Indigenous Health- national reforms- changes in health status
Introduction
Indigenous national health reforms policy remains an important policy developed to solve health issues that have affected the Aboriginal and Torres Strait Islanders people. The policy was developed following the magnitude of poor health and the negative health implications of the health status of indigenous Australian communities. Some of the health issues that have affected these communities include health inequalities, poor living conditions, unemployment status, high literacy level, and high mortality rate. The government in consideration of these health issues came up with indigenous stakeholder informed policy that seeks to reduce the gaps that exist within these communities. Many different actors contribute to the formulation and implementation of this policy and some of these include the government department of health, indigenous community-controlled health organizations, indigenous people, non-governmental organizations and research organizations. The policy has been implemented with little success and various factors still limited the implementation. The following paper, therefore, analyses the indigenous national health reforms policy.
Nature and size of the problem
Indigenous Australians experience poor health care services than any other Australians this is due to poor health care services that are available within areas where these indigenous communities live. The problem of health within indigenous communities has been great since historical times. Firstly, health care inequalities that exist within communities make it hard to access healthcare services. The native Australians have suffered from extreme health disadvantages that lead to poor health services within these communities hence a high mortality rate. The health inequalities within the indigenous communities have been a matter of concern since time in history. This has contributed to people's vulnerability to diseases and other poor health conditions (Islam, 2019). The table below shows the gap that exists between non-indigenous people dwelling withing major cities and indigenous people living in remote places.
|
Condition
|
Non-indigenous Australians
|
Indigenous Australians
|
|
Smoking
|
13%
|
18%
|
|
Obese
|
61%
|
67%
|
|
Physical exercise
|
64%
|
69%
|
|
Risky drinking
|
15%
|
18%
|
|
High blood pressure
|
22%
|
24%
|
Secondly, inaccessibility of areas where the indigenous communities live is another health concern making it hard to access health services within these areas. The accessibility problem to these aboriginal community areas makes it difficult for health care service providers to access in times of need. For instance, where there is an outbreak of contagious diseases the likelihood of the health provider to reach the remote places is very minimal. These places have been geographically isolated from the rest of the country making many places impassible for health care providers. The ratio of health facilities and the people who need health services is high with some areas without any health facility. This shows the situation that remains the same despite the government trying to solve (Factor, Williams & Kawachi, 2013).
Thirdly, the poor health situation among the Australian native people is huge that points to death, disabilities, poor living standards, and other social issues. Indigenous communities are most likely to die of many diseases as compared to other Australians. The indigenous health problem has been characterized by poor health conditions that favor many diseases. This makes people from indigenous communities to suffer from multiple diseases as compared to these Australians. The level of disability among these indigenous communities is 6 times likely than other Australians. Moreover, lack of better health services makes this indigenous community suffer from diseases such as cancer, tuberculosis, HIV/AIDS and other diseases. Statistics also show that 1 in 5 of indigenous people is most likely to smoke as compared to other non-indigenous people when only 1 in 8 people smoke (Australian Bureau of Statistics, 2012).
Fourthly, the wider gap exists in terms of living conditions within remote areas that make the health care service provision not easy. The indigenous communities live in poor health conditions characterized by low education that hinders health care service. This has affected the health status of these people leading to more poor health than other Australians. Also, indigenous communities suffer from diseases that require resources to treat which these people could not afford. The health inequality gap has existed since the time of colonial activities that enable the alienation of the locals from their resources (Cunningham, 2010).
Historical development of the policy
Historical facts show the disparities in health care service within the indigenous Australians. The historical perspective and observations have enabled the development of the policy to reduce the effect of historical issues. Some historical issues influenced the development of the indigenous national health policy and national health reforms. Firstly, historically, the mortality rate of indigenous people has been low estimated to be 20 years lower than other Australians. Various factors contribute to the poor health status that has affected the native Australians people (Pascoe, 2012). For instance, the lack of accessibility to health care places people from Aboriginal and Torres Strait Islanders at the edge of health risk from environmental factors. There was a high population of Aboriginal and Torres Strait Islanders people living in conditions that do not support good health. Also, low access to basic health care and health infrastructure has lead to health concerns reaching the national level (Factor, Kawachi & Williams, 2011).
Secondly, racism existed against indigenous Australia leading to disparities in health care services. Racism existed since the time of British colonial rule that placed these communities under high exploitation. These people were exploited in terms of land and other resources making the indigenous people remain poorer than other Australians (Kelaher, Ferdinand & Paradies, 2014).
Thirdly, historical injustices that existed within the indigenous Australian communities enable these people to suffer for a lack of health services. The historical injustices that affected the Aboriginal and Torres Strait Islanders people have made them react negatively to health services. This is due to past mistakes that were witnessed by these communities when the government remains silent despite the suffering of these communities (World Health Organization, 2013). Marginalization that existed and was set by colonial rule influences the social and resource injustices that saw many indigenous people remain landless as their land forcefully taken away by foreigners. Little progress in reducing the historical health injustices among the Aboriginal and Torres Strait Islanders people still calls for national government attention (Cunningham & Paradies, 2012).
Fourthly, during the colonization of the indigenous people, colonizers brought introduced diseases that were not of the native. This resulted in death and a high mortality rate that is still felt within the indigenous communities. Many Aboriginal and Torres Strait Islanders people were devastated with death and were instead locked up as prisoners by colonial people. The government of Australia after independence did not change the situation as the ill health persisted until later when the federal government begins to act. Various diseases increased the mortality rate and also reduced the life expectancy rate to more than 20 years below the normal Australians life expectancy. This has been disputed by many researchers indicating that the health situation within Aboriginal and Torres Strait Islanders people can be avoided. This has reached the national level pressurizing the government to act in swift to develop a policy that will bring reforms (Dudgeon, Wright, Paradies, Garvey & Walker, 2010).
The social-economic factor that has existed since historical times has highly contributed to the poor health status of the Aboriginal and Torres Strait Islanders people. The indigenous people were faced with unemployment in the health sector, poor status of education, limited investment and poor living conditions such as a house. Historically, Aboriginal and Torres Strait Islanders people lacked space within the national health care system and this resulted in the poor health status of the people. Low literacy level was also an important health contributing factors that led to inaccessibility to health services by the indigenous people. The unemployment status of the indigenous people enables the government to look incapable of helping the Aboriginal and Torres Strait Islanders people (Alford, 2014).
Main actors involved in the policy advocacy
Many actors are involved in the indigenous health national reform policy. Firstly, the indigenous communities are key actors as they have been suffering from poor health care services. The government through the department of health has been trying to reduce the health dicrpersies that exist within indigenous communities by involving the local in health service provision. This has seen many Aboriginal people being involved in the National Health Service system. This is also to ensure that the areas where these people live remain culturally competence when it comes to health service delivery (Zhao, You, Wright, Guthridge & Lee, 2013).
Secondly, the indigenous community health controlled organization has been operating at the community level to help reduce the impact of these health disparities. Development and implementation of indigenous health national reform policy have seen the government moving to use indigenous community-controlled health organizations. The government through the department of health devised a plan that developed community-controlled health organizations through the National Aboriginal Community Controlled Health Organization that spearhead various local community-controlled health organizations. These organizations work within the community level though with national scope (Shinn, Krause & Safranek, 2012).
Thirdly, the department health is another key factor that has been at the forefront of advocating for the indigenous health policy. The department of health has been advocating for the health reforms that enable reducing the gap that currently exists. The government department of health has adopted various recommendations for health reforms that purpose to increase the number of Aboriginal people in the health care system in terms of employment. This serves to increase the participation of the indigenous people in health delivery. Furthermore, health reform policy is meant for the department of health to improve on the health standards of people living in remote places (Steering Committee for the Review of Government Service Provision, 2013).
Lastly, community-based non-governmental organization that operates within the community level. There are many different non-governmental organizations and research organizations working in places where the Australian native people leave. These also include various learning institutions that work to study the health care situations within these communities. The main aim is to the champion human right for native people. In addition, the government has been encouraging non-governmental organizations or research organizations with good proposals to come for funding to improve the health care need of indigenous people (Zhao, Connors, Lee & Liang, 2015).
Policy implementation
The policy has been implemented through the success has been minimal as compared to the health need of native Australian people. The indigenous health policy and national reforms have been implemented since development and this has been due to the need to close the gap in health care services. Firstly, the government has implemented the indigenous health policy and this is evident through various developments that have been conducted within these communities. These developments are still challenged with various systematic factors that require high government involvement. For instance, improving the health status of indigenous people requires infrastructure development and realignment of health resources towards Australian people (Wakerman & Humphreys, 2011).
Secondly, the government formed various community-based health organizations to help in the implantation of health reforms. This community has been working at the community level through the support from the government is still limited. Funding for these communities has been a major challenge that requires swift intervention. The government's move to form this community-controlled health organization was to enable the cultural provision of health service where the culture of the indigenous people would prevail. This also enables Aboriginal and Torres Strait Islanders people to take part in the management of these community-controlled health organizations (Thomas, Wakerman & Humphreys, 2015).
Thirdly, the government has been adopting various national health system reforms that ensure that indigenous communities are involved in health services. The government through the department of health has been reforming the employment sector of the health to include Aboriginal and Torres Strait Islanders people. This is meant to make the employment status of the indigenous people better as compared to how the situation has been. Infrastructure development is the last strategy of the government through the building of health facilities. This has still met with some challenges that include a low population is some places. This also requires massive resources to build transport systems hence the accessibility of these places. With the limited funding of the government, the implementation of this strategy is still poor (Priest, Mackean, Davis, Briggs & Waters, 2012).
Fourthly, the government has been advocating for various health care strategies within these indigenous communities. The government has been championing various health strategies that aim to improve the health situation of indigenous communities. This has enabled funding of various health activities such as primary health care dubbed as PHC Activity (Thomas, Wakerman & Humphreys, 2014). This is also coupled with funding of indigenous community-controlled health organizations that are managed by people from Aboriginal and Torres Strait Islander communities. Furthermore, the government seeks to reduce the gap that exists in terms of mortality rate and life expectancy between indigenous people and other Australians (Ong, Carter, Kelaher & Anderson, 2012).
Lastly, improved health outcomes are another area that shows the implementation of the national health reforms among the indigenous communities. According to the government, the health care outcomes indicate there is a reduced child mortality rate from 217 deaths per 100000 indigenous children to 146 deaths per 100000 by 2016. Moreover, the gap that formerly existed in birth life expectancy between indigenous communities and the non-indigenous community has reduced from 11.4 to 10.6 years in males and 9.6 to 9.5 years in the female. The smoking rate has also reduced from 51% in 2002 to 42% in 2015. The decrease in alcohol consumption is another area that has been from 19% to 15% during the period between 2008 and 2015 (Australian Bureau of Statistics, 2013).
Evaluation of the policy
The policy was evaluated ant this has led to various recommendations that need improvement. The government has involved many different players in the evaluation of the policy to determine its success during the implementation. Firstly, the government has conducted its evolution to determine the status of the national health of native Australian people. This has also seen the government through the department updating or reporting on the limited implementation of this policy (Steering Committee for the Review of Government Service Provision, 2013). Secondly, various health care organizations have evaluated the implementation state of the policy to identify gaps that currently exist. This has resulted in the development of new statistical differences that exist between indigenous and non-indigenous people. Thirdly, various researchers have cited the health differences that still exist between Aboriginal and Torres Strait Islanders people and to other Australians. This has been due to an evaluation of the implementation of the indigenous health policy (Australian Institute of Health and Welfare, 2012).
Some challenges were identified at the implementation of the policy. Firstly, the evaluation identified the underfunding of the policy that leads to little success. The limited funding of the policy is a challenge that led to poor implantation of the health reforms. Many areas where the native people lives lack basic resources and infrastructures that affect health care service provision. Limited funding that considers these massive resource requirement limit implementation of the policy. Moreover, it was identified that more resources are required to help meet the health needs of these indigenous people (Nelson, Abbott & Macdonald, 2010).
Secondly, the gaps that exist between indigenous communities and other Australian are wider than imagined. The evaluation identified gaps in the implantation of the policy that need to be considered. Based on the historical injustices and inequalities, the gap that exists within indigenous health and national health requires more time to reduce. Besides it was established that to reduce the gap more resources are needed than was initially allocated (Australian Bureau of Statistics, 2013).
Thirdly, limited political support was identified as issues that undermined the implementation. Lack of political support is another challenge that affected the implementation of the policy. National reforms needed to increase the level of participation of the indigenous people in the national health system and this requires a political goodwill to implement. The implementation lacked this political support leading to limited implementation. Limited support has been witnessed when the indigenous people and related organizations push for equal employment within the health system. This has made the government react by increasing some employment slots for native Australian people within the department of health. This is still low as compared to other Australians already taking up space in the health system (Braveman & Gottlieb, 2014).
Fourthly, the evaluation identifies the challenges of attaining health equity, especially within the indigenous health level. Indigenous community level lack many policy support structures that hinder implementation. The inaccessibility of many places within the indigenous community reduces health service delivery. Many areas where the indigenous communities live lack infrastructures such as health facilities, road and water systems that reduce the implementation possibilities (Islam, 2019).
Lastly, the evaluation of the policy also cited statistical differences between the indigenous Australians and other nonindigenous Australian people. For instance, currently, it is estimated that indigenous people are still facing some issues such as 2.1 times likely to die by the end of the fifth birthday. This shows that there is a minimal change in the health issues that have been affecting the indigenous communities (Australian Bureau of Statistics, 2011).
In conclusion, the national health status of the native Australian people still requires the conclusive implementation of indigenous national health reforms policy. The historical facts point to social, economic and health disparities that resulted in poor health status within the indigenous communities. Native Australian people have been alienated from health resources prompting the government to involve indigenous stakeholders in the development of the policy. The indigenous national health reform policy has been implemented with little success due to various resources and political factors. Various governmental and non-governmental organizations have evaluated the policy to explain the national health status of Aboriginal and Torres Strait Islanders people. Therefore, there are a lot of issues that need to be resolved to ensure proper implementation of the indigenous national health reform policy.
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