NSG2204 Indigenous Culture and Health

Introduction

The World Health Organization reports that the disparities in socioeconomic status like health between the aboriginals and non-indigenous is one of the largest in the world. The life expectancy of the aboriginal individuals born between 2010 and 2012 was approximated to be 10.7 years lesser than the non-indigenous male population and 9.6 years lesser than the female population. The indigenous population’s health is hugely determined by numerous factors which are linked to their cultural practices. They have faced health inequalities at all levels of the livelihoods like insufficient access to healthcare services, few education opportunities, and inadequate nutritious food. Comprehending the historical reasons for the prevalent health disparities of the indigenous health is vital in gaining the awareness to significantly engage with the indigenous population and collectively chart a way forward.

Colonization of Australia exacerbated the annihilation of the indigenous people via prevalent killings and the introduction of the hitherto unknown infectious diseases. Health disparities of the indigenous population increased due to government policies which oversaw massive destruction of communities and families via stolen generation; removal of young people from their families. The paper critically analyses the contemporary and historical Australian government policies which have impacted on the social determinants of health for the aboriginal population, their culture and the effect on the cardiovascular disease.

Government policy of assimilation; stolen generation

The Commonwealth Government, in 1937, a held a forum concerning the aboriginal people which resolved that the indigenous people (of mixed race) should be assimilated or absorbed in the bigger populace. The main objective of the assimilation policy was to make the indigenous people ‘problem’ slowly fade away so that they can would lose their cultural identity (Parry, 2012). The policy of assimilation was based on the general assumption that the lives of the indigenous people would significantly improve if they were absorbed into the white society. The policy proposed that the indigenous people be allowed to ‘phase out’ via natural elimination process, or if possible, absorbed into the non-indigenous population. Indigenous children’s names were regularly changed, and several were forbidden from communicating in their conventional language. Most children were adopted by the white communities and some were placed in institutions in which neglect and abuse were frequently practiced. People of the First Nations who were removed from their families and communities were left with permanent mental health issues like trauma and were not given rights like other non-indigenous population (Shepherd, Jianghong, Cooper, Hopkins & Farrant, 2017).

The impact of assimilation policy on cardiovascular diseases

Cardiovascular disease remains one of the major causes of mortality rates among the aboriginals in Australia with the population rate 1.9 times that of non-indigenous population.  The aboriginal children who suffer from cardiovascular disease have poor access to adequate health care facilities (Kyly Michelle, Gatton, Ray & Alison, 2017). In addition to the poor healthcare received by these patients, there cases are exacerbated by high levels of post-traumatic stress disorder and suicide, anxiety, depression, and socioeconomic outcomes. Patients having receiving poor education will significantly not understand the intricacies of the diseases, thus will continue to suffer from the disease (Field et al., 2020). Efforts to ensure that children abolish their cultural heritage always created a sense of shame about being of aboriginal heritage leading to a culture disconnection and the inability to pass culture from future generations. Patients suffering from cardiovascular disease will not benefit from the tradition medicinal knowledge which is vital in managing the disease. Several patients of the cardiovascular disease have never recovered from the trauma of having their children separated from while some turned into alcohol as a coping mechanism increasing their vulnerability to the disease (Molloy, Walker, Lakeman & Lees, 2019). This is exacerbated by other social determinants like access to education and stable income.

Between 1995 and 1997, the commission on Human Rights and Equal Opportunity in Australia conducted a National Inquiry in to the government assimilation policy which were documented in ‘bringing them home report’ (Bodkin-Andrews & Carlson, 2016). The report detailed practices, laws and policies which enabled children to be separated from their families. In 1999, the Government of Australia provided a motion of reconciliation in the national assembly which articulated sincere and deep regret (Short, 2016).

Closing the Gap policies and cardiovascular disease

Currently, closing the gap on the aboriginal health disparity and disparity is becoming the principal aboriginal policy objective of the government of Australia. The National Agreement on Closing the Gap is a government’s policy and strategy which aims to enhance the life outcomes of the indigenous people. Closing the gap policy identified four reform targets which aim to transform the way governments at community, state and national levels can work to enhance the health outcomes of the indigenous population (Nakata, Nakata, Day & Peachey, 2017). The priorities include; shared decisions and formal partnerships to strengthen and build structures that empower the indigenous people to shared making of decisions with different administrations. Establishing sectors controlled by communities to deliver healthcare services that promote closing the gap policies. Transforming organizations within the government to promote accountability and effectively respond to the needs of the indigenous population. Allow the access to region specific data and information to support indigenous people and their organizations to achieve the other mentioned priority areas (Anna, Emily, Melanie & Lillian, 2020).

Closing the gap policy proposes cardiovascular screening guidelines which improves management and care to the patients. The policy points that primary healthcare providers like nurses should pick out aboriginal patients, offer quality care and acknowledge their rising risk as well as lower age of disease onset (Reath & O’Mara, 2018). Moreover, closing the gap states that it is important to ensure that all healthcare facilities offer culturally safe, supportive and trauma-informed settings in which to work the patients, their families and communities. Access of indigenous people to recommended pharmaceutical benefits scheme co-payments done within the policy framework should ensure equity to the patients.

Where a person lives remains an important social determinant of health especially for the cardiovascular patients. Empirical research suggests that homeless adults and those who live in overcrowded places face 61%-72% higher rates of cardiovascular diseases relative to the whole population. Eliminating overcrowding will significantly improve the health conditions of the aboriginal population suffering from cardiovascular events. Overcrowding is one of the priority policies of the Closing the Gap with approximately $5.6 billion set aside to be spent nationally on remote aboriginal housing (Gracey, 2014). This is very vital in easing and reducing the problem of overcrowding and housing

Cultural competence of nurses

To address the various social determinants of health in indigenous communities, nurses must be culturally competent and able to understand the underlying and unique cultures of the aboriginal communities. Australia has diverse cultural health population which expects to get quality healthcare services which are culturally sensitive (Dunbar, Bourke & Murakami, 2019). In Australia, cultural competence is described as the corresponding host of policies, attitudes and behaviors in agencies, systems or among healthcare workers and enables them to operate effectively in cross-cultural conditions. In healthcare environments especially in indigenous communities, culturally competent nurses understand and recognize the effect that own professional and cultural beliefs have on practices in places of work (Jongen, McCalman, Bainbridge & Clifford, 2018). A cultural competent healthcare provider should recognize that cultural diversity happen across all diversity levels, both at secondary and primary levels. Such as nurse will understand and recognize the significant humanity in individuals regardless of their cultural background (Clifford, McCalman, Bainbridge & Tsey, 2015).

For nursing practice to be culturally sensitive, it should respond and mirror the needs of the cardiovascular disease patient becoming accessible, efficient, acceptable, adaptable and effective to all the mental health patients in the aboriginal population. To identify care needs and expectations of a culturally diverse cardiovascular disease patient, nurses have to consider his or her own cultural systems as well as biases and the potential for misinterpretation and misunderstanding of behaviors which are culturally bound (Frisby & O’Donohue, 2018). Moreover, in developing a therapeutic plan for an aboriginal cardiovascular disease patient, nurses must understand the unique patterns of feeling, behaving and feeling. The understanding offers a blueprint for contextualizing the expectations, reactions and behaviors (Stuart & Nielsen, 2010).

Conclusion

Good wellbeing and health is linked to a host of factors which entail socioeconomic risk factors, use of and access to effective healthcare facilities and services, personal health endowments and environmental factors. The social determinants of health cause serious socioeconomic disparities between aboriginals and non-indigenous population in Australia. Government policies have increased the disparities of health in the country. The policy of assimilation caused a lot of health challenges for the aboriginal communities, particularly to the communities and families that were affected. The stolen generation have suffered for years and even though the government issued an apology to the victims, a lot needs to be done to bridge the gap. Closing the gap is executed to the right the wrong of historical injustices meted on the aboriginal community.

References

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