Health care for Indigenous Australians

CHAPTER 12 Health care for Indigenous Australians



Adrian Miller, Rick Speare


When you finish this chapter you should be able to:


• understand the history and development of the Aboriginal Medical Services (AMS) movement

• have insight into the structural and operational aspects of AMS

• gain an understanding of the funding arrangements for Indigenous health

• explore the epidemiology of health and illness of Indigenous Australians and compare this data with international Indigenous populations

• examine Indigenous Australian participation in the health workforce

• examine current health policy for the health of Indigenous Australians.


Introduction


The health of Aboriginal and Torres Strait Islander people has been consistently reported as far poorer than that of the rest of the Australian population. This disparity can not be explained by biomedical reasoning or scientific extrapolation alone. There is an assumption that all who read about Indigenous health will have knowledge of who Indigenous Australians are. However, this assumption will be challenged. Many non-Indigenous Australians have had very little contact with Indigenous Australians and know little about the historical context. This issue may lie at the very heart of the debate about Australian Indigenous affairs (McCorquodale 1997). Much of this debate has been entrenched in Social Darwinism — a social theory that attempted to apply Charles Darwin’s theory of natural selection with survival of the fittest and adapt it to human populations in an attempt to stratify human cultural and evolutionary development (Attwood 1989: 87–8).


Although Social Darwinism has no scientific credibility, it does, however, have strength with uneducated and ill-informed members of the public. Oppressive government policies were developed to manage and control Indigenous populations and had authority under the protection, assimilation and integration policies, which were underpinned by paternalistic forms of the Social Darwinian theory (Attwood 1989). Therefore, much of the social construction of who an Indigenous Australian is has been disseminated and constructed within government policies and academia and not by Indigenous Australians (McCorquodale 1997).


The focus of early Australian anthropological research was on describing rather than understanding cultural differences (Firth 1998). This informed government policy on how to deal with Aboriginal populations and theorised that so-called ‘full-bloods’ would die out and so-called ‘mixed race’ Aboriginals could be assimilated into the wider society (Firth 1989; Horton 1994). In recent years, anthropological influence on government policy has been highly criticised, especially by anthropology’s own fraternity (Cowlishaw 1992).


Readers of this chapter should reposition their thinking away from a biological determinant approach of cultural or ethnic identity (i.e. from skin colour and distinctions between traditional verses urban people) and progress towards a social justice and human rights approach. This will allow a common and agreed understanding of who constitutes an Indigenous Australian. Indigenous Australians are considered to be all people who self-identify as Aboriginal or Torres Strait Islander, are identified by their community as Aboriginal or Torres Strait Islander, as well as those people who consider themselves as being a descendant of either of the above. Approximately 90% of Indigenous people identify as being of Aboriginal origin, 6% identify as being of Torres Strait Islander origin and 4% identify as being of both Aboriginal and Torres Strait Islander origin (Australian Institute of Health and Welfare [AIHW] 2005e: 3).


Archaeological evidence shows that Aboriginal people occupied Australia for 40 000–60 000 years prior to European arrival and possibly longer (Veth, O’Connor & Wallis 2000). The doctrine of terra nullius, the assumption that British sovereignty could be claimed over Australia as it was uninhabited, was used to justify British colonisation and was only officially overturned by the High Court of Australia with the Mabo decision (Reconciliation and Social Justice Library 1996). Until 1992, Australian law did not recognise Indigenous Australians as having legitimate rights to land, sea and occupation (Reconciliation and Social Justice Library 1996). Despite this legal affirmation, Australia continues to have a persistent difference in health status and socioeconomic disadvantage between Indigenous and non-Indigenous Australians. Matthews (1997) provides a causal pathway (Fig 12.1) to frame the links between colonisation and the current poor health and social disadvantage of Indigenous Australians. Casual pathways open up the concept of multiple outcomes from single pathways and multiple pathways to single outcomes (Stanley 2002).


image

Figure 12.1 Casual pathway of colonisation leading to economic and social disadvantage and poor health for Indigenous Australians


Source: Matthews 1997: 258


This pathway (Fig 12.1) hides the savagery of the interaction between the colonists and the Aboriginal inhabitants of Australia. Within 2 years of the First Fleet’s arrival, a series of localised wars began between the British invaders and respective Aboriginal nations as the invaders ventured across Australia (Connor 2005). The Aboriginal wars continued, always as localised events, until the Coniston massacre in Central Australia in 1928 (Wilson & O’Brien 2003). Although the Aboriginal wars are now largely forgotten, it is ironic that the Aboriginal man, Gwoya Jungarai, depicted on the obverse of the two dollar coin was a survivor of the Coniston massacre (Wilson & O’Brien 2003). This coin should serve as a reminder of the bravery of Aboriginal peoples.


Interwoven within Matthew’s (1997) causal pathway are the historical eras of governmental policies. In Figure 12.2 the official dates of when these policies were enacted are not detailed as implementation occurred at different times for each state and territory. Historically, Indigenous people’s access to government services was circumscribed by the colonial administrative systems after federation in 1901 (Anderson 2001).


image

Figure 12.2 Succession of government policies imposed on Indigenous Australians


Source: Adapted from Anderson 2006, Horton 1994, Wearne 1980



image Pause for reflection


The question must be asked whether the 2007 amendments to the Northern Territories Land Rights Act and the Northern Territory National Emergency Response Bill reflect past oppressive approaches dealt to Indigenous Australians or will it have positive health outcomes on Indigenous communities and the children that live in them. The Little Children Are Sacred report of the Northern Territory Board of Inquiry into the Protection of Aboriginal Children from Sex Abuse, which inspired the Commonwealth government to take this action, did not recommend such radical actions.


Indigenous access to health care services has been shaped to some extent by the historical development of the Australian health care system (Anderson 2001). The reasons why Indigenous peoples have had limited success with the Australian health system include:


• the location of health services in places that are difficult for Aboriginal and Torres Strait Islander peoples to access due to geographical and social isolation

• lower Medicare enrolment rates among Aboriginal and Torres Strait Islander peoples

• financial barriers to the provision of private and community-based health care, including up-front fees for services and medications

• health care services that are felt to be unwelcoming or unfriendly to Aboriginal and Torres Strait Islander peoples

• poor linkages between private, government and specialist sectors of health services and poor linkages between health services and other related programs

• poor performance of the health system in meeting the needs of those with complex and multiple conditions

• general (mainstream) health promotion approaches, which, until recently, were not designed to meet the needs of Aboriginal and Torres Strait Islander peoples

• a workforce which is largely non-Indigenous and untrained in the issues relevant to Aboriginal and Torres Strait Islander individuals, families and communities and generally unwilling to work in rural and remote areas (National Aboriginal and Torres Strait Islander Health Council [NATSIHC] 2003a: 20).


History of Aboriginal controlled health services: 1970 reforms and community health


Through collective action, Indigenous people’s response to the barriers to health care in Australia led to the development of an alternative pathway to access health care through the establishment of Aboriginal Medical Services (AMS) (Hunter et al 2005). The first AMS were established in Sydney and Melbourne in the early 1970s, and by 1978 there were 12 AMS established in other parts of Australia (Hunter et al 2005; Anderson & Wakerman 2005). This movement was also seen by Indigenous groups as an expression of self-determination; the process by which people express and determine their own future and destinies.


The innovative approach by the AMS to primary health care was based on the Alma-Ata declaration (1978) and mirrored contemporary international aspirations for accessible, effective, appropriate, needs-based health care with a prevention and social justice focus (Hunter et al 2005). AMSs are now known as Aboriginal Community Controlled Health Services (ACCHSs), of which there are more than 130 across Australia (National Aboriginal Community Controlled Health Organisation [NACCHO] 2006; NATSIHC 2003b: 18–19).


By definition, an ACCHS must be:


• an incorporated Aboriginal organisation

• initiated by a local Aboriginal community

• based in a local Aboriginal community

• governed by an Aboriginal board of directors that is elected by the local Aboriginal community

• delivering holistic and culturally appropriate health services to the community that controls it (Hunter et al 2005; 338).

The distinguishing characteristics of ACCHSs include:


• Culturally appropriate and autonomous primary health care services initiated, planned and governed by local Aboriginal communities through their elected Aboriginal board of directors.

• Aboriginal people play key roles in ACCHSs as managers, service providers and advocates, and in brokerage, liaison, advocacy and service development. Aboriginal health workers are the largest occupational group in the ACCHS service sector.

• Provision of comprehensive health care. Depending on local health and related needs and the historical development of particular services, they draw together a range of services, including primary clinical care provided by GPs, maternal and child health services, services for social and emotional wellbeing, health promotion and public health programs, health screening programs, dental care and welfare services. Many services support access to ‘mainstream’ health care by providing advocacy or liaison, and help with transport.

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Mar 24, 2017 | Posted by in MEDICAL ASSISSTANT | Comments Off on Health care for Indigenous Australians
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