al, 2003). Using a socio-environmental model
(Baum, 2008), a public health intervention is proposed.
School teachers are offered a package of information and training which will equip
them to deliver a block of lessons to year six school students. Providing interactive
information has been shown to be successful with this age group (Graffunder, Noonan et al.,
2004). The training will include information provided by other agencies such as SA Police,
local youth workers and mental health workers. The students will learn about respectful
behaviour and will translate this learning into positive statements regarding respectful
behaviour. In addition, they will design posters that will include their drawings and
declarations about respectful behaviour. Twelve of their pictures will be used to produce a
calendar for the following year that will be launched on White Ribbon Day (see
http://www.whiteribbon.org.au/). Funds for this project will be provided by local service
groups (Rotary, Zonta International, and the Girl Guides Association) who may also be
involved in classroom work (i.e. as guest speakers). The launch will include the school
students and class teachers along with local youth workers, representatives from SA Police,
local TAFE colleges, Local Government staff, General Practitioners and local media. Men
attending the event will be encouraged to state the White Ribbon oath (“I swear never to
commit, excuse or remain silent about violence against women. This is my oath.”
http://www.whiteribbon.org.au/ accessed online 8 March 2015). This program will be
evaluated and may be enhanced and further developed for the following year. In addition, the
program could be developed in other schools across that state.
Framework for the ‘Expect Respect’ Calendar Project
Frameworks and approaches to public health interventions are varied, and some have
been shown to have more success than others (Baum, 2008). Evaluations have highlighted
that interventions that draw on the strength and capabilities of the local community achieve
better health outcomes.
Community groups in many communities drive health action (Baum, 2008, p. 508).
Traditionally groups such as social clubs, women’s action groups and youth clubs offer
support, funding and ideas for community ventures. Following this notion, the ‘Expect
Respect’ project will be guided by a participation model (Baum, 2008, p 489). In addition, a
strength-based approach as described by Baum (2008) and Lin (2007) will also inform the
processes. The drive and passion often seen within service clubs (for example Zonta
International, 2015) serves to highlight that volunteer organisation can effect change, thus
highlighting a participatory manner of working (Baum, 2008).
In addition to this participation, a socio-environmental approach is utilised in this
intervention. A socio-environmental approach has been described as “the interrelationship
between social systems or setting and human health” (Lee, and Stewart, 2013, p. 795). In the
“Expect Respect” project the social systems are observed by the action of the teachers in the
classroom who will engage the young people to consider respectful behaviour in their own
lives and the lives of others. Moreover, the young people will consider health in relation to
disrespectful behaviour and the impact such conduct can have on a young person. Ideas of
mental health and illness will then be considered. Finally, the potential harm from family
violence will be examined. This will then be translated into the pictures and statements
(sketched and drafted by the students) to be included in the calendar. The students will see
their work in print. Funds raised from the sale of the calendars could be allocated to the next
year’s calendars or donated to the White Ribbon Campaign.
Gender, Depression and the Expect Respect Project
As noted by Sen and Ostlin (2008, p. viii.), “taking action to improve gender equity in
health … is one of the most direct and potent ways to reduce health inequities …”. This view
of gender resonates with that of Baum (2008), who notes that although women in
industrialised countries tend to live longer than men, they have poorer health overall. In
addition, women also experience more violence in their lives. However, data to capture this
information is lacking (Baum, 2008). The analysis of the different levels of power within
relationships is useful when examining the health of women (WHO n.d.). Gender analysis
can show how norms in society inform the individual how to behave as female or male.
The ‘Expect Respect’ project will assist in the development of appropriate skills for
both boys and girls. The young people will learn about respectful and safe behaviour in
society, and this will lead to improved safety for girls and boys. In turn, if society is safer for
young people then there will be less prevalence of depression.
Depression - Current evidence based theory influences
Current theory in public health has developed rapidly in recent years. The dominant
contemporary approaches to health are medical, behavioural and socioeconomic (Baum,
2008). According to Labonte (in Baum, 2008), a medical approach to health treats people
who are already unwell, a secondary approach to health addresses peoples’ behaviour in the
hope of changing their actions. Settings and organisational structures are examined in the
socioeconomic approach (Baum, 2008). The ‘Expect Respect’ project is built upon the
premise of both behavioural and socioeconomic models. The project aims to develop
behavioural changes to raise awareness of respectful behaviour and also challenges the
predominant gender frames. Moreover, the project examines family violence and its
relationship with depression and mental health. It also highlights a socio-environmental
methodology by inspiring the community to participate in action (Baum, 2008).
A goal of the socio-environmental approach to public health is for communities to
experience fewer "inequities between population groups” (Baum, 2008, p. 445). In the
‘Expect Respect’ project, it is hoped that the experience of learning about respectful
behaviour, along with community participation will result in fewer inequities and improved
mental health outcomes particularly for young women.
Primary prevention, in tandem with a corresponding whole of community response,
has had some extensive successes in the United States (Graffunder, Noonan et al., 2004).
The Expect Respect Project hopes to mirror these achievements, and continue to work with
the community as the project develops further.
Conclusion
Symptoms of depression can start early in life and affect the whole lifespan. Young
women often experience elevated rates of depression (Rees, Steel et.al, 2014), and this can be
related to factors that include family violence. The ‘Expect Respect’ project is proposed to
address depression in students in school which draws on the skills within the community.
Community partnerships will be established and enhanced throughout this project.
Funding will be sought from local service clubs (Rotary, Zonta International) and a
class teacher will deliver lessons regarding respectful and safe behaviour that will highlight
appropriate conduct and also highlight how poor behaviour and family violence can lead to
depression. A socio-environmental framework has been utilised along with considerations of
gender roles.
Depression in young people, especially among young women, must be addressed
adequately. The Expect Respect Project will prove to be a starting point for the community
to address depression in girls and, following evaluation, it can be rolled out throughout the
state.
References
Artz, S., Jackson, M. A., Rossiter, K. R., Nijdam-Jones, A., Géczy, I., & Porteous, S. (2014).
A Comprehensive Review of the literature on the impact of exposure to partner
violence for children and youth. International Journal of Child, Youth and Family
Studies, 5(4), 493-587.
Baum, F. (2008). The new public health, (3rd ed.). South Melbourne, VIC: Oxford University
Press.
Buzi, R. S., Smith, P. B., Kozinetz, C. A., Peskin, M. F., & Wiemann, C. M. (2015). A
Socioecological Framework to Assessing Depression Among Pregnant
Teens. Maternal and child health journal, 1-8.
Graffunder, C. M., Noonan, R. K., Cox, P., & Wheaton, J. (2004). Through a public health
lens. Preventing violence against women: An update from the US Centers for Disease
Control and Prevention. Journal of Women's Health, 13(1), 5-16.
Lee, P. C., & Stewart, D. E. (2013). Does a Socio_Ecological School Model Promote
Resilience in Primary Schools? Journal of School Health, 83(11), 795-804.
Lin, V., Smith, K., Fawkes, S. (2007). Public Health Practice in Australia: The organised
effort. Allen & Unwin, NSW Australia.
Marcus, M., Yasamy, M. T., Van Ommeren, M., Chisholm, D., & Saxena, S. (2012).
Depression: A global public health concern. WHO, 2012 accessed on line 8 March
2015.
Pinfold, V., Toulmin, H., Thornicroft, G., Huxley, P., Farmer, P., & Graham, T. (2003).
Reducing psychiatric stigma and discrimination: evaluation of educational
interventions in UK secondary schools. The British Journal of Psychiatry, 182(4),
342-346.
Rees, S., Steel, Z., Creamer, M., Teesson, M., Bryant, R., Mcfarlane, A. & Silove, D. (2014).
Onset of common mental disorders and suicidal behavior following women's first
exposure to gender based violence: a retrospective, population-based study. BMC
psychiatry, 14(1), 312.
Sen, G. and Ostlin, P., (2008). Gender inequity in health: why it exists and how we can
change it. Global Public Health: An International Journal for Research, Policy and
Practice. Volume 3, Supplement 1, 2008.
Sternberg, K. J., Lamb, M. E., Greenbaum, C., Cicchetti, D., Dawud, S., Cortes, R. M.,
Krispin, O. & Lorey, F. (1993). Effects of domestic violence on children's behavior
problems and depression. Developmental psychology, 29(1), 44.
Wilson, C. J. (2007). When and how do young people seek professional help for mental
health problems? The Medical Journal of Australia, 187(Supplement), S35-S39.
White Ribbon Campaign. http://www.whiteribbon.org.au/ accessed online 8 March 2015.
WHO. (1986). Ottawa Charter for Health Promotion. Retrieved from
http://www.who.int/healthpromotion/conferences/previous/ottawa/en/ on 14 February
2015.
WHO. (2003). Social determinants of health: The solid facts (2nd ed.). Retrieved from the
Torrens University Australia Library databases.
WHO. (1986). Ottawa Charter for Health Promotion. Retrieved from
http://www.who.int/healthpromotion/conferences/previous/ottawa/en/ on 14 February
2015.
WHO (n. d.). Gender and women’s mental health. Retrieved from
http://www.who.int./mental_health/prevention/genderwomen/en/
WHO and Calouste Gulbenkian Foundation. (2014). Social determinants of mental health.
Geneva, World Health Organization.
Zonta International (2015). http://www.zonta.org/ accessed online 8 March 2015.
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Answer
Indigenous Health Disparities
Health inequality has been a longstanding challenge for the Australian government. While there has been progress (for instance low infant mortality among Aboriginal and Torres Strait Islander peoples), the Indigenous population still experience significant health disadvantages as compared with non-Indigenous ones in Australia (Rheault, Coyer, Jones & Bonner, 2019). Arguably, the Aboriginals and the Torres Strait Islander community are associated with lower life expectancies and poor health in Australia unlike the non-Indigenous people. Efforts focused on addressing health disparities experienced between the two have not been effective hence, the gap in health recorded in Australia. This essay explores the forces that contribute to the health inequities experienced in Australia. Moreover, the essay discusses the function of the Aboriginal Controlled Community Health Services (ACCHSs) in tackling the health challenges experienced by the members of the Indigenous community in Australia.
Part 1: Forces Contributing to the Health Disadvantages
The social, economic, and political forces directly influence health, thus, explaining the variance in health between the Indigenous and non-Indigenous people in Australia.
Social and Economic Factors
Low socioeconomic status is regarded as a health risk factor. Arguably, persons having a low socio-economic status suffer from different stressful life situations that increase the potential of mental illnesses such as anxiety and depression (Reiss, Meyrose, Otto, Lampert, Klasen & Ravens-Sieberer, 2019). Negative life events besides other stressors are also directly associated with a person’s socioeconomic position. Evidently, lower household income results in increased levels of stress experienced by an individual within the lower socioeconomic bracket. Reiss et al. (2019) maintain that a low socioeconomic position is directly associated with stressful life event alongside other concerns which influence the mental health stability of an individual.
The Indigenous community in Australia has faced disadvantages on different levels of the socioeconomic spectrum with income being one of the most prevalent. The lower position on the spectrum increases their risk of living in poverty, unlike the non-Indigenous people. According to the Parliament of Australia (2020), a higher percentage of the Indigenous households live in remote areas in and survive on a low income. With this finding, it is accurate to derive that they are at a risk of poverty and may find it difficult to cater for essential services. Furthermore, it is evident that in regional centers and cities, the Indigenous community still experience poverty since they are not provided with equal access to resources as the non-Indigenous people (Parliament of Australia, 2020). In addition, statistics about poverty indicators presented by the Parliament of Australia (2020) relay that Indigenous people are three times worse in comparison to those from the non-Indigenous group. This suggests that they are at a risk of poor health associated with increased stress related with the low SES.
Due to their low-income levels, the Indigenous community finds it difficult to secure homes in areas with enough spacing since they are more costly. Therefore, most end up living in overcrowded regions that contribute to the spread of communicable diseases. In addition, with the high poverty, it is evident that the members of the community will find it difficult to afford a healthy meal for themselves and the infants. As a result, they are increasingly at a higher risk of suffering from chronic diseases such as diabetes in the future (Durey & Thompson, 2020).
Political Forces
Different policies established by the Australian government influences the health outcomes of the Indigenous communities. Heffernan, Andersen, Dev and Kinner (2012) explain that from colonization to the current day, the policy decisions established for the Aboriginal and the Torres Strait Islander people devised by the State, National and Territory governments and the churches alongside other institutions have significantly impacted the well-being and health of the members of the Indigenous communities. The inequitable policies evident in Australia have contributed to the unequal distribution of resources and power between the Indigenous and non-Indigenous communities. The level of the government’s commitment to the International Covenant on Civil rights and Political Rights (1996), also known as the Covenant, is questionable. Evidently, the Covenant maintains a stand that the denial of human rights is a way of violating the individual’s power of self-determination (Durey & Thompson, 2020). However, the government has shown less commitment to this policy as well as the provisions of the Northern Territory National Emergency Response, also known as the Intervention. Specifically, the government has overlooked the report clarifying on the importance of working with the Torres Straight Islanders and the Aboriginals when it comes to the establishment and implementation of initiatives supporting the members of the community. As a result, protecting the welfare of the Indigenous communities has remained to be a concern that worsens the case of resource distribution that further influences health. Notably, this increases the potential for assault victimization and the health gap noted between the Indigenous and the non-Indigenous persons (Kutcher, Wei & Coniglio, 2016).
Part 2: Aboriginal Community Controlled Health Services (ACCHSs)
Key Features
The Aboriginal Community Controlled Health Service (ACCHSs) refers to an amalgamated Aboriginal body that was initiated by and based within a local Aboriginal community (“Australian Institute of Health Welfare”, 2020). The group is focused on the delivery of a holistic and culturally competent health service to the people. Coombs (2018) shows that the primary features of the ACCHs are defined under the special policies governing the approach to health services offered for the patients. For instance, population health associated with the initiatives focused on promoting the wellbeing of the Indigenous community and special services to meet the needs of the local community members is also an important element of the body (Coombs, 2018).
Roles
The ACCHS plays four fundamental roles such as provision of community support, administration of primary clinical care, offering special needs program, and taking part in advocacy (Weightman, 2013). As a result, the body addresses the issue of health inequities experienced between the Indigenous and the non-Indigenous people in Australia. For instance, ACCHS devises principles focused on reorganizing the social relations framework in the region since this is directly related with how power is distributed in the community (Weightman, 2013). Additionally, ACCHS also aids in addressing the case of health inequities by stabling principles focused on guiding how opportunities and resources are located among the Indigenous and the non-Indigenous members of the community. In addition, the group establishes policies that strive to reduce the power of inequities between the oppressed and the privileged people. Evidently, the ACCHS model focuses on promoting health and community development, creating support resources for the members of the community and offering educational resources that can be used by health professionals to address the needs of the mainstream communities (Ong, Carter & Kelaher, 2012).
Barriers
Different barriers can inhibit ACCHSs’ efforts in addressing the health inequities experienced between the members of the Indigenous population and the non-Indigenous Australians. Institutional racism is one of the factors to be considered. Durey and Thompson (2012) argue that although interpersonal racism may not be considered as intentional at various levels, the effects can be drastic. For instance, it is evident that most facilities in Australia will not include standard forms for accounting for the Complex Indigenous Australian Kinship structures (Weightman, 2013). This makes it difficult for the members of the Indigenous communities to engage in follow-up care due to the culturally insensitive factors that the people face when recording personal information. For instance, terms such as “GP” may be used to refer to doctors. However, most members of the Indigenous communities may not understand the use of the “GP” term and its meaning. Therefore, the chances that the community members will present inaccurate information in the admission forms are increased. The lack of the institutional responsibility compromises the health outcomes of the Indigenous people and the efforts of the ACCHS in promoting health (Ong, Carter & Kelaher, 2012).
Interpersonal racism experienced between the Indigenous patient and the care providers is also a barrier to be considered. Evidently, a lack of interest and awareness regarding the lived experience of the community members undermines efforts of an effective communication, quality care and health (Ong, Carter & Kelaher, 2012). The lack of engagement arising from the failure to include interpreters to facilitate the process of communication in the health facilities make it difficult for the members of the Indigenous community to understand the health instructions and questions asked. This results to drastic consequences to the people and a hindrance to the efforts of the ACCHS by making it difficult for the Indigenous people to obtain quality care (Ong, Carter & Kelaher, 2012).
Conclusion
Conclusively, the gap between the Indigenous and the non-Indigenous members of the community is wide. The variance is accrued to social, economic and political factors that influence the power and resources administered between the community members. For instance, the Aboriginals and the Torres Strait Islander communities are mostly known to be members of the low socio-economic bracket. With their socio-economic position, they find it difficult to access fundamental resources such as proper housing, which increases the potential that they will suffer from poor mental and physical health concerns. However, with the ACCHSs model, the gap can be closed as the group focuses on community support, administration of primary clinical care, offering special needs program, and taking part in advocacy.
References
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Australian Institute of Health Welfare. (2020). Healthy Futures—Aboriginal Community Controlled Health Services Report Card 2016. Retrieved from https://www.aihw.gov.au/reports/indigenous-health-welfare-services/healthy-futures-aboriginal-community-controlled-health-services-report-card-2016/contents/table-of-contents Coombs, D. (2018). Primary Health Networks’ impact on Aboriginal Community Controlled Health Services. Australian Journal of Public Administration, 77, S37–S46. Durey, A. & Thompson, S. (2012). Reducing the health disparities of Indigenous Australians: time to change focus. BMC Health Serv Res 12, 151. https://doi.org/10.1186/1472-6963-12-151 Heffernan, E., Andersen, K., Dev, A. & Kinner, S. (2012). Prevalence of mental illness among Aboriginal and Torres Strait Islander people in Queensland prisons. Med J Aust, 197 (1), 37-41. Doi: 10.5694/mja11.11352 Kutcher, S., Wei, Y., & Coniglio, C. (2016). Mental Health Literacy: Past, Present, and Future. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 61(3), 154–158. https://doi.org/10.1177/0706743715616609 Ong, K.S., Carter, R., & Kelaher, M. (2012). Differences in primary health care delivery to Australia’s Indigenous population: a template for use in economic evaluations. BMC Health Serv Res, 12, 307. Doi https://doi.org/10.1186/1472-6963-12-307 Parliament of Australia. (2020). Chapter 13 - Indigenous Australians. Retrieved from https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/Completed_inquiries/2002-04/poverty/report/c13 Reiss, F., Meyrose, A., Otto, C., Lampert, T., Klasen, F. & Ravens-Sieberer, U. (2019). Socioeconomic status, stressful life situations and mental health problems in children and adolescents: Results of the German BELLA cohort-study. PLOS ONE, 14(3): e0213700. https://doi.org/10.1371/journal.pone.0213700 Rheault, H., Coyer, F., Jones, L., & Bonner, A. (2019). Health literacy in Indigenous people with chronic disease living in remote Australia. BMC Health Services Research. 19. Doi: 10.1186/s12913-019-4335-3. Weightman, M. (2013). The role of Aboriginal Community Controlled Health Services in Indigenous health. Australian Medical Student Journal, Retrieved from http://www.amsj.org/archives/3012
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