Health Care Plan
Indigenous Australian (commonly called Aboriginal and Torres Strait Island people) are the Australia’s indigenous people. These people are either Torre Strait Islander or Aboriginal in origin or both. This healthcare plan is proposed in response to Aboriginal People’s poor status of Health compared to the rest of the Australian population. Up to date, the Aboriginal People remain disadvantaged in terms of health compared to the non-Aboriginal population (Krysinska, Martin & Sheehan, 2009). According to studies, several factors, mostly socially determined contribute to the huge gap that exit in terms of the health status between the non-indigenous and indigenous health status. Among them include lower education as well as employment rate, higher rate of smoking, common long-term conditions of health, poor nutrition, inaccessibility to health services, and physical inactivity.
Continuing to ensure that such a health gap is closed would require innovation and long-term systematic approaches that would aim at improving the quality as well as integrate data and this is in addition to partnership and collaboration that reflect health’s ecological approach. It is also important to recognize the proper place as well as contribution made by the Torres Islander and Aboriginal peoples in Australian society (NATSIHC, 2003). Presently, such a gap appears to be closing, but is important to have long term plan of action to continue both within as well as outside the system of the healthcare to realize true equality of health as well as provide the idea of what has been attained so far. This plan would propagate for the addressing of the issues linked to the provision of healthcare among the Aboriginal. Apart from that, the plan would push for the redressing of issues such as unemployment, access to health, as well social segregation. The aim of the government, community, and other stakeholders has been to improve the community’s health outcome (Campbell, Pyett, & McCarthy, 2007).
The real issue has been the starting point of addressing health’s social determinants by putting emphasis on interventions that have involved the Aboriginals when it comes to social inequalities that they face (AHRC, 2005). In the past, the government of Australia has unsuccessfully attempted to address the health inequalities faced by the Aboriginal people. Few literatures exist to describe community empowerment and development to improve the health status of the Aboriginal people especially in the perspective of the Aboriginal people. The environment inhabited by an individual has a powerful effect on his/her health For indigenous Australians, colonization has ensured that the social and physical environment remain unfavorable for health. An effective intervention to ensure an improvement of population health requires an environmental change and strategies targeting clinical factors and individual behavior. This is the platform by which ecological approaches to health promotion and health programs can be implemented (Johnson et al. 2013). The emphasis of ecological approach focused intervention is the link between people, social, and physical systems in which they live and they include organizations, social networks, public policies, communities, as well as societies. According to the theory of ecology, projects intervening at various levels provide an immense potential for ensuring efficacy in health promotion. Right to health comprises of four main elements namely quality, availability, accessibility, as well as accessibility. This plan will incorporate all right to health’s aspects.
The 2003-2008 National Mental Health Plan recognizes the link between mental health and the emotional and social wellbeing that might occur in an event as well as setting of daily life. It is Important to acknowledge as well as address the complex relationship of psychological, social, biological, ecological, and environmental factors at individual, community, family, as well as national level. This will help in ensure an efficacy in promoting and supporting population-based approaches to cultural, social, emotional, and spiritual wellbeing. For Aboriginal as well as Torres Islander people, the health as well as wellbeing concept is intricately liked to a holistic comprehension of life itself. The concept of health of the Aboriginals is holistic, incorporating physical, mental, spiritual, and cultural health. This concept not only incorporates ‘whole body’ but is also steeped in the harmonized interrelations constituting the cultural wellbeing. The recognition of difference in culture is essential for the delivery of services to the Aboriginals and Torres Strait Islander people and this is especially if the legitimate practices, expectations, values, as well as cultural rights are not compromised. Aboriginal and Torres Strait Islander emotional, social, spiritual, and cultural determinants are complex. At the same time, they reflect factors that act across the continuum of development at individual, community, family, and society levels (Krysinska, Martin, & Sheehan, 2009).
The concept of SEWB (social and emotional wellbeing) can help in explaining the entail the indigenous comprehension of the interrelation of things (National Aboriginal Health Strategy cited in TNHLF, 2013). The capacity of an individual to ensure the attainment of their full potential is directly related to the community’s wellbeing. This is mainly thru emotional, cultural, and social wellbeing.
This plan comprises of four major sections namely consultation, development, implementation, and evaluation. The framing of these components will be within an approach of community development that aligns with indigenous principles of SEWB Of the interrelation between the individuals as well as the community (Vickery, Faulkhead, Adams & Clarke, 2004). The participatory action form would ensure that the framework of community development is guiding this health plan. Community development entails ensuring that the community members are fully participating is the process of finding solutions for the problems affecting them, and through this, the members of the community would acquire skills to come up with culturally acceptable services and programs for their communities (Campbell, Pyett, McCarthy, Whiteside & Tsey, 2004). PAR
Consultation entails the process of collecting data that would provide info to the future policy as well as act as a critique to the present practices. Engaging with the indegious Australian communities as well as development of certain plans of response may be facilitated by ICC (Indigenous Coordination Centre). Thru such an arrangement, there can be the development of tailored responses meant for the Aboriginal and Torres Strait Islander communities, and this is mainly after consultation with the members of the community (Armstrong, 2013). It is important to focus the research on the issues affecting the people and this can only occur if the communities give in details the issues affecting them (Sheehan, Martin, Krysinska & Kilroy, 2009). Consultation in the case of our plan would be conducted using PAR (participatory action plan). Participatory action research (PAR) entails a way of ensuring that things are better after working together. It also entails a systematic process that integrates social justice issues and ensures that a genuine partnership with members of the community does exist. Once the members of the community are able to perceive the result as well as benefits, they would eventually work together (Crane & O’Regan, 2010).
PAR is mainly a cyclical process focusing on observation, planning, reflection, as well as sharing. Both the community development and PAR approaches are perceived as the best methods to work with the members of the community. Effective PAR can enhance efficacy in the commitment of the Aboriginal and Torres Strait Islanders’ cultural integrity and this is possible when they reconnect with their spirituality, cultures, source of strength, traditional territories, with each other, as well as with language. Consultation ensures that all the stakeholders including the health leaders of the Aboriginal and Torres Strait Islanders and the Social Justice Commission of the Aboriginals and Torres Islanders are mutually working together.
The pathway to ensuring the closure of the gap is intricately related to improved outcome of education and economic development. It is important for the government in consultant with community leaders, to seriously confront the unacceptable outcomes and the deep-rooted disparities in the health of the Aboriginal and Torres Strait Islanders communities. It is also important to ensure a long-term approach that ensures the securing of the future of the non-Aboriginal and Aboriginal as this would ensure that the nation is healthy. This can be achieved through consultation with the communities (Armstrong, 2013). As indicated in 2005’s report of Aboriginal and Torres Strait Islander Social Justice Commission, the human rights systems and the government should work in consultation to ensure that the health needs of the indigenous Australians are addressed. It is important for all the health stakeholders to work in consultation with the Indigenous people, senior government officials, as well as Aboriginal-Controlled health services to address the health gap (NATSIHC, 2003).
This proposed health plan’s development must revolve around certain key principles and these include a partnership among various stakeholders. Such partnership approaches with the members of the community would provide strength when it comes to reaction to the complex issues for instance alcohol use and drug abuse, violence, interpersonal conflict, loss, as well as grief. Such a partnership is also essential because it improves the process of data collection, research as well as evaluation and at the same time sharing the best approach practices across sectors and communities.
Literatures giving a description of community development as well as empowerment to improve the Aboriginal’s health outcome are limited especially in the perspective of the aboriginals. This is mainly contributed by the fact that community development is usually done instead of being theorized, evaluated, as well as written up. Few studies do comprehensively offer a discussion of approaches of community development and at the same time demonstrate that increased control and empowerment outcomes can be fostered through the utilization of this approach. Long-term research is essential to define the capacity for diverse interventions of community development to contribute to improved outcomes of health as well as empowerment (NATSIHC, 2003). Apart from that, it is essential to develop appropriate as well as practical evaluation methodologies that have the capacity to assess as well as explain community empowerment and development processes as well as outcomes, and their contributions to improved health. There exists a complex link between the indigenous people as well as their environment and this relationship involves communities, social systems, social policies, and organizations (Johnston et al. 2013).
Another principle is that of cultural competence. The stakeholders as well as the implementing agencies need to have training on cultural competence and awareness. In Australia, the promotion of cultural competence is an essential tool for reducing the disparities of health between the Non-Aboriginal and Aboriginal Population. There has been the incorporation ogf cultural competence training in the medical education in both the US and the Britain. It is important for Australia to implement such a move as this will help in enhancing the comprehension as well as the awareness of indigenous thus preventing discrimination against the cultures (Dudgeon et al. 2000). In many models of culture competence, an analysis of relations of power between the clients and the provider of the healthcare is missing. According to March (2005), no direct relationship does exist between the training of cultural competence and the health improvement of the indigenous people. It is essential to ensure that cultural incompetence history is considered when it comes to the development as well as the execution of the proposed plan of health (Gridley & Sanson cited in Dudgeon et al. 2000). Cultural competence entails a set of attitudes, congruent behaviors, as well as policies that are intertwined ensuring efficacy in working across the various cultures.
It is important to ensure that the cultural as well as linguistic diversity present in the culture of the Aboriginals as well as Torres Strait Islander comprehended from the beginning. Another integral healthcare plan part is the development of leaders, services, as well as indigenous workforce (Zurick et al. 2010). This would foster empowerment at the community and the individual level since it aims at promoting collaborative as well as locally appropriate interventions as manifested by community controlled services that ensure the interagency collaboration (Thackrah & Thompson, 2013).
Individual’s SEWB (social and emotional wellbeing) should be incorporated in the plan mainly because it reveals the importance of the link to land, spirituality, culture, family, community, and ancestry and the effect of the same to the individual. The ongoing healthcare and wellbeing deterioration is attributed to SEWB barriers (Campbell et al. 2004). It is important for the health care plan to have a holistic approach. Finally, it is important to ensure that the healthcare plan is developed based on research. The 2003-2008 National Mental health Plan recognizes that there occur mental health influences in the settings and events of day to day life (Australian Government, 2013).
This health plan’s implementation involves the leadership of Aboriginal and Torres Strait Islander, a shared ownership, as well as partnership with government and other stakeholders. Without indigenous leadership especially in health and education sector, success in the long-term strategies can never be achieved (NCAFP, 2012). The main challenge encountered is that on highly educated people dominated the leadership positions. It is also essential for the provider of the healthcare to be more aware of the culture of the indigenous people (TNHLF, 2013). Cultural competence is thus essential for effective implementation of this program. The four components of health namely availability, accessibility, acceptability, and quality become evident through the provision of health to the healthcare services. Apart from that, empowering the community members to make their own decisions are essential as it ensures that they are making their own decisions regarding the health needs. Such a concept is essential in guiding the proposed plan’s implementation (Thackrah & Thompson, 2013).
The PAR (Participatory Action Research) forms the basis for this health plan. Evaluation is an ongoing process which is undertaken until an attainment of a conclusion is achieved. Program evaluation in this proposed plan is used to assess the health program. To obtain optimal benefit from the evaluation of the program, as well as research with the aboriginal people, full partnership must be available. Evaluation would be an ongoing process which would be undertaken severally until the full comprehension (Crane & O’Regan, 2010). Two strategies namely the PAR methods and community development approach have been used to develop this plan and the same criterion is used to ensure the achievement of the evaluation (Crane and O’Regan, 2010). Implementation in the case of this study would involve determining whether the strategies have been successfully implemented. Apart from that, implementation would involve measurement to ascertain whether the stated outcomes of health have been achieved. The evaluation of the program would involve determining what the main issue is, whether the plan is viable, how to deliver the program, and the cost-effectiveness of the program. In essence, each activity of evaluation is usually developmental in nature. Several indicators including supportive instead of directive relationship would be used in the partnership evaluation. The local people (Aboriginals and Torres Strait Islanders) would be involved in the evaluation plan if they have the capacity to comprehend the problem affecting them and the solution to that problem (Ford, 2010; Campbell et al. 2004). The evaluation of emotional and social wellbeing will only be evident in health behavior change as well as great identity sense and community in the indigenous population (Hipwell, 2009).
The “2003-2013 National Strategic Plan for Aboriginal and Torres Strait Islander Health” is committed to develop plans of implementation that provide details of the specific activities aimed at meeting the health needs of the community. Among its aims include the creation of accessible as well as affordable health system (Australian Government, 2013).
Campbell, D., Pyett, P. & McCarthy, L. 2007, ‘Community development interventions to improve Aboriginal health: Building an evidence base’, Health Sociology Review, vol. 16(3–4), pp. 304–14. Retrieved from http://www.lowitja.org.au/community-development-interventions-improve-aboriginal-health-building-evidence-base#sthash.pKC7y1bD.dpuf
Australian Association of Social Workers (AASW). (2013). Practice Standards. Retrieved from http://www.aasw.asn.au/practitioner-resources/related-documents
Australian Human Rights Commission. (AHRC) (2005). The Indigenous Health Challenge. Retrieved from <
Arabena. K. (2013). Future intitiatives to improve the health and wellbeing of Aboriginal and Torres Strait Islander peoples. Medical Journal of Australia, 199(1).
Armstrong. R. (2013). A time and a place. Medical Journal of Australia, 199(1).
Australian Government, (2013). National Aboriginal and Torres Strait Islander Health Plan 2013-2023.
Campbell. D., Pyett. P., McCarthy. L., Whiteside. M., & Tsey. K. (2004). Community development and empowerment — A review of interventions to improve Aboriginal health.
Beyond Bandaids: Exploring the underlying social determinants of Aboriginal health. Retrieved from http://www.lowitja.org.au/beyond-bandaids
Crane, P. (2011). Participatory Action Research Workbook: A workbook designed to support the recording key elements of a participatory action research process. Retrieved from http://eprints.qut.edu.au/41575/2/41575.pdf
Crane, P., & O’Regan, M. (2010). On PAR: Using participatory action research to improve early intervention. Department of Families, Housing, Community Services and Indigenous Affairs; Australian Government. Retrieved from
http://eprints.qut.edu.au/Dudgeon, P., Garvey, D., & Pickett, H. (2000). Working with Indigenous Australians: A handbook for psychologists, Gunada Press, Perth, W.A., pp. 349-356.
Ford, P. (2010). ‘Chapter 4’, Aboriginal knowledge narratives and country, Post Pressed, Teneriffe, Qld, pp. 67-87.
Hipwell. W (2009) An asset-based approach to Indigenous development in Taiwan, Asia Pacific Viewpoint, 50(3) pp. 289-306.
Johnston. L., Doyle. J., Morgan. B., Atkinson-Briggs. S., Firebrace. B., Marika. M., Reilly. R., Cargo. M., Riley. T. & Rowley. K. (2013) A review of programs that targeted environmental determinants of Aboriginal and Torres Strait Islander health, International Journal of Environmental Research and Public Health. 10, 3518-3542.
Johnston-Goodstar, K. (2013). Indigenous youth participatory action research: Re-visioning social justice for social work with Indigenous youths, Social Work, 58(4), 314-320.
Krysinska. K., Martin. G., & Sheehan. N. (2009). Identity, Voice, place: Suicide Prevention for Indigenous Australians — A social and wellbeing approach. The University of Queensland, Brisbane. ISBN 978-0-9808207-5-1.
NATSIHC, [National Aboriginal and Torres Strait Islander Health Council] (2003). National Strategic Framework for Aboriginal and Torres Strait Islander Health: Framework for action by governments. Retrieved from
NCAFP [National Congress of Australia’s First People] (2012). Policy paper — What does success look like? Measuring the success of the National Aboriginal and Torres Strait Islander Health Plan. Position Paper. Retrieved from http://nationalcongress.com.au/wp-content/uploads/2012/11/What-Does-Success-Look-Like-Measuring-the-Success-of-the-NATSIHP.pdf
Sheehan. N., Martin. G., Krysinska. K. & Kilroy. K. (2009). Sustaining Connection: Towards a cultural strengths framework for Aboriginal and Torres Strait Islander Community, Spiritual, Social and Emotional Wellbeing. University of Queensland, Brisbane. ISBN 987-0-9808207-3-7.
The National Health Leadership Forum (TNHLF). (2013). Submission on the National Aboriginal and Torres Strait Islander Health Plan. The National Congress of Australia’s First First Peoples. Retrieved from http://nationalcongress.com.au/wpcontent/uploads/2013/10/CongressNATSIHPSubmissionWeb.pdf
Vickery. J., Faulkhead. S., Adams. K. & Clarke. A. (2004). Indigenous insights into oral history, social determinants and decolonisation. In Beyond Bandaids: Exploring the underlying social determinants of Aboriginal health. Retrieved from http://www.lowitja.org.au/beyond-bandaids
Zurick. F., Dudgeon. P., Gee. G., Gaskin. B., Kelly. K., Paradies. Y., Scrine. C. & Walker. R. (2010). Chapter 6: Social determinants of Aboriginal and Torres Strait Islander social and emotional wellbeing. In N. Purdie, P. Dudgeon & R. Walker (Eds. (2013). Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice. Commonwealth of Australia.