The Australian Indigenous Doctors’ Association
The Australian Hospital and Healthcare Bulletin presents the winter edition foreword by Dr Tammy Kimpton, President of the Australian Indigenous Doctors’ Association.
[caption id="attachment_8186" align="alignleft" width="630"] ROCKHOLES WEST OF KINTORE (ACRYLIC ON LINEN, 181 X 271CM)
BY WENTJA MORGAN NAPALTJARRI.
COURTESY OF THE ARTIST AND ART EQUITY
While Australia has a strong healthcare system, which is reflected in good health outcomes for many Australians, it does not serve all Australians equitably. As a group, it is well known the Aboriginal and Torres Strait Islander population is the most disadvantaged, and has the worst health indicators and outcomes in Australia.
These differences in health indicators and outcomes between Aboriginal and Torres Strait Islander people and their non- Indigenous counterparts can be observed across the lifespan. These differential outcomes encompass rates of ear disease approximately three times higher for Aboriginal and Torres Strait Islander children compared to non-Indigenous children and much higher rates of psychological distress for youth. Aboriginal and Torres Strait Islander adults experience chronic diseases at both younger ages, and at higher rates than in the wider Australian community. In terms of life expectancy there is a continuing gap of 10.6 years and 9.5 years for Aboriginal and Torres Strait Islander men and women and their non- Indigenous counterparts.
While Aboriginal and Torres Strait Islander people experience a heavier burden of poor health, this is not reflected in rates of access to the overall healthcare system. Aboriginal and Torres Strait Islander people do access the healthcare system at a rate 1.1 times greater than their non-Indigenous counterparts, it is estimated that to appropriately reflect the burden of disease that this rate would need to be 2-3 times higher.1
When we look at the tertiary healthcare system in Australia there is a clear disparity between the Aboriginal and Torres Strait Islander population and their non-Indigenous counterparts. While an Aboriginal and Torres Strait person is more likely to be admitted to hospital than a non-Indigenous person, in all states and territories in Australia they are less likely to have a medical or surgical procedure whilst they are in hospital.2 For example when we look at cancer – the second highest killer for Aboriginal and Torres Strait Islander people – an Indigenous person is less likely to have adequate treatment, and when they do have treatment, they are more likely to wait for a longer period of time to access this treatment. 3 4
Another indicator that the tertiary healthcare system is not meeting the needs of Aboriginal and Torres Strait Islander people is the high rate of preventable hospitalisations. From June 2008 to July 2010 the overall rates for potentially preventable hospitalisations for Aboriginal and Torres Strait Islander people was five times that of non-Indigenous people. These hospitalisations accounted for 26 per cent of hospital admissions for Aboriginal and Torres Strait Islander peoples.5
While there is progress being made in some areas of Aboriginal and Torres Strait Islander health, for example we are on track to meet the Closing the Gap target of halving the gap in child mortality within a decade, it is clear from the above analysis that more needs to be done. So where should the Australian hospital and the healthcare system be focusing their efforts to really make the difference in health outcomes for Aboriginal and Torres Strait Islander people? Improving health outcomes is a complex issue, and efforts will need to be focused in multiple areas and levels by a broad range of people and organisations and be strengths based rather than deficits focused.
[pullQuote]“For Aboriginal and Torres Strait Islander people our culture is a source of strength, resilience, happiness, identity and confidence. Each of these factors are inextricably linked to health and wellbeing, making the protection and promotion of culture critical to progressing improvements in Aboriginal and Torres Strait Islander health.”[/pullQuote]
While we know that people’s individual efforts can and do make a difference, it is vitally important that appropriate structural arrangements are in place to service long term and sustainable improvements in Aboriginal and Torres Strait Islander people’s health outcomes. One element of this is building and enhancing structural arrangements that empower Aboriginal and Torres Strait Islander people to engage with their own health. This is enabled through elements such as well funded Aboriginal and Torres Strait Islander Community Controlled Health Services (CCHS) as well as strong Indigenous leadership and governance arrangements.
Aboriginal and Torres Strait Islander Community controlled health services – that is primary health care services that deliver comprehensive, holistic and culturally appropriate health care that is initiated and operated by a community – offer a strong and effective healthcare model for Aboriginal and Torres Strait Islander people. These services are the strong preference of Aboriginal and Torres Strait Islander people, with up to two-thirds of Indigenous people relying on their local CCHS, and the demand for demand for CCHS increasing 6.3 percent annually.6 However, currently these services are not adequately funded with three quarters of government Indigenous specific health expenditure being directed toward mainstream health services.7
Another example of putting in place structural arrangements is the Collaborative Agreements that AIDA has in place across the medical education and training continuum from Medical Deans Australia and New Zealand, to the Confederation of Postgraduate Medical Education Councils, and Committee of Presidents of Medical Colleges. These agreements support the entry, articulation and graduation of Aboriginal and Torres Strait Islander medical students and doctors on their journeys into and through medicine into specialties, as well as the inclusion of Aboriginal and Torres Strait Islander health within medical education and training continuum.
For Aboriginal and Torres Strait Islander people our culture is a source of strength, resilience, happiness, identity and confidence. Each of these factors are inextricably linked to health and wellbeing, making the protection and promotion of culture critical to progressing improvements in Aboriginal and Torres Strait Islander health.8
Quality healthcare for Indigenous patients needs to be responsive to cultural differences and the impacts of racism (conscious and unconscious). Therefore addressing racism, both within and without the healthcare system, will be an important facet of fostering cultural safety. We know that racism can have a profoundly negative impact on a person’s health, as well as their ability and willingness to access the healthcare system. It will be important to address racism both at an institutional and personal level and make our hospitals and health care system culturally safe places for Aboriginal and Torres Strait Islander people.
We know that health programs for Aboriginal and Torres Strait Islander people that are targeted and appropriately developed are well used and effective. As example of this is the Inala Indigenous Health Service Southern Queensland Centre of Excellence for Aboriginal and Torres Strait Islander Primary Health Care, in Brisbane, QLD. In 1994 the centre only had 12 Indigenous people registered as clients and conducted about 900 doctor consultations, since implementing a number of strategies informed by the local community; it now has more than 6000 Indigenous patients who attend more than 20,000 doctor consultations each year.9 Strategies implemented by Associate Professor Noel Hayman and his team at the service include: employing more Indigenous staff; creating a culturally safe waiting spaces; staff cultural awareness training; disseminating information to the Indigenous community; and promoting inter-sectorial collaboration.
The continuing significantly poorer health outcomes experienced by Aboriginal and Torres Strait Islander people needs to be urgently addressed. As noted earlier, this is a complex issue and change must be structural rather than based on the efforts of individual people. It is important that policies and programs be strengths based rather than deficits focused and actively engage Aboriginal and Torres Strait Islander people in the true sprit of partnership. Developing and enhancing cultural safety while addressing racism in the Australian hospital and healthcare system will be a critical determinant to improving Aboriginal and Torres Strait Islander health.
The Australian Indigenous Doctors’ Association (AIDA) is the nation’s peak body for Aboriginal and Torres Strait Islander doctors and medical students. AIDA also advocates for improvements in Aboriginal and Torres Strait Islander people’s health in Australia. We are working towards improving the health of Aboriginal and Torres Strait Islander people, reaching parity of Indigenous health professionals across the entire health sector and creating a health system that is culturally safe, high quality, reflective of need, and respects and integrates Aboriginal and Torres Strait Islander cultural values.
[caption id="attachment_8189" align="alignright" width="150"] AIDA President,
Dr Tammy Kimpton.[/caption]
Dr Tammy Kimpton, a Palawa woman from the west coast of Tasmania, graduated from the University of Newcastle in 2003 and is a Fellow of the Royal Australian College of General Practitioners. Tammy is the current President of the AIDA. Tammy has been actively involved in Aboriginal and Torres Strait Islander medical education and training issues for a number of years. Tammy has been a member of AIDA since its inception and is a founding member of the Indigenous GP Registrars Network, with considerable involvement with Australian General Practice Training and General Practice Education and Training. Tammy is also a mother of three young children and is working in a private practice in Scone, NSW with visiting rights to Scott Memorial Hospital.
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