Self-determination, Self-management and Integration Policies for Aboriginal Health

Discuss about the Indigenous Education and Perspectives for Integration.

From the year 1972 to 1988, the Australian government emphasized on the policy which advocated on the self-management, self-determination and integration. The three approaches are discussed below:

• Integration- this focuses on having a cordial relationship between the white community and the aboriginal people, while at the same time recognising the needs of the aboriginal people to have different aspirations and needs in some of the areas of their life.
• Self-determination- this approach takes the aspirations and the needs to be further extented. This literally means that the aboriginal people possess the right to choose their own destiny and the government will play the enabling role through which the aboriginals will receive the economic, social, technical skills and financial support.
• Self-management- it is the present federal policy and is similar to the approach of self-determination, while it stresses on the fact that the Aboriginals must be held accountable and responsible for the management and decisions regarding finance (Eckermann, Dowd & Chong, 2010).

The self-determination has been described as the best practice example that has provided the aboriginal people with the rights that are enshrined in the United Nations Declaration. By prioritizing the needs and wants of the indigenous people with respect to the health needs, the aboriginal community has received a shift in power and dynamics. Through the self-determination, the health condition of the aboriginal people has improved considerably (Mazel,2016).

As a health professional the above policies will impact my outlook and will also help me to properly engage with the aboriginal community. The policies exclusively focus on them and keep the aboriginal communities at the centre point. The integration policy has a strong coordination with the procedures followed by the health professionals. It is always a better approach to develop a cordial relationship with the people of the indigenous communities for proper delivery of the health care. This increase attachment and proper engagement and leads to building up of faith. Secondly, the self-determination policy has empowered the indigenous people to choose the health needs accordingly (Corntassel, 2012). This has reduced the burden of analysing the health condition by the health professionals. This has actually reduced the burden and will help the health professionals like us to act directly on the health issues that are vital and important. Whereas, through the self-management the aboriginal people are held responsible for their own decisions and thus, from health professional perspective, the aboriginal become more concerned about their health care needs.

Poverty can be defined as a condition of life which is created by the amalgamation of the different types of the factors, which when comes together result in the reduction of the standard of living below the acceptable limit that is acceptable by the community. Researchers have shown that there is a positive relationship between the individual’s social and economic status with the health of a particular person. Poor literacy and the poor education are linked positively with the individual health status of the poor people and it affects the way they access the health information. Due to the low income of the poor people, they are unable to access the healthcare facilities and the medicines. The rundown housing and the overcrowded places are directly associated with poverty and it plays a major role in the spread of the communicable diseases. The poor quality of the infant diet due to poverty leads to the improper development of the children and results in the development of the chronic diseases in the later part of the life. High-risk behaviour like smoking and drinking addiction has resulted in the socio-economic status among the Australian indigenous people (Healthypeople.gov, 2018).

Impact of Poverty on Aboriginal Health

Studies have shown that the poor people have less financial support and thus are unable to drive and control their life properly. This plays a contributory role in which the indigenous people become unhealthy due to the burden of stress. These stresses arise from the prolonged exposure to the psychological demands that come along with the poverty, and it leads to a situation where an individual finds it difficult to control the chances of reducing the condition. The build-up of the stress leads to the chronic stress and it negatively impacts the metabolic pathways, circulatory system and immune system through the various hormonal pathways. The build-up of stress thus leads to the emergence of diseases and health problems. The other types of health issues like the mental health problems and the violence against the women are the rampant problems which occur at the community level (Humanrights.gov.au, 2018). There are other reasons for poverty which can be positively related to poverty like the unemployment and lack of employment is also closely related to the improper education or lack of education. Lack of the proper housing provisions also results in to a lower standard of living and this, in turn, affects the eating habits and improper lifestyle (Benach et al., 2014).

The impact of racism on the Australian aboriginal has resulted in the development of poor mental health, suicidal risks, depression, and anxiety. Early childhood and the late adolescent have been identified as the major contributing factor for the physiological distress due to racism. It is important to note that the young people have a perception in their mind that the racism act as an impediment towards achieving the goals in life. Studies have shown that mental health issues at this stage of life results in the development of stage which is likely to persist and affect the health, social and educational outcomes adversely (Shepherd et al., 2017). I have found that the poor parental mental health is more likely to impact the mental health of the children, which will impact the wellbeing, health and the developmental parameters.The racial discrimination has resulted in the denial of the Australian aboriginals to get access to the equitable service provisions, public and community life and freedom from violence. The main grounds of racial discrimination are the rurality, visibility, gender, religion, education, and age. All these aspects are directly related to the frequency and the rate of racial discrimination is experienced by a single individual. The experience of mind is associated with the worsening condition of mental health. The discrimination is experienced by the individual in a governmental setting, employment and shops (Ferdinand, Paradies & Kelaher, 2015).

Impact of Racism on Aboriginal Mental Health

Racial discrimination and the mental wellbeing of the Australian aboriginals have resulted into a negative impact if the root cause of racial discrimination is not addressed then it might lead to worsening mental health. I will emphasize on an individual for the treatment of a mental disease. However, the issue here is different, as a health professional I will face difficulty in treating such individuals. For the purpose of treatment of the individuals affected with the mental disorders, the treatment procedures will require the management of various types of external factors. Factors like racial discrimination will involve a lot of external players and it is beyond my capability to work on the external factors. My responsibility will become complex considering the plenty of aspects I will be dealing with. An Australian aboriginal will have mental issues like depression, anxiety and although this can be treated the recurrence of the racial discrimination issue will lead to the further deterioration of the mental health condition (Ferdinand, Paradies & Kelaher, 2015).

Culture shock can be defined as the turmoil condition or the disturbance of the mental state of a condition which a person experiences and it includes the feelings of dissatisfaction, frustration, powerlessness, and helplessness when a sub-culture or a new culture is encountered. Culture shock can be identified through the psychological and the physical changes due to prolonged exposure and adaptation to the new scenarios and environment (Dongfeng, 2012).

An aboriginal person from a remote community who is admitted to a large tertiary hospital in the city will experience several types of barriers and communication is one of them. The various communication issues which I think an aboriginal person will face are language or jargon issues, the pattern of speech and level of understanding. From my perspective an aboriginal person at this stage will encounter powerlessness and will be dependent on others; an aboriginal person will experience anxiety and fear due to the incompetence of communication; at the hospital an aboriginal person will feel withdrawal; and lastly such an aboriginal person will accept the professional knowledge (Eckermann, Dowd & Chong, 2010). Communication is considered as a jargon of health and language of health and this leads to the development of the anxieties within the patient and it also occurs due to ignorance. Aboriginal patient admitted that are admitted to a city hospital will always experience an isolated and stigmatised feeling, even when that person is not stigmatised by others. There are situations where a patient might feel withdrawal and left out from others due to the lack of the ability to communicate. The patient will not be able to have trust upon the nurse and at the same time will be unable to express his problems to the nurse properly. The same will be true from the perspective of a non-aboriginal nurse. Thus, there will be a total lack of effective communication and the healthcare will not be delivered effectively (Kourkouta & Papathanasiou, 2014).

Barriers to Effective Communication in Aboriginal Healthcare

Effective communication plays a major role in effective care delivery at the community level. I will emphasize on the language and the culture of a particular community will be able to communicate effectively (O’hagan et al., 2014). Being a health care professional, I will try to learn and gain knowledge of the Australian aboriginals in order to increase my competency in effective communication. In order to gain the trust of a patient that belongs from a different cultural background, I will take care and respect the feelings of that patient. For this reason, I need to be able to communicate effectively.

Importance of empowerment- community controlled health services for the aboriginals means that the aboriginals can be given the power to handle their own asset and control their own life. I as a healthcare professional will work for the empowerment of the aboriginal people through the government promised policies like the self-management and self-determination. In order to empower the aboriginals, it is necessary that the services that are aboriginal by health service delivery, control and management, organization and inception (Ware, 2013). The services for the aboriginal people need to be designed in a way so that it can be run by the people, for the people and according to the ease and needs of the people through a holistic and harmonic way. The decision-making body also can be shifted from the medical professionals to the community elected boards. The best way to empower the aboriginals is through the framing of the community controlled health services and I consider these as vital principles which underlie the empowerment. Providing the scope to the various activities which are to directly strengthen the cultural and social identity will further lead to community empowerment (Bourke et al., 2012). It is important to note that the regardless of the region where the aboriginals live, if I can combine the attitudes of the health professionals, economic and cultural factors and historical factors it can render the aboriginals to avoid the existing health services. I think that it is an established fact and it is needless to say that the treatment the aboriginals received via some of the mainstream institutions has led to a detrimental effect on the individuals. I will actively integrate with the community controlled health services and this will provide ample amount of scope in terms of the appropriate, accessible and affordable services and it allows choices based on the services that are extremely popular and accessible to the aboriginal people. The health services controlled by the aboriginals are more effective and the preventive healthcare strategies for the aboriginals. I will work for the empowerment of the aboriginals and this can be effectively done by policies or legislations entirely based on the self-determination. In order to empower and provide the care in their own cultural setting, it is important to keep the empowering process to be funded by the Australian government (Eades et al., 2012).

Reference

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Bourke, L., Humphreys, J. S., Wakerman, J., & Taylor, J. (2012). Understanding rural and remote health: a framework for analysis in Australia. Health & Place, 18(3), 496-503.

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Eades, S. J., Sanson-Fisher, R. W., Wenitong, M., Panaretto, K., D’Este, C., Gilligan, C., & Stewart, J. (2012). An intensive smoking intervention for pregnant Aboriginal and Torres Strait Islander women: a randomised controlled trial. The Medical Journal of Australia, 197(1), 42-46.

Eckermann, A. K., Dowd, T., & Chong, E. (2010). Binan Goonj: bridging cultures in Aboriginal health. Elsevier Australia.

Ferdinand, A. S., Paradies, Y., & Kelaher, M. (2015). Mental health impacts of racial discrimination in Australian culturally and linguistically diverse communities: a cross-sectional survey. BMC public health, 15(1), 401.

Ferdinand, A., Paradies, Y., & Kelaher, M. (2013). Mental health impacts of racial discrimination in Victorian Aboriginal communities. Lowitja Institute.

Healthypeople.gov. (2018). Social Determinants of Health | Healthy People 2020. Healthypeople.gov. Retrieved 2 May 2018, from https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health

Humanrights.gov.au. (2018). Social determinants and the health of Indigenous peoples in Australia – a human rights based approach | Australian Human Rights Commission. Humanrights.gov.au. Retrieved 2 May 2018, from https://www.humanrights.gov.au/news/speeches/social-determinants-and-health-indigenous-peoples-australia-human-rights-based

Kourkouta, L., & Papathanasiou, I. V. (2014). Communication in nursing practice. Materia socio-medica, 26(1), 65.

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O’hagan, S., Manias, E., Elder, C., Pill, J., Woodward?Kron, R., McNamara, T., … & McColl, G. (2014). What counts as effective communication in nursing? Evidence from nurse educators’ and clinicians’ feedback on nurse interactions with simulated patients. Journal of advanced nursing, 70(6), 1344-1355.

Shepherd, C. C., Li, J., Cooper, M. N., Hopkins, K. D., & Farrant, B. M. (2017). The impact of racial discrimination on the health of Australian Indigenous children aged 5–10 years: analysis of national longitudinal data. International journal for equity in health, 16(1), 116.

Ware, V. (2013). Improving the accessibility of health services in urban and regional settings for Indigenous people (Vol. 27). Australian Institute of Health and Welfare.