The Situation for Indigenous People before Closing the Gap was developed

Good health is a great asset. No one can experience wealth without health and wellbeing. Health and wellbeing are the driving forces to work which accords us resources that can enable us to create wealth. The health of an individual is determined by some factors. Such factors include education, housing as well as income and employment. Such factors will contribute to a healthful environment which influences our health either positively or negatively. Our health may affect the way we think or behave. Different individuals experience their health and wellbeing differently based on the social determinants. Some can easily access the social determinants while others are locked away from accessing them.

Australia is a country inhabited by people of different origins. There are the Indigenous people as well as non-Indigenous people. The Indigenous or first people commonly known as the Aboriginal and Torres Strait Islander peoples feel that their health and wellbeing is not considered by the Federal government. The government is instead preoccupied with meeting the health and wellbeing of the non-Indigenous. Such people feel vulnerable and are working hard to ensure that they also get value for their money. There has been a series of developments along this line with the latest being the CTG policies. This write up will look at the development history. What was happening before the CTG policies, involvement of stakeholders in the designing and implementation, the requirements of the Federal and other territorial government in the implementation of the plans, government’s development of the health care system, the place of the government in sabotaging the implementation as well as the efforts of the Indigenous people in ensuring that the policies are realised.  

Closing the Gap Policy, the History and the Data that Influenced its Creation

Australia. Department of the Prime Minister and Cabinet (2017) observed that the  Closing the Gap Policy  program will bridge the health and life expectancy gap occurring between the Aboriginal and Torres Strait Islander peoples and the foreign Australians within a generation.

The Situation for Indigenous People before Closing the Gap was developed

The situation was a big challenge for the Aboriginal and Torres Strait Islander peoples as they could not access quality social determinants. According to Calma, Dudgeon and Bray (2017 p.257), the Indigenous people lived in overcrowded places, or their houses were dilapidated, and any ability to purchase a decent house was a preserve of the few. Few of Aboriginal and Torres Strait Islander peoples could access education. The obstruction to access basic education resulted in high levels of illiteracy. Lack of decent employment and income was common.  Mitrou et al. (2014 p.201) argue that the limited access to the social determinants poorly affected the Indigenous peoples’ access to better health care services.

Impact of Judy’s Diabetes and how it is addressed within the Closing the Gap Including the Long-Term Consequences to the Health and Social Determinants

Currently, the implementation of the Close the Gap Statement of Intent has been partial and incoherent. It has been carried out through the Closing the Gap Strategy. This is because of lack of an effective health equality plan, lack of a national plan to address issues of housing and health infrastructure as well as the social determinants. Sufficient funding has not been factored, thus challenging program implementation. Jordan (2018) observed that there was lack of complementary systematic focus on developing the capacities of primary health service in accordance to the Indigenous needs guided by the Aboriginal Community Controlled Health Services with a shift of the Aboriginal and Torres Strait Islander health from an ‘after the event’ response to a  preventive footing.

Impact of Judy’s Diabetes and how it is addressed within the Closing the Gap Including the Long-Term Consequences to the Health and Social Determinants

Diabetes is a chronic disease. In the long run, it may affect Judy’s mobility as the disease affects the motor neurons of the nervous system. Her immobility will challenge her access to health facilities.  If Judy is a member of the Closing the Gap, she will obtain improved management of her health condition. This is because under this policy there will be effective follow-up plans attributed to a sufficient workforce who will be deployed within the patient’s vicinity. The workforce will have adequate competencies to deliver adequate care.

Mitrou et al. (2014 p.201) stated that social determinants of health are those social as well as economic factors that can affect the health of individuals and community either positively or negatively as they affect the environment in which they live. These social determinants can change people’s health by influencing their thoughts as well as their behaviours. Such social determinants include housing, income and employment as well as education. The Aboriginal and Torres Strait Islander peoples have been facing social discrimination. This compounded by the fact that Judy is sick may affect her access to social determinants. Seuring, Archangelidi and Suhrcke (2015 p.823) observed that with the policy, the patient would be able to acquire some decent employment, live in a modest house, and this will further support her efforts for seeking better health services.

Impacts of Chronic Diseases (Diabetes) on Indigenous Groups versus Non-Indigenous Groups

The small, as well as the large blood vessels serving her feet, will be negatively affected thus challenging her morbidity. According to Noble et al. (2015 p. 666) escalation of the condition may also result in other parts of her body being affected. Such as the digestive system, the kidney, heart, brain as well as her skin. When the skin has affected by any treatment on a wound will not yield the intended results. This is different from the non-indigenous people of Australia who can easily access better health services. Jordan (2018) notes that the disease burden of the Aboriginal and Torres Strait Islander population is 2.3 times as compared to that of the non-Indigenous people.

Impacts of Chronic Diseases (Diabetes) on Indigenous Groups versus Non-Indigenous Groups

Social Determinants that can be applied to Indigenous Groups about Diabetes and Health Care

Two social determinants will be most applicable to Judy’s situation. She will need to have a decent house. Any health care provider will not have an excuse to visit her at home as the environment in which she is living in inhabitable. Her employment in a decent job will also improve her disease management capacities. Lindberg et al. (2015 p. 860) point out that diabetes is a nutritionally related disease. Therefore, Judy will be in charge of her nutrition if she has some regular finances.

Benefits of Closing the Gap and how it Impacts on the Social Gradient (Economic Burden)

Once Judy is registered on CTG, she will be able to access social determinants such as decent housing as well as employment.  Australia. Department of Health (2013) states that with the modest house, health providers who will be available at the community level courtesy of the policy will be willing to visit the patient. When she sticks in the compound, this improves the healing process and time as opposed to when she has to move to seek the services of a health care provider.  de Wit et al. (2014 p. 1817) observed that with employment the patient could check on her dietary needs as well as meeting other health-related bills.

Referral of Judy by Aboriginal Liaison Officer and Aboriginal Medical Services

AMS refers to Aboriginal Medical Services while ALO refers to Aboriginal Liaison Officer.

The role of an ALO officer is to be a bridge between the patient and relevant health care providers. Diabetes affects a patient’s mobility. According to Katzenellenbogen et al. (2015 p. 430), the best advice by an ALO in such a case is to seek the services offered at the community level.  The ALO is not involved in treatment but referrals as they work with an extensive network of health care providers.

The AMS provides services revolving around medical, dental, drug and alcohol services as well as managing of the aged. In diabetes two management there in a multidisciplinary approach to treatment where patients are reviewed first by a diabetes educator and a General Practitioner and then conduct onsite referrals for eye-related cases. In outlining the roles of the AMS, Hart, Cavanagh and Douglas (2015 p.252) notes that the AMS also assist in organising appointments, transport of patients as well as patients’ follow-up and monitoring. Once they review the patients, they refer them to health care centres.

Social Determinants that can be applied to Indigenous Groups about Diabetes and Health Care

The AMS reviewed and discharged Judy. Munns et al. (2016 p.363) conclude that after review, the patient is referred to ALO. ALO wrote a note to the nurses at the community level requesting them to assist Judy once they identified her needs. Upon knowledge of her residence, they are better placed to send her to the right facility at the community level. In Judy’s case, with the challenge of mobility, she needed a provider who will be able to visit her at her home physically.  

Conclusion

Good health is paramount for any individual. Good health affects an individual’s thoughts as well as their behaviours. The health services provided thus requires to be sensitive to the patient’s needs, culture notwithstanding.  The Aboriginal and Torres Strait Islander peoples are a group of people who have been suffering from racial discrimination which has affected their health and wellbeing. To improve their health and wellbeing, there was a development of the CTG policies which would enable them to participate in the design and implementation of health policies that can better their health and wellbeing. Entrenched in these policies were the social determinants of health such as housing and employment. Some of the developments were the establishment of the ALO and AMS as institutions which would assist the Indigenous peoples to access better health care services coupled with an increased and competent workforce. However, these policies are far from realisation as the key stakeholders such as the Aboriginal and Torres Strait Islander peoples have at times found themselves missing during the designing processes. Therefore, greater commitment from the Federal government to work with relevant stakeholders and the allocation of sufficient resources to implement the CTG policies is crucial.

References

Australia. Department of Health, 2013. National Aboriginal and Torres Strait Islander Health Plan: 2013-2023. Department of Health.

Australia. Department of the Prime Minister and Cabinet, 2017. Closing the Gap: Prime Minister’s Report 2017. Australia. Department of the Prime Minister and Cabinet.

Calma, T., Dudgeon, P. and Bray, A., 2017. Aboriginal and Torres Strait Islander social and emotional wellbeing and mental health. Australian Psychologist, 52(4), pp.255-260.

de Wit, H.M., Vervoort, G.M., Jansen, H.J., de Grauw, W.J., de Galan, B.E. and Tack, C.J., 2014. Liraglutide reverses pronounced insulin-associated weight gain, improves glycaemic control and decreases insulin dose in patients with type 2 diabetes: a 26 week, randomised clinical trial (ELEGANT). Diabetologia, 57(9), pp.1812-1819.

Hart, B., Cavanagh, M. and Douglas, D., 2015. The “Strengthening Nursing Culture Project”–an exploratory evaluation study of nursing students’ placements within Aboriginal Medical Services. Contemporary nurse, 51(2-3), pp.245-256.

Jordan, K., 2018. Submission to the Closing the Gap Refresh: The need for structural reform to the current policy approach.

Katzenellenbogen, J.M., Miller, L.J., Somerford, P., McEvoy, S. and Bessarab, D., 2015. Strategic information for hospital service planning: a linked data study to inform an urban Aboriginal Health Liaison Officer program in Western Australia. Australian Health Review, 39(4), pp.429-436.

Lindberg, R., Lawrence, M., Gold, L., Friel, S. and Pegram, O., 2015. Food insecurity in Australia: Implications for general practitioners. Australian family physician, 44(11), pp.859-862.

Mitrou, F., Cooke, M., Lawrence, D., Povah, D., Mobilia, E., Guimond, E. and Zubrick, S.R., 2014. Gaps in Indigenous disadvantage not closing: a census cohort study of social determinants of health in Australia, Canada, and New Zealand from 1981–2006. BMC Public Health, 14(1), p.201.

Munns, A., Toye, C., Hegney, D., Kickett, M., Marriott, R. and Walker, R., 2016. The emerging role of the urban-based aboriginal peer support worker: A Western Australian study. Collegian, 23(4), pp.355-361.

Noble, N.E., Paul, C.L., Turner, N., Blunden, S.V., Oldmeadow, C. and Turon, H.E., 2015. A cross-sectional survey and latent class analysis of the prevalence and clustering of health risk factors among people attending an Aboriginal Community Controlled Health Service. BMC public health, 15(1), p.666.

Seuring, T., Archangelidi, O. and Suhrcke, M., 2015. The economic costs of type 2 diabetes: a global systematic review. Pharmacoeconomics, 33(8), pp.811-831.