Impact Of Close The Gap Policy On Indigenous Australian Health: A Case Study Of Type 2 Diabetes Mellitus Essay.

Background on CTG Policy and Targets

Indigenous Australians that includes Australians of Aboriginal origin and Torres Strait Islander are victims of social discrimination and lack of governmental support which has imposed negative impact on their economic, academic and health development. This essay is about the impact of Close the gap policy on the health status and longevity of the indigenous Australians. This essay also discuss the impact of CTG policy on Judy, a 57 years old Aboriginal Australian.

Closing The Gap (CTG) policy is a strategy taken by the Council of Australian Governments (COAG) in March 2008 that includes the leaders of state, federal and territory along with local governments, which involves closing the gaps in health equality and life expectancy between Torres Strait Islander, Aboriginal Australians and the non-Indigenous Australians within 25 years (Ackehurst et al. 2017). The policy is targeted to Torres Strait Islander and Aboriginal people who comprise more than two and a half percent of the total population of Australia. According to estimation, 90 percent of the targeted population is of aboriginal origin while 6 percent are of Torres Strait Islander origin and 4 percent are of both Aboriginal and Torres Strait Islander Origin (Taylor and Guerin 2010). In order to monitor the changes, COAG has set certain measureable targets that includes eliminate the differences in life expectancy within a generation, to decrease the mortality rates by half and ensure early childhood education access of indigenous children below the age of five, within a decade and within 5 years respectively (The REM Framework 2016). The policy also targets to half the gap in academic activities, year 12 attainment and equivalent attainment rates for indigenous students by 2020 (Bainbridge et al. 2015). It also ensures decrease the gap by half in employment outcomes within a decade. Aboriginal Australians and Torres Strait islander, through decades, were subjected to imposition of oppressive legislation. Hence this policy was enacted to prevent oppression by enforcing equality between indigenous and non indigenous Australians. According to the report of COAG Reform Council, good progress has been done on three targets namely, early childhood education, child mortality rates and year 12 or equivalent attainment whereas, no significant improvement has been reported in health statics, academic achievement and employment outcomes of Indigenous Aboriginal Australians (Taylor, Kickett and Jones 2014). Despite the fact that expectation from the CTG policy was high, according to the latest Prime minister report 2017, the results CTG is still below expectations on most fields, especially health (Core Issues and Organisation Lecture 2017). The report stated that Aboriginal and Torres Strait Islander people are still the least healthy sub-population of Australia. Several limitations of the CTG policy can be considered as the reason behind the laxity of the policy. One of the major limitations of CTG is the lack of regular engagement and communication of the disability service providers with the aboriginal community due to which unsatisfactory health care services are experienced by the later (Reeve et al. 2015). Considering the fact that development of health is directly dependant on economic development, lack of attention of the government on the economic development of the Aboriginal community can be considered as another reason behind the partial failure of the policy (Lip and Scheme 2016).

Limitations of CTG Policy

Type 2 diabetes mellitus is a long term metabolic disorder which is identified by high blood sugar level, insulin resistance and lack of insulin (Sherwood 2013). Common symptoms of the disease include frequent thrust and urination and often unexplained weight loss. As in the case of Judy, diabetes can also causes leg ulcer since highly fluctuating blood sugar level can convert even a mild injury in leg to leg cancer. The physical impact of the leg ulcer caused due to Type 2 Diabetes Mellitus (T2DM) on Judy involves severe pain resulting in sleepless nights along with swelling, malodor and discharge. Due to T2DM, Judy is also having frequent urge for urination. Considering the fact that she has almost lost her mobility due to the leg ulcer, a bed pan is provided to her.  The physical health of Judy has imposes a negative impact on her emotional and spiritual health. The fact that she has temporarily lost her mobility is making her fell helpless since she lives by herself. Besides that, severe pain and sleepless night is making her feel depressed and impotent. A healthy spiritual state of mind helps patients like Judy to be recovered even from severe diseases by fighting depression and anxiety and improving the ability to cope with the physical stress (Purdie et al. 2010). Considering the fact that T2D is highly prevalent among indigenous Australians, it has been included in the CTG policy. T2D in Aboriginal Australians and Torres Strait Islander is associated with poor blood sugar control and high morbidity due to poverty, genetics, poor health literacy and remoteness as in case of Judy who is an Aboriginal 57 year old widow woman. Judy was admitted in a health care under Aboriginal Medical Service (AMS) where she was diagnosed with T2D along with leg ulcer and since she has an Aboriginal background, Judy was referred by AMS and ALO to the community health centre. Some major long-term health consequences of T2DM for Judy are kidney disease, diabetic retinopathy and neuropathy along with macro vascular issues. Benefits of CTG policy of Judy involves getting medications that are prescribed to her along with service from the community health centre at a much lower price.

The terms ‘AMO’ and ‘ALO’ stand for Aboriginal Medical Officers and Aboriginal Liaison Officers respectively (Taylor, Foster and Fleming 2008). The chief function of an ALO is to ensure that all the Aboriginal Australians along with Torres Strait Islanders are able to access mainstream healthcare services. ALOs are trained to acquire culturally appropriate expertise and skills and they communicate sensitively with the indigenous Australians along with working closely with Aboriginal medical services and other health care providers. The role of an ALO is to provide training and healthcare education to health service staffs about Medical Benefit Schedule (MBS) and Indigenous health care plans. Secondly, ALOs increases the indigenous Australians enrolment in Medicare and ensure the authenticity of the medical benefits claimed (Couzos and Murray 2008). The role of ALOs also comprises of providing advice and support about new Medicare initiatives along with promoting Medicare services and programs at local Indigenous events and forums. The AMOs on the other hand, are Indigenous people provide Aboriginal Medical Service (AMS) which includes medical, aged care, dental and alcohol and drug services to about 5,5000 indigenous people each year (Best and Fredericks 2014). Considering the fact that Judy who is a 57 years old Aboriginal woman was suffering from T2DM along with leg ulcer, she is eligible for accessing AMS. This is the reason why the AMO has stated in the discharge letter that she is eligible to be registered for CTG and Judy is referred by both the ALO and AMO to the Community health care center. Since Judy is suffering from leg ulcer, she needs to have regular dressing in order to be cured. However, she lives alone in her house and has lost her mobility due to the leg ulcer. For this reason, the ALO has requested the healthcare community to send community nurses for daily dressing of the leg ulcer since AMS are not able to attend to this necessity. Thus, both AMO and ALO has played a major role in acquiring health care services by Judy.

From the essay, it can be concluded that one of the chief purposes of the CTG policy is to reduce the health issues of the indigenous Australians. Considering the fact that the percentage of health issues of the indigenous Australians is far more than that of non-indigenous people due to poverty, lack of education and governmental support, the CTG policy demolish its limitations to irradiate the gap. In case of Judy, beside treating and providing medication to her for T2DM, she is also recommended to access daily dressing facilities at her residence. Thus, both the AMS and ALO are helping Judy to be recovered from the disease to a great extent.

Reference list:

Ackehurst, M., Polvere, R.A. and Windley, G., 2017. Indigenous Participation in VET: Understanding the Research. National Centre for Vocational Education Research (NCVER).

Bainbridge, R., McCalman, J., Clifford, A. and Tsey, K., 2015. Closing the gap.

Best, O. and Fredericks, B., 2014. Yatdjuligin: Aboriginal and Torres Strait Islander nursing and midwifery care. Cambridge University Press.

Core Issues and Organisation Lecture. (2017). [image] Available at: https://www.youtube.com/watch?v=hcpaSPooEEw&feature=youtu.be [Accessed 11 Dec. 2017].

Couzos, S. & Murray, R. (2008). Aboriginal Primary Health care: An Evidence-based Approach, 3rd edn, Oxford University, South Melbourne.

Lip, C. and Scheme, P., 2016. Australian Register of Naturopaths and Herbalists Australian Standard Geographic Classification–Remoteness Areas British Medical Association Better Outcomes in Mental Health Care Council of Ambulance Authorities. Understanding the Australian Health Care System, p.427.

Purdie, N., Dudgeon, P. and Walker, R., 2010. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice.

Reeve, C., Humphreys, J., Wakerman, J., Carter, M., Carroll, V. and Reeve, D., 2015. Strengthening primary health care: achieving health gains in a remote region of Australia. The Medical Journal of Australia, 202(9), pp.483-487.

Sherwood, J., 2013. Colonisation–It’s bad for your health: The context of Aboriginal health. Contemporary nurse, 46(1), pp.28-40.

Taylor, K. and Guerin, P., 2010. Health care and Indigenous Australians: cultural safety in practice. Macmillan Education AU.

Taylor, K., Kickett, M. and Jones, S., 2014. Aboriginal and Torres Strait Islander health curriculum project: findings from preliminary consultation process. Undertaken for Health Workforce Australia as part of the Aboriginal and Torres Strait Islander Health Curriculum Framework Project. Adelaide, South Australia.

Taylor, S., Foster, M. and Fleming, J., 2008. Health care practice in Australia: policy, context and innovations. Oxford University Press.

The REM Framework. (2016). [image] Available at: https://www.youtube.com/watch?v=TswEEGemBco&feature=youtu.be [Accessed 11 Dec. 2017].