Indigenous health

  • Category:
    Other
  • Document type:
    Essay
  • Level:
    Undergraduate
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    4
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    2451

INTRODUCTION

The government of Australia has had a longstanding challenge on trying to improve the wellbeing of the indigenous people of Australia. The United Nations committees have identified the gap that exists between the health of indigenous Australians and that of the general population as a human rights concern. This owed to the fact that the gap has remained uncharacteristically wide. The Australian government has also acknowledged this. The social determinants theory recognizes the interconnection of many social factors in determining population health and inequality. It is also basically known that when the enjoyment of one human right is infringed, it automatically impacts on the enjoyment of another right. This provides a methodology for determining of the impact of the various policies introduced by the Australian government on the health of various indigenous Australians.

The causes of health problems within the indigenous communities are the unequal distribution of health facilities and poor health infrastructure which include unhealthy food, poor sanitation services and lack of proper housing among the indigenous communities. This paper does not however consider improving the health of indigenous people. Rather, this paper describes the prevalence and incidence of Dementia and Diabetes, which mostly affect indigenous people at a relatively high rate, making considerations to the geographical variation. This paper further uses a social determinants approach to explain why the conditions are disproportionately prevalent among the indigenous people.

Among the many diseases and health disorders that affect the indigenous people of Australia include but not limited to:

  • Dementia

  • Cardiovascular diseases (CVD)

  • Diabetes

  • Kidney problems

  • Respiratory problems

  • Eye disorders

  • Ear problems

  • Oral infections

  • Communicable diseases

This paper will however narrow down on two health issues that affect the indigenous people of Australia. These health issues are Dementia and Diabetes.

DEMENTIA

The government of Australia has recognized dementia as the present and future major health problem by giving dementia priority on matters of national health. Research conducted within Kimberley has indicated higher prevalence of dementia (4-5 times higher) among the aboriginal than it is reported among the rest of Australians. This has prompted the formation of the National Indigenous Dementia Strategy that should provide a framework on how to tackle the prevalence of dementia among the indigenous people. Despite some progress being made, Alzheimer’s Australia needs more resources to make the implantation of the strategy more successful (Alzheimer’s Australia, 2015).

Dementia and Cognitive Impairment in Kimberley Indigenous Australian, a project conducted in Kimberley about the higher cases of dementia reported among indigenous Australians has proven this fact (Smith, Prof. Flicker, et al). The research has over several years detailed on three major areas:

To develop a tool that can be used for assessment purposes. This tool has been named the Kimberley Indigenous Cognitive Assessment tool, which can be used to identify the people of the indigenous population who may have been infected by dementia.

Applying this tool for the study and subsequently validating the results by special assessment.

Identifying how the people living with dementia have been segregated in the access to services in Kimberley.

Evidence of Prevalence of Dementia

The number of indigenous people aged over forty five years in Kimberley total to around two thousand, and one hundred. Four hundred people were sampled. The community had to approve for the research to be successful. Indigenous workers and interpreters were carefully selected and trained. In order to identify the members of the community aged forty five and above, lists patients of community clinics were used. Another town, from which a third of legitimate residents were randomly sampled, was also included.

Individuals were first to be assessed using KICA (an assessment method which is made of several simple tests which are designed to assess cognitive capacity) assessment tool. The participating persons were after three months assessed again by two independent experts who are not aware with the results obtained using the method described above. Other experts oblivious of the research above agreed after conducting several diagnosis using the data from assessments obtained.

The indigenous individuals targeted for the research were more than willing to take part. Very few of them, less than 10% declined to participate at all. More than half (55%) of those who participated were females. The average age was sixty years, of which 40% were well educated.

AGE (YRS)

NUMBER OF CASES

PREVALENCE RATE

PREVALENCE RATIO

Rest of Population

Rest of population

Source: Alzheimer’s Australia, 2015

The prevalence of dementia among individuals above the age of 45 recorded over twelve percent in comparison with the rate of less than three percent of the rest of Australians. This can alternatively mean that the indigenous people are almost five percent more likely to be diagnosed with dementia than the general population of Australia. Males are more valnurable to dementia among the indigenous people than females, according to the research, although the rate is higher among the females in the general population. There were important risk factors associated with dementia which included age, gender (male), previous incidences of stroke, injury on the head, cigarette smoking and lack of formal education (Alzheimer’s Australia, 2015).

This research has been regarded as very strong and reliable, although it has its own shortcomings. The fact that access to proper medical attention and good medical facilities, there is high a possibility that some cases were under reported while others would have gone completely unrecorded. Brain imaging was not possible at all due to the amount of time and resources associated with it. From the number of representations obtained, the younger individuals may have not been properly represented mainly because they are highly mobile and bear the highest percentage of refusal and unwillingness to participate.

More research needs to be conducted into why dementia is more prevalent among the indigenous people of Australia. Although this is so, it can also be logical to make the assumption that dementia would be more prevalent among the urban indigenous people than the general population of Australia. It is also of important to note that over sixty percent of the aboriginal population of Australia lives in rural and sub-urban settlements.

The National Dementia Strategy

Several measures have been installed by the government of Australia to try and provide the assistance needed by the indigenous people. One of these measures is the National Indigenous Dementia Strategy. The National Indigenous Dementia Forum organized by Alzheimer’s Australia in October 2006 attracted more than thirty Indigenous people from all over Australia. This program got funding from the Government of Australia using the National Dementia Support Programme. Those who participated came up with a resolution that a programme with national approach was necessary to tackle the menace of dementia so as to allow the indigenous people of Australia to age successfully.

Those who participated in the forum came up with six action points that should be integrated into the National Indigenous Dementia Strategy. These six points include:

Educating the population on the prevalence and prevention: Alzheimer’s Australia was tasked with developing and delivering this education and how people can prevent themselves from contacting dementia which should target the indigenous people.

Support and Care: to ensure that indigenous population who are infected and those who take care of them can easily find support and care in all the services that they may need.

Research: the indigenous population to collaborate with the already established organizations in implementation of agenda of research. The aim is determining the extent that dementia has spread in the community, identifying the likely factors that may lead to the spread of dementia, catering for the needs of those infected and the affected and make improvements to the services offered to those affected with dementia.

Diagnose, refer and treat: being flexible in responding to those indigenous people who need help as well as their families. This should also include the means on how to diagnose, treat and refer patients suffering from dementia.

Workforce issues: Provision of funds so as to develop a workforce specific to a certain locality. This should be a workforce with the ability to conduct their duties in consistence with the values of the community, what they aspire for and their culture; ability of informing, advising, counseling and offering the services that the community may need.

Partners and Collaborators: Alzheimer’s Australia together with the National Indigenous Dementia Advisory Group (NIDAG) tasked with overseeing the framing operations and strategy in collaboration with the relevant organizations.

Progress So Far

The first step which was to identify the degree of spread of the disease within the indigenous population was already taken and accomplished. By the help of the funds from the Australian Government using the NDSP, Alzheimer’s Australia is already successful in recruiting an officer called the National Indigenous Liaison Officer. The southern Australia region has also been given its official. The most important achievement is that people are more understanding and aware of dementia within the indigenous population.

The Government of Australia has also provided funds for developing a Dementia Learning Resource for Aboriginal and Torres Strait Islander Communities, through Alzheimer’s Australia. The Department of Health and Ageing has put in place plans to widen the scope of distributing this resource. This resource has multipurpose goals and they include:

  • Raising awareness among the Aboriginal and Torres Islander communities.

  • Creating empowerment to the Indigenous people for the access of available services and supports.

  • Empowering workers to be able to come up with strategies necessary to counter the effect of the disease among the Indigenous people.

  • Provision of support and training to Indigenous educated elite and other working and living among Indigenous people.

The work on the well being of Indigenous people is still going on with the University of Western Australia being able to secure funding from the National Health and Medical Research Council for the assessment and analysis of the service gaps that exist for those suffering from dementia within Kimberley. Such a study will go a long way in revealing what kinds of services specific to the people with dementia should be offered to Indigenous people in the remote and rural areas.

DIABETES

This disease belongs to a group of disorders where the body is unable to convert glucose into energy, a condition which leads into a situation where there is an increase in blood sugar level. The uncontrolled rise in blood sugar level can lead to various very serious health issues like kidney failure, stroke, heart disease, limb amputations, eye diseases and blindness (Australian Institute of Health and Welfare, 2011).

Diabetes is most commonly known in its three types, that is, type 1 diabetes, type 2 diabetes and gestational diabetes mellitus (GDM) – a form which generally occur among pregnant women (Lalor E., et al, 2014). The diabetes type 1 is less common among the indigenous population (Australian Institute of Health and Welfare, 2010). Type 2 diabetes is on the other hand is a very big health menace that majority of Aboriginal and Torres Strait Islander individuals have to contend with. Indigenous people tend to develop this type of diabetes at a tender age and thus die more in comparison to the general population. GDM is on the other hand experienced among pregnant Indigenous women than the general women population (Australian Institute of Health and Welfare, 2010). The problem with this disease affecting indigenous people is that it is not diagnosed until it is at an advanced stage (National Aboriginal Community Controlled Health Organization, 2005).

Nine percent of Aboriginal and Torres Strait Islander persons recorded cases of diabetes in the 2012 – 2013 AATSIHS (Australian Bureau of Statistics, 2014). The figure was over three times higher than the cases reported among the rest of the population. Ten percent of Aboriginal and Torres Strait Islander women reported cases of occurrence of diabetes, compared to eight percent of Aboriginal and Torres Strait Islander men who were recorded.

The 2012 – 2013 AATSIHS reported a higher prevalence of diabetes among the remote dwelling Aboriginal and Torres Strait Islander people, a figure quoted at 13 percent compared to 8 percent of non-remote dwelling population (Australian Bureau of Statistics, 2014). More younger Indigenous people have been reported to be adversely affected by diabetes compared to non-indigenous people. This increases with increase in age – five percent of indigenous people between the ages of twenty five and thirty four years up to forty percent aged fifty five years and above, as illustrated in the chart below (Australian Bureau of Statistics, 2014):

indigenous healthSource: ABS 2014

In the years 2012 and 2013, many hospital separations were conducted (2,749 in total), for Aboriginal and Torres Strait Islander population in Australia. This figure is four times the number of the rest of the population affected (Steering Committee for the Review of Government Service Provision, 2014).

Diabetes caused the death of 202 Indigenous people in NSW, SA, Qld, WA and in NT in the year 2013 (Australian Bureau of Statistics, 2015). It was also the second highest cause of death for the Indigenous people. Death from diabetes was six more likely among the Aboriginal and Torres Strait Islander people than among the non-indigenous population.

CONCLUSION

Over time, the health of Indigenous people has improved but is same as that of non-indigenous people. The continued witnessing poor health among the indigenous population cannot be pointed on to a single factor but rather a cocktail of several factors relating to employment, education, income and social and economic factors. There is need for better basic health services for the indigenous people and that is easily accessible to them. This would make it easier to diagnose their health issues at an early stage and thus being able to be handled effectively.

References

  1. Alzheimer’s Australia (2007). Dementia: Major Health Problem for Indigenous People.

  2. Australian Bureau of Statistics (2015) Causes of death, Australia, 2013. Canberra: Australian Bureau of Statistics

  3. Australian Institute of Health and Welfare (2008) Diabetes: Australian facts 2008. Canberra: Australian Institute of Health and Welfare

  4. Australian Institute of Health and Welfare (2015) Aboriginal and Torres Strait Islander health performance framework 2014 report: detailed analyses. Canberra: Australian Institute of Health and Welfare

  5. Australian Bureau of Statistics (2015) Causes of death, Australia, 2013: Deaths of Aboriginal and Torres Strait Islander Australians [data cube]. Retrieved 29 Aug. 2016 from http://www.abs.gov.au/ausstats/subscriber.nsf/log?openagent&3303_12

  6. Australian Institute of Health and Welfare (2011) Prevalence of Type 1 diabetes in Australian children, 2008. Canberra: Australian Institute of Health and Welfare

  7. Royal Australian College of General Practitioners (2014) General practice management of type 2 diabetes: 2014-2015. Melbourne: Royal Australian College of General Practitioners

  8. Lalor E, Cass A, Chew D, Craig M, Davis W, Grenfell R, Hoy W, McGlynn L, Mathew T, Parker D, Shaw J, Tonkin A, Towler B (2014) Cardiovascular disease, diabetes and chronic kidney disease: Australian facts — mortality. Canberra: Australian Institute of Health and Welfare