Background

1. Analyse the principles of health education at an individual level and explain how they inter-relate with social learning theory, behavioural and lifestyle health interventions, health literacy, health communication, and media. 

2.  Evaluate the impact of local, national and global health policy in determining health care strategies and service provision. 

3. Critique and apply health promotion frameworks, tools and models to assess and evaluate primary health care programmes. 

4.  Evaluate a range of existing strategies for primary health care, public health and population health intervention, regarding their impact on individuals, families, groups and communities.

Several local and regional health education programs exist in the Australian scenario in respect to the Aboriginal and Indigenous Population.  This particular population of people suffers from various health-related ailments. They are mostly affected with diseases such as mental health problems, diabetes, sexually transmitted diseases, cancers, pneumococcal diseases, and several others (McCuaig and Nelson 2012). This study reflects upon the mental health based principles of the health education programs designed for the Aboriginals. The frequency of mental health disorders that ails the Aboriginals is as high as 12.4%. A dramatic increase in the prevalence of mental health disorder has been found among the Aboriginals according to a 2014 report (AHMAC 2012). Programs such as MHFA (Mental Health First Aid) program, Closing-The-Gap initiative and several other notable initiatives has been taken by the Department of Health, Australia to improve the health conditions and promote awareness among the Aboriginals. The Bio-Psycho-Social determinants of mental health and their impacts on the Aboriginals have also been discussed. In further sections, critical appraisal of the application of the Health Promotion frameworks, tools and models of Primary Health Care program has also been carried out. The strategies of Public Health and Interventions and their impacts on individuals, families and communities have been evaluated.

The health care programs as designed by the government should be a continuous assessment program involving the Aboriginals and not a casual overview of the mental health (Malseed, Nelson and Ware 2013). Conditions such as depression, anxiety disorder, are affecting several Aboriginal youths. The most common mental health disorders as observed are dementia, schizophrenia. Habits such as smoking, drug and alcohol abuse has resulted into developing dementia (Kanowski, Jorm and Hart 2009). Strokes are also prevalent among the Aboriginals and are responsible for developing dementia. Substance abuse is the main reason for schizophrenia. Mental stress that arises from the condition of unemployment among the Aboriginals, also leads to the development of both dementia and schizophrenia (Azzopardi et al., 2013). Most of these Aboriginals are deprived of necessities of a civilized society such as poor levels of housing and transportation facilities and dwindling level of income. There has been a negative impact on the emotional level of the Aboriginal people as they had been forced to relocate during the advent of colonization (McCuaig, Nelson and OccThy 2013). The emotional trauma has been the main reason behind the Aboriginals in developing mental health related problems. The occurrences of suicide among the Aboriginals have also increased and lack of education is increasing the figure by the day. Several recommendations and reflective studies have been carried out on the mental health of the Aboriginals, such as ‘Ways Forward’ National Consultancy Report on Aboriginal and Torres Strait Islander Mental Health, ‘National Strategic Framework for Aboriginal and Torres Strait Islander People’s Mental Health’ as  well as the  ‘Social and Emotional Wellbeing 2004-2008’ and ‘National Mental Health Plan 2003-2008’ (Jennings, Spurling and Askew 2013). These initiatives aimed at increasing the mental health awareness and education among the Aboriginal community. The principle that has been outlined in the recommendations has been incorporated in the MHFA program for the Aboriginals.  

MHFA Program

The MHFA program, as launched by the government was devised as a training program in Australia in order to promote mental health based skills for the Aboriginals (Aspin et al. 2012). The program aimed at helping the Aboriginals to come to terms with the trauma inflicted upon them since the colonial era. The MHFA has proved to be very successful among the Aboriginals and the Government should continue funding the program in order to sustain it in the long run (Durey 2010). As an initiative from the WHO (World Health Organizations) known as, ‘Health Promoting Schools’ Framework’ for promoting awareness of mental health among the youths of the Aboriginal community (Oliver 2013). These school based education programs help in assessing the status of the mental health of the youths, as well as help them in developing a self-efficient attitude so that they do not suffer from anxiety and depression and refrain from developing suicidal tendencies.

The mental health of an individual, leans of the biological, psychological and social determinants (Carey et al. 2013).  The social aspect plays the most important role in affecting the mental health as having a poor health status reduces the chances of a community to climb higher in the ladder of social-economy. The low education statistics, unemployment, scarce job openings has led to poor health among the Aboriginals (Gibson et al. 2015). Racism is one of the primary social determinants that affect the mental health. The discrimination faced by the Aboriginals on different levels influences their mental health. Racial discrimination is identified with verbal abuse, physical assault and unfair treatment on social platforms (Panaretto et al. 2014). This leads to low level of confidence and esteem among the Aboriginals, pushing them towards the very margins. This attitude of the non-Aboriginals prevents the Aboriginals to come out in the open and embrace the modern and technologically advanced ways of the civilized world (Durey, Lin and Thompson 2013). The emotional wellbeing of the children gets affected as they are frequently bullied at schools and other social gatherings. The Aboriginals still find it difficult to come to terms with the fact that they had been mistreated and usurped from their own lands and properties (Kelaher, Ferdinand and Paradies 2014). Now they live in their own country as second grade citizens. These concepts highly affect the emotional well being of the Aboriginals and make them vulnerable in developing mental health related problems. The government has taken several initiatives to improve the condition of the Aboriginals; however, the main drawback lies in their lack of cultural understanding of the Aboriginals (Donato and Segal 2013). The recommendations are rarely in accordance with the cultural values and practices of the natives and being a conservative race, the Aboriginals seldom let go of their beliefs for the sake of the non-Aboriginals. The Aboriginals face more problems during these health drives or initiatives as a considerable communication gap exists which leads to misinterpretation of the ailments, a wrong diagnosis will result into wrong administration of the medicines (Bourke et al. 2012). This situation can prove to be life threatening at times.

Evaluation of the Determinants of Health Impacts on THE Aboriginals

The MHFA programs have helped highly in improving the mental health of the Aboriginals. The health workers who are part of this program are culturally competent and they reach to the level of the Aboriginals and make themselves more accessible to their issues (Clifford, Doran and Tsey 2013). This attitude makes the Aboriginals let go of their apprehension and thereby accept the help provided by the workers of MHFA program.

Primary health care meets the basic health care needs of the patients. In Australia, the citizens receive it through physicians, health care workers, nurses and several other mediums. It usually involves the promotion of health, prevention of diseases and managing and treating ailments. The services are usually directed as per the health ailments of the people (Hepworth et al. 2015). The Primary Health Care program has different strategies directed towards the Aboriginals due the cultural difference. The services outlined by Primary Health Care program are always patient oriented and therefore it is the only services that are available to these Aboriginals who fall under the category of rural health (Hayman, Askew and Spurling 2014).

One of the first strategies is to develop structures and policies which would support the framework of primary health care which aims at bridging the gap in between the Aboriginals and non-Aboriginals in the health care aspect (Oliver-Baxter, Brown and Bywood 2013).

The second strategy aims at the Government making a dedicated effort in reducing health based inequities among several levels of population. The government should ensure an improved quality of life by providing proper health care facilities to one and all. The gap between the people’s needs and the health care services should also be bridged (Browne et al. 2012).

The third strategy aims at devising tailored programs, campaigns or drives in order to allow active participation on part of the Aboriginals in these initiatives. The communication gaps need to be worked upon by appointing culturally and linguistically competent health care workers (Baum et al. 2014).

The fourth strategy promote health care education and programs that would help provide a better understanding the chronic diseases and life threatening conditions that cripples the Aboriginal society (Carroll et al. 2015).

The fifth strategy aims at utilizing whatever available evidences that exist regarding the cultural background of the Aboriginals so that the health care workers can be prepared to handle such situations where the Aboriginals might not be entirely open towards accepting the modern treatment techniques to be applied to treat those (Reeve et al. 2015).

Evaluation of Range of Existing Strategies of Primary Health Care and its Impact on Aboriginal health

The sixth strategy discusses the issues of funds that disrupt the health care programs aimed at the Aboriginals. Therefore the government should work to dissolve the gap between the state funding services as well as the Commonwealth (Baum et al. 2013).

The seventh strategy states that lack of proper documentation and implementation of the plans regarding Aboriginal health prevents the application of newer interventions to deal with the health problems of the Aboriginals (Davy et al. 2016).

The eighth strategy would be in appointing more and more health care workers in order to improve the patient to health care personnel ratio. Not only volunteers but nursing students should also be encouraged to enroll for the health care workers’ positions that deal with improving Aboriginal health (Kelaher et al. 2016).

The ninth strategy should be aimed at framing proper plans and also work towards implementing them and not abandoning them halfway. The social and health care sectors should in delivering the promises that are being made as part of the primary health care program (Bath and Wakerman 2015).

The tenth strategy of the primary health care program should frame at making a continuous effort in providing safe and competent health services to one and all. No discrimination is made in providing quality services to the patients irrespective of their creed, race and kind (Chamberlain et al. 2016).

The eleventh strategy aims at complete utilization of the available technology as well as infrastructure in order to provide competent health care to all (Armstrong and Hayman 2014).

The Aboriginals continue to face discrimination in the hands of the non-Aboriginals and this the main reason why the strategies as devised by the primary health care program has failed over the years to establish a proper framework that can help them in dealing with their health related problems This gap can only be bridged through education. Education will allow proper understanding of their conditions and facilitate in communicating better with the health care personnel regarding their ailments. The government has to work in collaboration with the schools and community services to sensitize the non-Aboriginals and abolish institutionalized racism which is crippling the society and affecting the mental health of the Aboriginals.

Conclusion

It is necessary for the Government to devise strategies in order to continue with the funding of the various programs that already exist in order to promote primary health care among the Aboriginals. Efforts should be made to continue funding the initiatives so that more and more of the Aboriginals can come forward with their ailments and can be cured on time. It is necessary that the social differences between the Aboriginals and non-Aboriginals to be dissolved otherwise it will keep affecting the social image of the Aboriginals. It has been seen that they mostly suffer from the conditions such as depression and anxiety only because they go through racial discrimination on several levels and due to this there is a dearth of jobs for them where they are freely accepted within the workforce.  The government also needs to sensitive the people in the society so that they do not discriminate. Cultural competence among the health care workers will allow the Aboriginals to come forward and communicate freely about their health related problems.

References:

Armstrong, R. and Hayman, N., 2014. Health services for Aboriginal and Torres Strait Islander people: handle with care.

Aspin, C., Brown, N., Jowsey, T., Yen, L. and Leeder, S., 2012. Strategic approaches to enhanced health service delivery for Aboriginal and Torres Strait Islander people with chronic illness: a qualitative study. BMC health services research, 12(1), p.1.

Australian Health Ministers’ Advisory Council (2012) Aboriginal and Torres Strait Islander Health Performance Framework 2012 Report. AHMAC, Canberra.

Azzopardi, P.S., Kennedy, E.C., Patton, G.C., Power, R., Roseby, R.D., Sawyer, S.M. and Brown, A.D., 2013. The quality of health research for young Indigenous Australians: systematic review. Medical Journal of Australia, 199(1), pp.57-63.

Bath, J. and Wakerman, J., 2015. Impact of community participation in primary health care: what is the evidence?. Australian Journal of Primary Health, 21(1), pp.2-8.

Baum, F., Freeman, T., Jolley, G., Lawless, A., Bentley, M., Värttö, K., Boffa, J., Labonte, R. and Sanders, D., 2014. Health promotion in Australian multi-disciplinary primary health care services: case studies from South Australia and the Northern Territory. Health Promotion International, 29(4), pp.705-719.

Baum, F.E., Legge, D.G., Freeman, T., Lawless, A., Labonté, R. and Jolley, G.M., 2013. The potential for multi-disciplinary primary health care services to take action on the social determinants of health: actions and constraints.BMC public health, 13(1), p.460.

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

Browne, A.J., Varcoe, C.M., Wong, S.T., Smye, V.L., Lavoie, J., Littlejohn, D., Tu, D., Godwin, O., Krause, M., Khan, K.B. and Fridkin, A., 2012. Closing the health equity gap: evidence-based strategies for primary health care organizations. International Journal for Equity in Health, 11(1), p.1.

Carey, T.A., Wakerman, J., Humphreys, J.S., Buykx, P. and Lindeman, M., 2013. What primary health care services should residents of rural and remote Australia be able to access? A systematic review of “core” primary health care services. BMC health services research, 13(1), p.1.

Carroll, V., Reeve, C.A., Humphreys, J.S., Wakerman, J. and Carter, M., 2015. Re-orienting a remote acute care model towards a primary health care approach: key enablers. Rural and remote health, 15(2942).

Chamberlain, C.R., MacLean, S., Bawden, G., Kelaher, M., Munro-Harrison, E., Boyle, J. and Freeman, K., 2016. An ‘equity’domain could strengthen the utility of a framework for assessing care coordination for Australian Aboriginal families. International Journal of Care Coordination, 19(1-2), pp.42-46.

Clifford, A.C., Doran, C.M. and Tsey, K., 2013. A systematic review of suicide prevention interventions targeting indigenous peoples in Australia, United States, Canada and New Zealand. BMC public health, 13(1), p.1.

Davy, C., Cass, A., Brady, J., DeVries, J., Fewquandie, B., Ingram, S., Mentha, R., Simon, P., Rickards, B., Togni, S. and Liu, H., 2016. Facilitating engagement through strong relationships between primary healthcare and Aboriginal and Torres Strait Islander peoples. Australian and New Zealand Journal of Public Health.

Donato, R. and Segal, L., 2013. Does Australia have the appropriate health reform agenda to close the gap in Indigenous health?. Australian Health Review, 37(2), pp.232-238.

Durey, A., 2010. Reducing racism in Aboriginal health care in Australia: where does cultural education fit?. Australian and New Zealand Journal of Public Health, 34(s1), pp.S87-S92.

Durey, A., Lin, I. and Thompson, D., 2013. ‘It’s a different world out there’: improving how academics prepare health science students for rural and Indigenous practice in Australia. Higher Education Research & Development,32(5), pp.722-733.

Gibson, O., Lisy, K., Davy, C., Aromataris, E., Kite, E., Lockwood, C., Riitano, D., McBride, K. and Brown, A., 2015. Enablers and barriers to the implementation of primary health care interventions for Indigenous people with chronic diseases: a systematic review. Implementation Science, 10(1), p.1.

Hayman, N.E., Askew, D.A. and Spurling, G.K., 2014. From vision to reality: a centre of excellence for Aboriginal and Torres Strait Islander primary health care. Med J Aust, 200(11), pp.623-4.

Hepworth, J., Askew, D., Foley, W., Duthie, D., Shuter, P., Combo, M. and Clements, L.A., 2015. How an urban Aboriginal and Torres Strait Islander primary health care service improved access to mental health care.International journal for equity in health, 14(1), p.1.

Jennings, W., Spurling, G.K. and Askew, D.A., 2014. Yarning about health checks: barriers and enablers in an urban Aboriginal medical service.Australian journal of primary health, 20(2), pp.151-157.

Kanowski, L.G., Jorm, A.F. and Hart, L.M., 2009. A mental health first aid training program for Australian Aboriginal and Torres Strait Islander peoples: description and initial evaluation. International Journal of Mental Health Systems, 3(1), p.1.

Kelaher, M., Ferdinand, A. and Paradies, Y., 2014. Experiencing racism in health care: the mental health impacts for Victorian Aboriginal communities.Med J Aust, 201(1), pp.1-4.

Kelaher, M., Sabanovic, H., La Brooy, C., Lock, M., Lusher, D. and Brown, L., 2014. Does more equitable governance lead to more equitable health care? A case study based on the implementation of health reform in Aboriginal health Australia. Social Science & Medicine, 123, pp.278-286.

Malseed, C., Nelson, A. and Ware, R., 2014. Evaluation of a school-based health education program for urban Indigenous young people in Australia.Health, 6(07), p.587.

McCuaig, L. and Nelson, A. (2012) Engaging Indigenous Students through School-based Health Education. Australian Institute of Health and Welfare, Canberra.

McCuaig, L., Nelson, A. and OccThy, M., 2012. Engaging Indigenous students through school-based health education. Australian Institute of Health and Welfare.

Oliver, S.J., 2013. The role of traditional medicine practice in primary health care within Aboriginal Australia: a review of the literature. Journal of ethnobiology and ethnomedicine, 9(1), p.1.

Oliver-Baxter, J., Brown, L. and Bywood, P., 2013. Integrated care: what policies support and influence integration in health care in Australia.Adelaide: Primary Health Care Research & Information Service.

Panaretto, K.S., Wenitong, M., Button, S. and Ring, I.T., 2014. Aboriginal community controlled health services: leading the way in primary care. Med J Aust, 200(11), pp.649-52.

Reeve, C., Humphreys, J., Wakerman, J., Carroll, V., Carter, M., O’Brien, T., Erlank, C., Mansour, R. and Smith, B., 2015. Community participation in health service reform: the development of an innovative remote Aboriginal primary health-care service. Australian journal of primary health, 21(4), pp.409-416.