NUR332 - University of the Sunshine Coast Assessment Answer

The health status of 'Australian Indigenous Peoples' before Invasion

Australian history is heavily interlinked with the inhabitation of its Indigenous people, who have lived in the continent for more than 65,000 years. Before the European settlers arrived in the late 18th century, the Aboriginal and Torres Strait Islander peoples prospered in unique cultures and languages along with diverse environments and societies (Ogbeide et al., 2021). Before the arrival of the British, the health and well-being of the Australian Indigenous people were deeply related to activities like fishing, hunting and gathering. In addtion to this, the Indigenous communities exhibited a complex understanding of medicinal plants and associated remedies, which helped in the management of numerous injuries and illnesses (Ahmed et al., 2021).

The Health Status of Australian Indigenous Peoples in the Present Scenario

The current health status of Indigeneous Australians is of concern. For instance, the disease burden is 2.3 times higher in the case of Aboriginal and Torres Strait Islander peoples (Department of Health and Aged Care, 2021). Secondly, due to a history of trauma and disconnection, the instances of mental health conditions are pretty significant, along with very high levels of psychological distress (Australian Institute of Health and Welfare, 2022). Lastly, the rates of chronic health conditions are also higher among Indigeneous Australians, which was responsible for 70% of the health gap in 2011 (AIHW, 2016).

Assimilation Policy of 1961 and its impact

The Assimilation Policy of 1961 was an approach by the government of Australia for the inclusion of Indigenous Australians, giving them equal rights and opportunities while leading to the eradication of their cultural identity as it was considered to be inferior (Australian Institute of Aboriginal and Torres Strait Islanders Studies, n.d). For example, this policy gave birth to the concept of stolen generations due to the forced removal of children from their families, resulting in generational trauma and loss of cultural identity. In addition to this, the forced relocation of Indigenous families led to a disintegration of closely knit communities resulting in higher issues of substance abuse, domestic violence and mental health illnesses (Vretherton & Mellor, 2006).

Consequences of racism in sports (Impact on mental health of Australian Indigenous men)

The Assimilation Policy of 1961 impacted the health status of Australian Indigenous men and women extensively, especially with respect to the involvement of Indigenous Australian men in sports. The intent of assimilation, coupled with the eradication of the cultural identity of Indigenous Australians, highlighted racism as a significant element impacting the identity and mental health of Indigenous male athletes. Several studies have emphasised racism being a critical determinant of health with respect to Indigenous Australians. For instance, The “Close the Gap” campaign, an initiative by the government of Australia, acknowledges that racism has a negative impact on the well-being and health of Indigeneous people (Australian Human Rights Commission, 2022). Firstly, racism has a significant impact on mental health. A study by Tatz & Adair (2009) has revealed that episodes of racism act as contributing factors to the development of mental health issues in Indigenous male athletes due to feelings of isolation, anxiety, depression and psychological distress.

Secondly, the assimilation policy aimed at the eradication of the cultural identity of Indigenous Australians. This adherence to Western norms has created a conflict that has resulted in a lost sense of identity and belonging among Indigenous male athletes (Williams et al., 2022). Thirdly, due to racism, Indigenous male athletes also suffer due to limited representation and opportunities. For instance, a study by Donaghue & Walker (2007) found that Indigenous athletes were underrepresented, discriminated and the portrayal was often focused on stereotypes and prejudices rather than attributes and accomplishments. Experiencing racism and discrimination can have a detrimental impact on the performance and motivation of Indigenous male athletes. According to a study by Rigney (2020), the psychological toll of racial abuse can lead to lost confidence and focus, potentially leading to a decline in Indigenous athletic performance and career prospects.

Consequences of racism on Indigeneous Australian maternal and fetal health

Firstly, access to quality healthcare has been reduced for Indigenous women due to racism and historical biases in the healthcare system. A study by Brock et al. (2014) revealed that the rates of Indigenous women attending antenatal care were significantly low as compared to non-Indigenous Australian women, as they felt misunderstood or disrespected. Secondly, the Assimilation Policy involved the assimilation of Indigenous peoples into mainstream society resulting in ignorance related to Indigenous beliefs and practices. This is made it frequent for Indigenous pregnant women to come across healthcare providers who are culturally insensitive, leading to hesitation among Indigenous pregnant women in seeking necessary medical care and assistance (Birch et al., 2009).

Thirdly, it has been found that the ratio of infant and maternal mortality rates has been relatively high among Aboriginal and Torres Strait Islander females, with 16.9 and 16.4, respectively (AIHW, 2023). This can be credited to the prevalence of racism and other stereotypes associated with the Indigenous community leading to disparity with respect to access to healthcare. Lastly, the trauma and distress experienced by Indigenous pregnant women have been found to have adverse effects on the unborn child. For instance, a study by Aguiar & Halseth (2015) revealed that episodes of racism and discrimination during pregnancy could result in a detrimental impact on the health and well-being of future generations. In additon to this, according to a study by Parayiwa & Behie (2018), maternal stress can lead to adverse birth outcomes such as low birth weight and preterm birth.

Impact of racism on the health and well-being of Australian Indigenous: Engagement of men and women with healthcare professionals during the pandemic

Firstly, Indigeneous Australians found it very challenging to access healthcare facilities during the COVID-19 pandemic. For example, a study by Fitts et al. (2020) found that Indigenous communities did not have adequate access to COVID-19 testing sites and healthcare facilities. The study also revealed that racism and the lingering effects of laws made in the past as the Assimilation policy contributed to these challenges.. Secondly, racism also had a significant impact on the quality of care received by Indigenous men and women during the pandemic. A report by the Australian Institute of Health and Welfare (AIHW) (2023) highlighted the instances of racial discrimination reported by Indigenous Australians in healthcare settings by nurses, doctors and other healthcare personnel (11% in 2014 to 20% in 2022).

In addition to this, experiences of racism during the pandemic led to the exacerbation of issues related to mental health among Indigenous Australians. This led to increased instances of depression, anxiety and other psychological distress (Diaz et al., 2021). According to a report by the Australian Bureau of Statistics (ABS), Indigenous Australians went through psychological distress to a greater extent as compared to non-Indigenous Australians (ABS, 2019). Lastly, Indigenous Australians were disproportionately impacted by the pandemic. The infection rates were higher, along with poorer health outcomes among Indigenous Australians in comparison to non-Indigenous Australians. Social elements like racism and other stereotypes, existing health inequalities and other socio-economic disadvantages can be held responsible for this (AIHW, 2022).

Reflection

5 principles of Cultural Safety and their application in my future practice

Being a healthcare professional working with Australian Indigenous People, such as nurses and midwives, I understand that it becomes my responsibility to ensure cultural safety while providing care that is unbiased, respectful and inclusive (Gerrard et al., 2021). For this, I choose to apply the five principles of Cultural Safety, originating from I. Ramsden's 2002 work. This will also help me contribute to the progress of "Closing the Gap" targets, ensuring culturally safe practices that are culturally safe and sound (Brascoupé & Waters, 2009). Firstly, I will reflect on my own culture and biases. For this, I will engage in a process of introspection which will involve examining my own beliefs, cultural background and biases. Having knowledge of and being aware of my biases would enable me to acknowledge the differences that I share with Indigenous Australian colleagues and clients. In addition to this, it would ensure that none of my interactions or decisions are influenced by any preconceived notions leading to an open-minded and inclusive approach (Bennet et al., 2011).

Secondly, following the principle of respecting and valuing Indigenous Australian cultures, I will make a conscious effort towards understanding and appreciating the diversity that exists within the histories, cultures and traditions of Indigenous Australian peoples. As a part of this, I would learn about family structures, spiritual beliefs, practices related to healing and the connection they have with their land. This would help in valuing and respecting the Indigenous cultural heritage and result in the establishment of rapport and trust. Moreover, I would make sure that the preferences and practices are valued in their experiences related to healthcare (Brascoupé & Waters, 2009).

Thirdly, through the principle of engaging in ongoing cultural learning, I commit to involving myself in training and education related to Indigenous history, health and cultural safety. It will comprise being part of various seminars, workshops and programs related to cultural awareness and education. This will help me to stay updated and informed about the unique needs and challenges of Indigenous Australians associated with accessing quality healthcare (Brascoupé & Waters, 2009).

Next comes the fourth principle of Cultural Safety, which believes in engaging in open and respectful communication. In adherence to this, I will communicate with Indigenous clients in a respectful and open manner. It would involve indulging in active listening regarding their concerns, making use of suitable terminology and language and asking open-ended questions. This will lead to the creation of a safe and supportive environment where Indigenous Australians feel heard, included and respected and are comfortable in sharing their needs and concerns (Brascoupé & Waters, 2009). Finally, in accordance with the fifth principle, which dictates advocating for Indigenous Australian clients and colleagues, I will be vocal and supportive in terms of my advocation for the rights of Indigenous clients. I will show active participation in supporting initiatives, programs and policies associated with closing the gap in disparities existing in healthcare. This will also involve me empowering and encouraging Indigenous clients regarding self advocation and providing access to relevant support and resources (Brascoupé & Waters, 2009).

Reporting racist behavior in the workplace and advocating for my Indigenous Australian clients and colleagues

Firstly, I will be prompt in reporting events that involve discriminative or racist behaviour in the workplace in accordance with established reporting procedures. Under this, I will inform my immediate supervisor and the human resources department as this would help in the prevention of similar issues in the future and lead to effective addressing of the issue (Herring et al., 2013). Secondly, I will abide by the Australian Health Practitioner Regulation Agency’s (Aphra) stance on racism, which focuses on respecting diversity and promoting equitable and inclusive healthcare (Gerard et al., 2021). I would also ensure that I adhere to the necessary guidelines, upholding standards of conduct to the highest and providing unbiased care and support. Thirdly, I will ensure that strict confidentiality is maintained with respect to processes that involve reporting racist behaviour. This will play an essential role in creating a safe and comfortable environment where Indigenous clients and colleagues can share experiences without any hesitation or fear of facing retaliation or victimisation.

Moreover, maintaining confidentiality would encourage people to voice their grievances to a greater extent (Paradies, 2005). Furthermore, I will be vocal when it comes to creating an environment that is inclusive and values diversity and mutual respect. It will involve active participation in training and programs related to increasing cultural awareness and educating non-Indigenous colleagues and clients on the importance of cultural safety and anti-racism in healthcare. This will lead to Indigeneous clients and colleagues feeling heard, included, and appropriately represented. Lastly, I will be actively involved in supporting and promoting cultural safety in the workplace, I will also make sure that the practices related to healthcare are culturally appropriate are empathetic and respectful towards the values and beliefs of Indigenous clients and colleagues (McGough et al., 2018).

References

Aguiar, W., & Halseth, R. (2015). Aboriginal peoples and historic trauma: The processes of intergenerational transmission. National Collaborating Centre for Aboriginal Health= Centre de collaboration nationale de la santé autochtone. https://www.ccnsa-nccah.ca.pdf

Ahmed, F., Zuk, A. M., & Tsuji, L. J. (2021). The impact of land-based physical activity interventions on self-reported health and well-being of Indigenous adults: A systematic review. International Journal Of Environmental Research and Public Health, 18(13), 7099. https://doi.org/10.3390/ijerph18137099

Australian Bureau of Statistics. (2019). National Aboriginal and Torres Strait Islander health survey, 2018–19. https://www.abs.gov.au/statistics/people/aboriginal-and-torres-strait-islander-peoples/national-aboriginal-and-torres-strait-islander-health-survey/latest-release

Australian Human Rights Commission. (2022). Close the Gap: Indigenous Health Campaign. https://humanrights.gov.au/our-work/aboriginal-and-torres-strait-islander-social-justice

Australian Institute of Aboriginal and Torres Strait Islanders Studies. (n.d). The policy of assimilation. https://aiatsis.gov.au/sites/default/files/catalogue_resources/18801.pdf

Australian Institute of Health and Welfare. (2016). Australian Burden of Disease Study: impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2011—summary report. https://www.aihw.gov.au/reports/burden-of-disease/illness-death-indigenous-australians-summary/summary

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

Australian Institute of Health and Welfare. (2022). Rural and remote health. https://www.aihw.gov.au/reports/rural-remote-australians/rural-and-remote-health

Australian Institute of Health and Welfare. (2023). Aboriginal and Torres Strait Islander mothers and babies. https://www.aihw.gov.au/reports/mothers-babies/indigenous-mothers-babies/contents/maternal-and-perinatal-mortality#maternal

Australian Institute of Health and Welfare. (2023). Cultural safety in health care for Indigenous Australians: Monitoring framework. https://www.aihw.gov.au/reports/indigenous-australians/cultural-safety-health-care-framework/contents/summary

Bennett, B., Zubrzycki, J., & Bacon, V. (2011). What do we know? The experiences of social workers working alongside Aboriginal people. Australian Social Work, 64(1), 20-37. https://doi.org/10.1080/0312407X.2010.511677

Birch, J., Ruttan, L., Muth, T., & Baydala, L. (2009). Culturally competent care for aboriginal women: a case for culturally competent care for aboriginal women giving birth in hospital settings. International Journal of Indigenous Health, 4(2), 24-34. https://jps.library.utoronto.ca/index.php/ijih/article/view/28970/23955

Brascoupé, S., & Waters, C. (2009). Cultural safety exploring the applicability of the concept of cultural safety to aboriginal health and community wellness. International Journal of Indigenous Health, 5(2), 6-41. https://jps.library.utoronto.ca/index.php/ijih/article/view/28981/23928

Bretherton, D., & Mellor, D. (2006). Reconciliation between Aboriginal and other Australians: The “stolen generations”. Journal of Social Issues, 62(1), 81-98. https://doi.org/10.1111/j.1540-4560.2006.00440.x

Brock, E., Charlton, K. E., & Yeatman, H. (2014). Identification and evaluation of models of antenatal care in Australia–A review of the evidence. Australian and New Zealand Journal of Obstetrics and Gynaecology, 54(4), 300-311. https://doi.org/10.1111/ajo.12210

Department of Health and Aged Care. (2021). Status and determinants of Aboriginal and Torres Strait Islander health. https://www.health.gov.au/topics/aboriginal-and-torres-strait-islander-health/status-and-determinants

Diaz, A., Baweja, R., Bonatakis, J. K., & Baweja, R. (2021). Global health disparities in vulnerable populations of psychiatric patients during the COVID-19 pandemic. World Journal of Psychiatry, 11(4), 94. https://doi.org/ 0.5498/wjp.v11.i4.94

Donaghue, N., & Walker, I. (2007). Contact sports: Judgements of Aboriginal and non-Aboriginal Australian football league players' performance. South African Journal of Psychology, 37(4), 771-782. https://doi.org/10.1177/00812463070370040

Fitts, M. S., Russell, D., Mathew, S., Liddle, Z., Mulholland, E., Comerford, C., & Wakerman, J. (2020). Remote health service vulnerabilities and responses to the COVID‐19 pandemic. Australian Journal of Rural Health, 28(6), 613-617. https://doi.org/10.1111/ajr.12672

Gerrard, J. M., Godwin, S., Chuter, V., Munteanu, S. E., West, M., & Hawke, F. (2021). Release of the National Scheme’s Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy 2020-2025; the impacts for podiatry in Australia: A commentary. Journal of Foot and Ankle Research, 14, 1-13. https://doi.org/10.1186/s13047-021-00466-8

Herring, S., Spangaro, J., Lauw, M., & McNamara, L. (2013). The intersection of trauma, racism, and cultural competence in effective work with Aboriginal people: Waiting for trust. Australian Social Work, 66(1), 104-117. https://doi.org/10.1080/0312407X.2012.697566

McGough, S., Wynaden, D., & Wright, M. (2018). Experience of providing cultural safety in mental health to Aboriginal patients: A grounded theory study. International Journal of Mental Health Nursing, 27(1), 204-213. https://doi.org/10.1111/inm.12310

Ogbeide, A. E., Nash, S., Ghaju, S., & Dune, T. (2021). Ageing in Indigenous Australians. Aging Across Cultures: Growing Old in the Non-Western World, 259-283. https://link.springer.com/chapter/10.1007/978-3-030-76501-9_17

Paradies, Y. (2005). Anti‐racism and indigenous Australians. Analyses of Social Issues and Public Policy, 5(1), 1-28. https://doi.org/10.1111/j.1530-2415.2005.00053.x

Parayiwa, C., & Behie, A. M. (2018). Effects of prenatal maternal stress on birth outcomes following tropical cyclone Yasi in Queensland, Australia (2011). International Journal of Disaster Risk Reduction, 28, 768-775. https://doi.org/10.1016/j.ijdrr.2018.02.005

Ramasubramanian, S., Riewestahl, E., & Ramirez, A. (2023). Race and Ethnic Stereotypes in the Media. In Oxford Research Encyclopedia of Communication. https://doi.org/10.1093/acrefore/9780190228613.013.1262

Rigney, D. (2020). Sport, Indigenous Australians and invader dreaming: A critique. In Sport and postcolonialism (pp. 45-56). Routledge. https://www.taylorfrancis.com/chapters/edit/10.4324/9781003086772-4/sport-indigenous-australians-invader-dreaming-critique-daryle-rigney

Tatz, C., & Adair, D. (2009). Darkness and a little light:'Race'and sport in Australia. Australian Aboriginal Studies, (2), 1-14. https://search.informit.org/doi/abs/10.3316/INFORMIT.650427795514142

Williams, J., Pill, S., Evans, J., & Davies, M. (2022). ‘… if my family didn’t play football… we would literally have pretty much nothing’: how high school Aboriginal students continue culture through rugby league and Australian football. Sport, Education and Society, 27(1), 57-71. https://doi.org/10.1080/13573322.2020.1814716

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