HealthIndigenous health is a social justice issue The statistics of Indigenous ill health are well documented (Dodson 1994). These include rates of death are 3 to 6 times of that of the general population, a life expectancy around 20 years less than that of other Australians, ubiquitous ear and eye diseases, and so on. This situation has been widely criticised by many prominent people over the years and it puts Australia in breach of a number of international conventions to which it is a signatory. The facts of early death and widespread disability and ill health among Indigenous peoples publicised and put before the Australian public and governments many times. Most people are shocked by these ‘facts and figures’ and governments typically promise to give the issue a high priority (although not necessarily in relation to funding allocations and meaningful strategies). These reactions however have been shown to make almost no positive impact or contribution to progress the issue. At best the statistics remain the same or get worse - the only national figure that has shown significant improvement in recent decades is infant mortality. Morbidity and mortality figures tell us how sick people are and what diseases (and so on) they suffer from. However, focusing only on diseases or on their immediate associated risk factors, will at best only have a marginal effect on health status. To get a better picture we need not only to consider the links between various health problems, direct causative factors and underlying factors; but also to view the whole thing as a social justice issue. We also need to recognise and understand the impact of history, culture and worldviews on value systems and decision-making processes of Indigenous people. Key issues to address include those of power, governance and control of decision-making processes in general, and appropriate strategies for facilitating change resulting in improved health outcomes more specifically. In this way, lack of progress has all too often been the norm, with sickness perceived as a ‘way of life’ for Indigenous people. The notion that ‘nothing can be done’, that the problem is insoluble, becomes entrenched in the minds of both Indigenous and non-Indigenous Australia. The every day human cost is not felt or understood in any meaningful way, and lack of hope for a healthier future for Indigenous peoples becomes pervasive. The demoralising hopelessness is itself one of the major health problems. Yet among the numerous reports and analyses of the issues there are many common conclusions and suggestions for positive ways forward. These include the following:
- The importance of a primary health care approach;
- The need for preventative rather than solely curative measures;
- Stepping back and genuinely supporting Indigenous people as they determine how to identify and implement and evaluate their own solutions;
- That it is as much a social and political issue as it is a biomedical one, and that this dictates a holistic approach involving all aspects of community development and self-determination for Indigenous people.
Of course, the obvious question is – If there is indeed widespread agreement about all these things, why then does so little seem to change, and what will it take to move the rhetoric into reality? If progress in Indigenous health was measured by the number of press releases, special projects, glossy posters or by the number of pamphlets (in English) exhorting Indigenous people to eat more people to eat more fruit or clean their houses or brush their teeth, there would be little to worry about. Concepts of health - What is good health? Health to Indigenous people is a matter of determining all aspects of their life, including control over their physical environment, of dignity, of community self esteem and of justice. It is not merely a provision of doctors, hospitals, medicines or the absence of disease and incapacity. Health is a multi dimensional concept that embraces all aspects of living and stresses the importance of survival in harmony with the environment. According to Indigenous worldviews 1, when factors that influence social well being and harmony with groups are maintained, people are healthy. However, when social, emotional and cultural well being is disrupted, ill health results. Indigenous spirituality was and still is essentially land centered. Whilst this broad definition of health is emphasised by Indigenous people in different ways, Indigenous people know that health cannot be disassociated from self-determination, land rights and cultural vitality; and it cannot be neatly divided into wellness and illness or mental and physical aspects. Indigenous health and factors affecting it is complex, and most Indigenous people are dispossessed in some way. They often share many of the negative features of other groups in similar contexts. These include poverty, poor education and training, low paid jobs, high rates of unemployment, substandard housing, and ill health. However, they also have to endure the history of Indigenous and non-Indigenous contact, the pain of racial prejudice and the reality of discrimination, evident in marginalisation and social dysfunction. The legacies of past policies live on in the present day, in people’s experiences, attitudes, values and perceptions. It is not possible to understand Indigenous health without setting it in an historical perspective. Despite what John Howard and others have said, without history there can be no understanding of the present and the future, no vision and no judgement. Comparison of Indigenous health today with that of their health prior to colonisation Although little information exists about Indigenous health before colonisation, there are indicators that their health was good. The social organisation based on kinship through ties with the land provided an effective psychological network, which was overall conductive to human health and well being. In relation to physical well being, the hunter-gatherer lifestyle dictated frequent exercise, which minimised the risk of obesity and associated health problems. In addition, the environment provided a wide range of naturally occurring plants and a great diversity of animal life. This allowed for a well balanced, nutritious diet of protein and plant foods, high in fibre and low in salt, sugars and fats. The actual composition of the diet was dictated by regional and seasonal variations in the availability of food. Groups were also spread out over the continent and this mitigated against the spread of disease. Hygiene was not a problem. Diseases specific to Indigenous peoples appear to have been few. Dental disease was relatively rare. The common cold and yaws and some skin diseases were probably endemic.
Trachoma may also have been present. Indigenous peoples developed a very extensive and effective pharmacopoeia, commonly known as bush medicine. Indigenous health after colonisation From the beginning of European occupation, Indigenous peoples were subjected to pressures, which have had disastrous consequences with respect to their health and severely decimating the population. This drastic reduction in numbers resulted in apart from the devastating effect of introduced disease to which Indigenous peoples had no immunity. These included small pox, measles, tuberculosis and influenza. Violence was another major factor responsible for population reduction. Many sources document the appalling effects of colonisation on Indigenous peoples. The ramifications of the historical events highlight the fact that the enforced change from the hunter-gatherer way of life to an impoverished way of life had disastrous consequences for both the physical and psychological health and well being of Indigenous peoples. In particular the dramatic change in way of life cannot be stressed too strongly. The Stolen Generations had a huge and ongoing impact on the social and emotional wellbeing of Indigenous peoples, with health indicators reflected in the rates of chronic diseases, mental disorders, family violence, and substance misuse. References This is not intended as an exhaustive list. Students should use the Library catalogue and databases to locate additional resources. National Aboriginal & Torres Strait Islander Health Council 2004, ‘National strategy framework for Aboriginal and Torres Strait Islander health 2003-2013 context’, Commonwealth of Australia.
http://www.health.gov.au/internet/wcms/publishing.nsf/Content/health-oatsih-pubs-healthstrategy.htm National Aboriginal & Torres Strait Islander Health Council 2004, ‘National strategy framework for Aboriginal and Torres Strait Islander health 2003-2013 framework for action by governments’, Commonwealth of Australia.
http://www.health.gov.au/internet/wcms/publishing.nsf/Content/health-oatsih-pubs-healthstrategy.htm Office of Aboriginal & Torres Strait Islander Social Justice Commission 1996, Indigenous Deaths in Custody 1989 – 1996, AGPS, Canberra. Reid, J & Trompf, P 1991, The health of Aboriginal Australia, Harcourt, Brace & Company, Marrickville. Royal Commission into Aboriginal Deaths in Custody 1991, Main Report, Canberra. Wass, A 2000, Promoting health - the primary health care approach, 2nd edn, Harcourt Saunders, Sydney. Journals Journals articles relating to this subject can be located in the University of Wollongong library homepage: http://www.library.uow.edu.au/eresources/subjects/hbs/hbsindigenous.html There are a number of databases which may be useful when searching for journal articles on Aboriginal and Torres Strait Islander health issues. While you can use databases such as Cinahl, Medline and PsycInfo, additional databases to try include:
- Meditext (Australian);
- Australian Public Affairs - full text (APAFT - partial full text);
- Aboriginal and Torres Strait Islander Health Bibliography;
- Health & Society Database (Australian);
- Indigenous Studies Bibliography (Australian from AIATSIS);
- Aboriginal and Torres Strait Islander Health Workers Journal;
- This gives you internet access to the journal: aihwjournal@indiginet.com.au.
Websites – Some suggestions to get you started or add to your collection Students are encouraged to use the internet to access the most current information on relevant topics and information suitable for patient and family education. Internet sources should only be used after careful critical analysis of the currency of the information, the role and standing of the sponsoring institution, reputation and credentials of the author, the clarity of the information and the extent to which the information can be supported or ratified by other authoritative sources. ATSILIRN (Aboriginal & Torres Strait Islander Library and Information Resource Network)
http://home.vicnet.net.au/~atsilirn/ Australian Institute of Aboriginal and Torres Strait Islander Studies
http://www.aiatsis.gov.au Australian Indigenous Health Info Net
http://www.healthinfonet.ecu.edu.au/ Australian Institute of Health and Welfare
http://www.aihw.gov.au/ Bringing Them Home: Report of the National Inquiry into the Separation of Aboriginal and Torres Strait Islander Children from Their Families
http://www.austlii.edu.au/au/special/rsjproject/rsjlibrary/hreoc/stolen/ Commonwealth Department of Health and Ageing
http://www.health.gov.au Congress of Aboriginal and Torres Strait Islander Nurses
http://www.indiginet.com.au/catsin/ Drudge Report
http://www.drudgereport.com/
Very useful site for world news Health is life: Report on the inquiry into indigenous health
http://www.aph.gov.au/house/committee/fca/indhea/inqinde2.htm Human Rights & Equal Opportunity Commission
http://www.hreoc.gov.au/index.html Indigenous Peoples of Australia
http://www.ldb.org/oz-indi.htm Koori Mail Newspaper
http://www.koorimail.com/index.php Menzies School of Health Research
http://www.menzies.edu.au National Health and Medical Research Council
http://www.health.gov.au/nhmrc/ National Rural Health Alliance
http://www.ruralhealth.org.au/nrhapublic/ Nganampa Health Council
http://www.nganampahealth.com.au Office for Aboriginal and Torres Strait Islander Health
http://www.health.gov.au/oatsih/index.htm Public Health Association of Australia
http://www.phaa.net.au/ Reconciliation and Social Justice Project
http://www.austlii.edu.au/au/special/rsjproject/ World Health Organisation (WHO) Website
http://who.int/whr/en Your Dictionary
http://www.yourdictionary.com You also might want to check out ‘Koori Radio – Live and Deadly’ on 93.7FM.
1. Health to Aboriginal people is a multi-dimensional concept that embraces all aspects of living and stresses the importance of survival in harmony with the environment. The NAHS (1989), states that health is: Not the physical well being of the individual; bit the social cultural well being of the whole community. This is a whole of life view and it includes a cyclical concept of life. Health care services should strive to achieve the state where every individual is able to achieve their full potential as human beings, and thus bring about the total well being of their community…
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