Health promotion Essay Example

Health care is a fundamental human right to which every individual should have an access. However, in the age of globalization and technological advancements we are in there are still persistent issues of concern with regard to outstanding disparities in health care access and provision. The issue of inequalities traverses both developing and developed nations. Australia is one of the healthiest nations in the world, according to World Vision with an average expectancy of 80 years (World Vison , 2007). By 2020, the governments intend s to have the country as the healthiest in its national health strategy of 2009. However, the gap between the health of indigenous and non-indigenous Australians is unacceptably wide, a fact agreed to by the United Nations as well as individual Australian governments (Calma, 2007). Mortality rate of indigenous men is eleven times the general population while women post a rate that is nine times the general population (Lewis, 2003). Given such a background, this paper seeks to explore the inequalities against women with respect to cervical cancer, a leading global cause of death amongst women. Is shall explore the demographic characteristics of Aboriginal women, risk factor and prevalence disparities and the consequent burden of illness. The role of social determinants of health in the disparity will also be explored as well as mitigation ways such as education and its benefits.

Demographic characteristics

The Aboriginal population of Australia has registered increased growth over time at a rate of 2.2% per annum. In 1991 it was 351, 000 people and grew to 517, 000 by 2006 to represent 2.5% of the total population. It is further projected to grow to between 713, 300 and 721, 100 by 2021 (ABS, 2012). Out of the total estimated resident population projected by the Australian Bureau of Statistics (ABS) at 22, 696, 000, the Bureau admits that it is difficult to estimate using standard approaches due to the volatility and unavailability of sufficient data on key components such as births, migration and deaths. However, the estimated number of aboriginal women stands at…… this comprises of women in Queensland, New South Wales (NSW), Victoria, Australian Capital Territory and Tasmania. The Northern presents the slowest growth rate.

The definition of indigenous has taken various dimensions across various regions globally to characterize the over 350 million people. However, an accurate definition should underline the following: relations to colonial rule, poverty, isolation, remoteness, political marginalization, landlessness, and inadequate access to social services (Carrin, 2009). The aboriginals are described as being part of indigenous Australians together with the Torres Islanders. Generally, this population presents a rural and young profile of 21 years median age and life expectancy of 72.9 years (Burns, Mailing, & Thomsn, 2010). In 2006, most lived in non-remote areas: such as regional areas (43%) and major cities (32%) whereas only 25% lived in remote areas (ABSb, 2011). With regard to socioeconomic status and outcomes, the indigenous Australians continue to lag behind their non-indigenous counterparts. This is with respect to education, health access and outcomes, and unemployment. From the report (Cat. No. 4704.0), there was a decrease of 6% percent unemployment rate between 2000 and 2008. However, remains 3 times higher than on the non-indigenous population. With regard to women, their affluence is related to socioeconomic opportunity disparities across the national divide as well as relative to male counterparts. In 2009, women accounted for a 45 percent of the total Indigenous Australians in the labor force (ABSc , 2010). They also comprised a 59% of the total Indigenous Australian who were not in the labor force. This situation is as a result of educational levels attained by the women. In 2006, Indigenous females had lower school attendance rates and completion. In this census, only a 5th of the Indigenous women had a post-school qualification compared to 37% of the non-Indigenous females. Additionally, only 5% of the former had a Bachelor degree and/or above and 15% had diplomas compared to 17% and 20% of the latter, respectively (ABS, 2008). This translates into income disparities whose degree has not changed in spite of a 9 percent increase (Burns, Mailing, & Thomson, 2010): see below, figure 1.

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Figure 1: income disparities (median weekly gross) for females 15 years and above between Indigenous and non-Indigenous (Steering Committee for the Review of Government Service Provision, 2009)

Health disparities

The Indigenous women have continued to receive poorer health access and outcomes across all areas relative to their non-Indigenous counterparts. Essentally, the Indigenous women experience better health outcomes due to aspects such as improved prevention, early and time detection and treatment and accessibility to health programs. As such, they will have lower burden of disease. Cervical cancer is among the common causes of death. Among the indigenous women, it has been reported to have a prevalence of 2-5 times that of the non-Indigenous and a mortality rate of 8-12 greater (Reath, 2008). The differences in national and regional burden traverses factors of urbanization, race, ethnicity and socioeconomic class. More rural indigenous women are likely to die from the cancer than urban dwellers. In addition, remote Aboriginal women have 18 times higher death risk than non-Aboriginal (Downs et al, 2008). The age factor presents factors that show skewness towards younger and reproductive women. In order to adequately address cancer care issues in a population, it is vital that there is an understanding of the burden of disease on individuals as well as the community. There are economical and social burdens, alike. From the social aspect, cervical cancer has been related to sexual activity. Its causative factor, the human papilloma virus (HPV) is sexully transmitted. This underlines the stigmatization of cervical cancer as being sexually transmitted. This has adverseley affected prevention measures undertaken by authorities such vaccines. Essentially, cervical cancer is preventable and should not be treated as being sexually transmitted but as a complication related to oncogenic infection of HPV (Cancer Council). With stigmatization and lack of knowledge or having the wrong knowlegde on the subject women have been keeping off prevention activities such as immunization and screening.

Literature has identified several risk factors for the disease: behavoral risks, co-factors, social, and demographic factors. In a nut shell, the risk factors include HPV infections, chlamydia infection sexual activity, smoking, diet, multiple pregancies, sexually transmitted diseases, low socioeconomic status and use of oral contraceptives (Shah & Rohan, 2004). This in addition to non-compliance to screening and early detection. With regard to sexual activity, cervical cancer has been related to early age sex, multiple sex patners as well as sex with uncircumcised man. This explains the higher prevalence amongst young women than older counterparts. Low socioeconomical factors are cited as being probably the most relevant single factor group. Essentially, other factors are also influenced by this factor. It has direct impact on income, affordability of services, lifestyles and individual behaviors. It is a direct influence on literary levels as well as access to services that are preventative.

With regard to prevalence and survival, there exists sharp disparities between Aboriginal and non-Aboriginal women. Cervial cancer is preventable. However, it is related to Aboriginal mortality rates 8 times those of non-Indigenous. There are several reasons cited as being causative of the difference. Firstly, Indigenous women post quite low participation screening programs. As such, early detection is unsuccessiful. This has been related to factors such as distance, isolation, communication, language, and cultural differences. As such they are hesitant to undertake Pap smear. The differeces highlighted are also with reference to relations with health care providers. Provider knowledge is vital in cervical cancer treatment. However, there literature that has faulted providers for lack of adequate understanding of needs, cancer data, approach methods and inadequate Aboriginality identification (Reath, 2008). This is an institutional barrier which affects the quality of healthcare. The ABS has cited that there has been a lack of adequate data on the Aboriginal community. This may be a central factor in the lack of understanding and consequent non-commensurate initiatives.

Together with low patient knowledge amongst Indigenous women, the inadequacy of provider knowledge waters down preventive measures. Patient knowledge revolves concerns for low cancer screening priority, inadequate or inappropriate health information and awareness on cancer prevention. This is also related to access to information on the subject. These factors have their effects being felt in the interaction with health systems. Across various population groups, adherence to prevention program is related to having an understanding of the disease and its major causative factors. Citing similar barrier in other indigenous communities- Hispanics immigrants (Downs et al, 2008) indicate a lack of knowledge which, along with cultural systems are party to low compliance. Due to lower health literacy levels, there are consequential late diagnoses and poor health outcomes. System and contextual factors also have an influence on willingness to accessing health programs and on outcomes thereof. The key systemic and contextual factors include cultural, economical, social, environmental, and institutional factors (Singer & Erickson, 2011).

The role of health education

Cervical cancer is a preventable disease. Primary in this is the role of education and promoting health literacy (Shah & Rohan, 2004). Health education entails communicating information and messages on health matters in simple and understandable means. It precedes the need for others such as screening, behavioral modifications as well as medical interventions. Educational strategies have focus on prevention by detailing in risky behavior reduction, enhancing acceptance and compliance to screening as well as follow-up. Shah and Rohan (2004) present a model by which each risk factors is addressed individually suggesting the need for an al inclusive approach. Apart from sensitizing women on risk factors for cervical cancer, health education is instrumental in attitude change. As indicated above, lack of knowledge or having the wrong knowledge is instrumental in deterring the success of preventive strategies, especially screening and the Pap smear adoption. Health education assists in eliminating attitude misconceptions about cervical cancer thereby improving individual acceptance and sense of responsibility. This reduces ignorance, stigma and fear related to the disease (Reath, 2008). In addition, there is enhanced knowledge of signs and symptoms as well as mitigation ways. Health education complements HPV prevention and counseling preventive interventions.

In order to acquire maximum benefits from health education amongst the Aboriginal women, it is vital that it is designed to be target centered and culturally oriented. This implies the need to begin with service providers in order to deal off fundamental institutional barriers. It is also important that it is based on current empirical data. It should reflect the national policy and intention that is culturally oriented and with consistence. It can be done on public media, in health facilities as well as community outreach.

In conclusion, cervical cancer is one of the leading causes of mortality for women globally. In Australia, there exists sharp disparities between minority and majority women population groups. The disparities are related to socioeconomic issues, racial and ethinicty and other demographic characteristics. Australia is one of healthiest nations, and projects to be the healthiest by 2020. However, Indigenous health care has not much changed and continues to demonstrate discriminative organization and outcomes. The Indigenous women are more prone to causative risk factors. They are also less likely to have early diagnoses implying lower survival chances. In preventing the prevalence, health education has been suggested a primary intervention especially with regard to the potential for attitude change and literacy.

References

ABS. (2008). Population characteristics, Aboriginal and Torres Strait Islander Australians: 2006. Canberra: ABS.

ABS. (2012). Population Projections, Australia, 2006 to 2101, cat. no. 3222.0. Canberra : ABS .

ABS. (2011). The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples, Oct 2010, cat. no. 4704.0. Canberra : ABS.

ABS . (2010). Labor Force Characteristics of Aboriginal and Torres Strait Islander Australians, Estimates from the Labor Force Survey,2009, cat. no. 6287.0. Canberra : ABS.

Burns, J., Mailing, C., & Thomsn, N. (2010). Summary of Indigenous women’s health. Retrieved April 4, 2012, from Australian Indigenous Health InfoNet: http://www.healthinfonet.ecu.edu.au/women-review

Calma, T. (2007). Social determinants and the health of Indigenous peoples in Australia – a human rights based approach. International Symposium on the Social Determinants of Indigenous health. Aldelaide : Australian Human Rights Commission .

Cancer Council. National cancer prevention policy 2007-09: Immunization-human papilloma virus. Canberra: Cancer Council.

Carrin, G. (2009). Health systems policy, finance, and organization. Amsterdam: Academic Press.

Downs, L., Smith, J., Scarinci, I., Flowers, L., & Parham, G. (2008). The disparity of cervical cancer in diverse populations. Gynecologic Oncology, 109 (2008) , 822-830.

Lewis, M. (2003). The people’s health. / Volume 2, Public health in Australia, 1950 to the present. Westport: Greenwood Press .

Reath, J. (2008). Breast and cervical cancer in indigenous women: Overcoming barriers to early detection. Australian Human physician, 37 (3) , 178-182.

Shah, K., & Rohan, T. (2004). Cervical cancer : from etiology to prevention. London: Kluwer Academic.

Singer, M., & Erickson, P. (2011). A companion to medical anthropology . Chichester: Wiley-Blackwell.

Steering Committee for the Review of Government Service Provision. (2009). Overcoming Indigenous disadvantage: key indicators 2009. Canberra : Productivity Commission.

World Vison . (2007). Australian Indigenous Poverty. Retrieved April 26, 2012, from World Vision: http://www.worldvision.com.au/Libraries/3_1_1_Issues_-_Indigenous/Australian_Indigenous_Poverty.pdf