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  • Subject Name : Medical Sciences

Introduction

Cultural competency is the capacity of persons, groups, or communities to interact with those from different cultural origins courteously and successfully (Beagan, 2018). It involves the knowledge, abilities, attitudes, and behaviours people need to get around and communicate in various settings including healthcare (Henderson et al., 2018). Cultural competency includes a deeper awareness and appreciation of diverse cultures, practices, values, beliefs, and traditions, in addition to the simple ability to tolerate cultural differences (Sharifi et al., 2019). It has been eye-opening to consider my position as a student nurse with respect to cultural competence. I have a basis for embracing variety owing to having been brought up in a multicultural home, but it has also made my prejudices and assumptions clear (Foronda et al., 2018).

The first step in overcoming these prejudices and ensuring I approach cross-cultural relationships with sensitivity and modesty is becoming aware of them. Additionally, my academic experiences have been crucial in forming my cultural competence for patient-centred care (Farnicka & Pocinho, 2018). My development was influenced by my interactions with peers from varied cultural origins, my participation in multicultural activities and discussions, and the diverse perspectives I studied in my curriculum. They have challenged my preconceptions and introduced me to the depth of human diversity, allowing me to gain greater cultural competency so I can encounter effectively with patient in future (Maharaja, 2018).

Influence of racial science

Racial science has undeniably had a profound impact on the institutions and systems that shape Australian society, with the health system no exception. Rooted in pseudoscientific notions of racial superiority and purity, this ideology was pivotal in shaping discriminatory policies with far-reaching and devastating consequences (Andrejevic & Selwyn, 2020). One glaring example is the White Australia Policy, a series of immigration restrictions from the late 19th century to the mid-20th century. Underpinned by the flawed notion of racial homogeneity, this policy deliberately excluded individuals of non-European descent from immigrating to Australia. The information is evident in the policies themselves and the explicit government statements of the time, highlighting the intent to maintain a racially homogeneous population (Male, 2022).

Moreover science found its way into the heart of Australian society through the forced assimilation policies inflicted upon Indigenous Australians. The Stolen Generations, a harrowing chapter in Australian history, saw Indigenous children forcibly removed from their families in the misguided belief that they needed to assimilate into European-Australian culture. This policy was steeped in the belief in European cultural and genetic superiority (O’Donnell et al., 2019). Government reports, such as the Bringing Them Home Report (1997), have documented these policies' profound and lasting impact on Indigenous families and communities, revealing the tragic consequences of racial science in action (Australian Human Rights Commission [AHRC], n.d).

The enduring impact of racial science can also be discerned in the alarming health disparities plaguing Indigenous Australians and other minority groups. These disparities manifest in higher rates of chronic diseases, lower life expectancies, and limited access to quality healthcare (Mayes, 2020). A report by the Australian Institute of Health and Welfare (AIHW) underscores these health disparities and their close ties to social determinants. The historical influence of racial science in shaping healthcare policies and access continues to reverberate through these ongoing health inequalities (AIHW, 2018).

Another regrettable consequence of racial science is cultural insensitivity in the healthcare system. Indigenous Australians and other minority groups frequently experience prejudice and mistrust in the healthcare industry, discouraging them from accessing necessary medical care (Doran et al., 2019). One such report highlighting the critical need for cultural competence in the healthcare industry is the National Aboriginal and Torres Strait Islander Health Plan (2021–2031) (Australian Government, 2021).

Social determinants of health and Indigenous Australians

Indigenous Australians' well-being is significantly shaped by social determinants of health, which represent a complex interplay of elements outside the traditional scope of healthcare. These factors affect many aspects of life, such as socioeconomic status, employment, housing, schooling, access to medical care, and social networks, and they have a significant and long-lasting impact on health outcomes (Jackson Pulver et al., 2019). The difference in household income between Indigenous and non-Indigenous families is one of the most apparent discrepancies. Indigenous households made $316 less per week than non-Indigenous households in 2021, according to statistics from the Australian Government. This income gap has wide-ranging effects on access to needs like wholesome food and a decent place to live. Financial constraints can cause food insecurity, influencing poor dietary decisions and unfavourable health effects (Australian Government, 2023). Insufficient housing conditions are also a concern; according to Australian Bureau of Statistics (ABS) data, Indigenous households are over two times as likely to face overcrowding as non-Indigenous households. In addition to posing physical health hazards, including those from infectious diseases, overcrowding harms mental health due to a shortage of privacy and space (ABS, 2023).

Education is another critical determinant that significantly impacts the health trajectory of Indigenous Australians. National Indigenous Australian Agency (NIAA) data from 2020 reveals lower school attendance and attainment rates among Indigenous populations (82%), limiting their future employment prospects and income potential. Education not only shapes economic opportunities but also influences health literacy and the ability to make informed health-related decisions (Australian Government, 2020). The employment situation for Indigenous Australians also compounds health disparities. The AIHW reported in 2023 that the unemployment rate for Indigenous Australians was nearly double that of their non-Indigenous counterparts. Secure employment bolsters income and contributes to self-esteem and overall well-being, reducing stress and mental health issues (AIHW, 2023).

Access to healthcare remains a critical challenge, rooted in geographic isolation and financial barriers. Indigenous communities often face greater distances to healthcare facilities, making timely access to medical services difficult. The AIHW reported that Indigenous Australians had higher rates of unmet healthcare needs, leading to delayed diagnoses and treatment, exacerbating health conditions (AIHW, 2022). Cultural factors should not be underestimated in this context. Historical trauma, cultural disconnection, and disrupted traditional lifestyles can significantly impact mental health and contribute to substance abuse issues. According to another AIHW report in 2022, Indigenous Australians were more than twice as likely to report high psychological distress as non-Indigenous Australians, underscoring the need for culturally sensitive healthcare and support services (AIHW, 2022).

Indigenous Australian perspectives and health practices

Understanding Indigenous Australian perspectives on health and well-being is not merely a matter of cultural sensitivity; it is a profound recognition of a holistic worldview that has sustained Indigenous communities for thousands of years. Indigenous Australians embrace a holistic approach to health, where physical, mental, emotional, and spiritual dimensions are interconnected. This perspective underscores the importance of balance, harmony, and connection with the land, community, and culture (Terare & Rawsthorne, 2020). These perspectives can profoundly guide contemporary health practices in individual and institutional/professional contexts. Individually, healthcare practitioners must cultivate cultural competence, moving beyond a one-size-fits-all approach to healthcare. Active listening and learning from Indigenous patients are essential, respecting their unique beliefs, practices, and preferences (Mackean et al., 2020).

When appropriate, collaborative care models that integrate traditional healing methods offer a more holistic approach. Indigenous patients should be empowered to play an active role in their healthcare decisions, aligning with the principle of self-determination. Institutionally, healthcare organisations must prioritise creating culturally safe environments. This involves examining and rectifying systemic racism, bias, and discrimination within healthcare systems (Walter & Suina, 2019). Cultural safety is increasingly recognised as integral to healthcare quality in Australia. Efforts to increase the representation of Indigenous Australians in the healthcare workforce should be supported, not only addressing employment disparities but also promoting culturally safe care. Investment in community-led health initiatives, which align with Indigenous perspectives and needs, can drive sustainable improvements in health outcomes (Parrella et al., 2022).

Examples such as the Aboriginal and Torres Strait Islander Health Plan (2013-2023), the Redfern Statement, and the Cultural Respect Framework for Aboriginal and Torres Strait Islander Health underscore the importance of aligning healthcare practices with Indigenous perspectives. These policies and frameworks emphasise culturally appropriate care, community involvement, and addressing social determinants of health (Mazel, 2018). For instance, the Redfern Statement highlights self-determination, culturally safe healthcare, and acknowledging social determinants. The Cultural Respect Framework for Aboriginal and Torres Strait Islander Health, on the other hand, provides practical guidance to health professionals, focusing on the importance of understanding Indigenous perspectives (Jackson Pulver et al., 2019).

Conclusion

In conclusion, tackling the complex challenges of Indigenous Australian health inequities requires cultural competency. It entails acknowledging the long-lasting effects of social variables on Indigenous well-being and the historical impact of racial science on healthcare practices. It is crucial to comprehend and accept Indigenous Australian viewpoints and health practices to close these gaps and achieve improved health outcomes. The historical injustices brought on by racial science emphasise how crucial it is for the healthcare system to be culturally competent. Fundamental steps toward resolving differences and fostering cultural sensitivity include acknowledging historical discrimination. Equally important is addressing the socioeconomic determinants of health, such as income inequality, education, and access to healthcare. These elements are intricately linked to health outcomes and call for broad policy adjustments.

Indigenous Australian viewpoints provide insightful ideas on holistic health and wellbeing. Healthcare professionals and organisations must consider these viewpoints actively, promoting cultural competence and establishing culturally safe settings. Healthcare outcomes may be further improved by collaborative care models that use conventional therapeutic modalities. It is essential to be sensitive to cultural differences and move toward a more equitable and tolerant healthcare system by including Indigenous Australian ideas. It is a call to action to address historical injustices and socioeconomic determinants of health and guarantee that all Australians, irrespective of their cultural heritage, have the chance to access safe and quality healthcare and experience enhanced health outcomes.

References

Andrejevic, M., & Selwyn, N. (2020). Facial recognition technology in schools: Critical questions and concerns. Learning, Media and Technology , 45 (2), 115-128. https://doi.org/10.1080/17439884.2020.1686014

Australian Bureau of Statistics. (2023). Housing statistics for Aboriginal and Torres Strait Islander Peoples. https://www.abs.gov.au/statistics/people/aboriginal-and-torres-strait-islander-peoples/housing-statistics-aboriginal-and-torres-strait-islander-peoples/latest-release

Australian Government. (2020). School attendance. https://ctgreport.niaa.gov.au/school-attendance

Australian Government. (2021). National Aboriginal and Torres Strait Islander Health Plan 2021–2031. https://www.health.gov.au/resources/publications/national-aboriginal-and-torres-strait-islander-health-plan-2021-2031

Australian Government. (2023). Income. https://www.indigenoushpf.gov.au/measures/2-08-income

Australian Human Rights Commission [AHRC] (n.d). Bringing them Home Report (1997). https://humanrights.gov.au/sites.pdf

Australian Institute of Health and Welfare. (2022). Social determinants of health. https://www.aihw.gov.au/reports/australias-health/social-determinants-of-health

Australian Institute of Health and Welfare. (2022a). Indigenous health and wellbeing. https://www.aihw.gov.au/reports/australias-health/indigenous-health-and-wellbeing

Australian Institute of Health and Welfare. (2023). Employment of First Nations People. https://www.aihw.gov.au/reports/australias-welfare/indigenous-employment

Beagan, B. L. (2018). A critique of cultural competence: Assumptions, limitations, and alternatives. Cultural competence in applied psychology: An evaluation of current status and future directions , 123-138.  https://doi.org/10.1007/978-3-319-78997-2_6

Doran, F., Wrigley, B., & Lewis, S. (2019). Exploring cultural safety with Nurse Academics. Research findings suggest time to “step up”. Contemporary Nurse , 55 (2-3), 156-170. https://doi.org/10.1080/10376178.2019.1640619

Farnicka, M., & Pocinho, M. (2018). What Can Psychology Offer in Cross-Cultural Dialogue: A Psychological Approach to Intercultural Competence. Cross-Cultural Dialogue as a Conflict Management Strategy , 70-83.  https://doi.org/10.1007/978-3-319-77231-8_7

Foronda, C. L., Baptiste, D. L., Pfaff, T., Velez, R., Reinholdt, M., Sanchez, M., & Hudson, K. W. (2018). Cultural competency and cultural humility in simulation-based education: An integrative review. Clinical Simulation in Nursing , 15 , 42-60. https://doi.org/10.1016/j.ecns.2017.09.006

Henderson, S., Horne, M., Hills, R., & Kendall, E. (2018). Cultural competence in healthcare in the community: A concept analysis. Health & Social Care in the Community , 26 (4), 590-603.  https://doi.org/10.1111/hsc.12556

Jackson Pulver, L., Williams, M., & Fitzpatrick, S. (2019). Social determinants of Australia’s first peoples: A multi-level empowerment perspective. Social determinants of health . https://opus.lib.uts.edu.au/bitstream/10453/159674/3/c1fa6ff7-3fe9-4f0d-be95-1805db43320f.pdf

Mackean, T., Fisher, M., Friel, S., & Baum, F. (2020). A framework to assess cultural safety in Australian public policy. Health Promotion International , 35 (2), 340-351. https://doi.org/10.1093/heapro/daz011

Maharaja, G. (2018). The Impact of Study Abroad on College Students' Intercultural Competence and Personal Development. International Research and Review , 7 (2), 18-41. https://files.eric.ed.gov/fulltext/EJ1188735.pdf

Male, T. O. R. (2022). Australian public policies regarding aboriginal affairs (1883-1972): A bilateral perspective (Master's thesis).  http://hdl.handle.net/10071/27495

Mayes, C. (2020). White medicine, white ethics: On the historical formation of racism in Australian Healthcare. Journal of Australian Studies , 44 (3), 287-302. https://doi.org/10.1080/14443058.2020.1796754

Mazel, O. (2018). Indigenous health and human rights: A reflection on law and culture. International Journal of Environmental Research and Public Health , 15 (4), 789.  https://doi.org/10.3390/ijerph15040789

O’Donnell, M., Taplin, S., Marriott, R., Lima, F., & Stanley, F. J. (2019). Infant removals: The need to address the over-representation of Aboriginal infants and community concerns of another ‘stolen generation’. Child Abuse & Neglect , 90 , 88-98. https://doi.org/10.1016/j.chiabu.2019.01.017

Parrella, A., Pearson, O., Davy, C., Barrie, H., Mott, K., Morey, K., & Braunack‐Mayer, A. (2022). Understanding culturally safe aged care from the perspectives of older Aboriginal Australians in rural and remote communities. Health Promotion Journal of Australia , 33 (3), 566-575.  https://doi.org/10.1002/hpja.541

Sharifi, N., Adib-Hajbaghery, M., & Najafi, M. (2019). Cultural competence in nursing: A concept analysis. International journal of nursing studies , 99 , 103386. https://doi.org/10.1016/j.ijnurstu.2019.103386

Terare, M., & Rawsthorne, M. (2020). Country is yarning to me: Worldview, health and well-being amongst Australian First Nations people. The British Journal of Social Work , 50 (3), 944-960. https://doi.org/10.1093/bjsw/bcz072

Walter, M., & Suina, M. (2019). Indigenous data, indigenous methodologies and indigenous data sovereignty. International Journal of Social Research Methodology , 22 (3), 233-243. https://doi.org/10.1080/13645579.2018.1531228

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