It would be hard to deny that for one of the smaller representing populations in Australia Indigenous Australians are the most disadvantaged in many areas ranging from employment, housing, justice and education among many more. There have been various attempts at overcoming the disadvantages Aboriginal people face. For the purposes of this literature review different literature will be discussed around addressing the social inequality and disadvantage of indigenous people in relation to improving on the gap in life expectancy and what fundamental elements need to be considered for the process to work effectively. Views of what has brought about the low life expectancy will be discussed to highlight the importance of were actions should be targeted. This will then be followed by a review of what actions are in place at the moment.
There are competing ideas in the literature as to what is the cause for the life expectancy gap between Indigenous and non-indigenous Australians, which also give different arguments as to how to address the problem, with one side taking a view of longevity and the other a holistic approach.
It is argued that Indigenous Australians health disparities could be narrowed with the improvement of the disparities in health service access, provision and use. As The inabilities to gain sufficient health care due to, distance, cultural and availability barriers has lead to indigenous health problems being constant and prolonged (Healey 2002).
However Eades of the of the Indigenous health research unit (2000,p.468) argues ‘ that a comprehensive approach to improving the health of Aboriginal and Torres Strait Islanders involves understanding the close relationships between their social and economic status and their health’. This holistic view of the social and economical status of Aboriginal people being improved upon to overcome health problems can be further reinforced through explanations of how psychological and social influences affect physical health and longevity (Wilkinson and Marmount 2003) in which it is stated ‘life expectancy is shorter and most diseases are more common further down the social ladder in each society. Health policy must tackle the social and economical determinants of health’ (p.10). McMurray and Param (2008) readdress the primary health care aspect and bring in the notion that cultural specific guidelines with-in health structures is the key in improving Aboriginal health. This however ignores the historical issues between Indigenous and non indigenous relations that affect the life expectancy gap as ‘the situation for indigenous Australians is further exacerbated by racism and prejudice, which have marginalised them from various aspects of social and community life, with additional detrimental effects on health’ (Eades 2000, p.469) and in effect the fear among Aboriginal people of institutional racism (Sweet 2003).
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Experiences of loss of traditional roles, a history of conflict and dispossession, failed assimilation and passive welfare are not isolated to indigenous Australians but have been experienced by indigenous peoples of other countries who have been colonised (Banks 2007). The statistics show however that indigenous Australians life expectancy compared to that of non- indigenous Australians to be considerably lower with men 11.5yrs difference women 9.7 yrs (Australian Bureau of statistics, 2010) were as ‘the longevity gap between MÄori and non-MÄori has closed slightly. The difference in life expectancy at birth of 8.2 years in 2005-07 compares with 8.5 years in 2000-02 and 9.1 years in 1995-97’ (statistics New Zealand 2008). Centres for Disease Control and Preventions (2010) also show the life expectancy gap in the U.S for Black or African American People to be somewhat lower than Australia’s and has been also closing slightly as at 1995 the gap was 7 years for both sexes and at 2005 has been reduced to 5.1 years.
As it has been established that health can be a reflection social determinants, it would be fare to say that the social status and relations of international indigenous people are further along than Australia. Canada, New Zealand and The United States all have specifically designed treaties of political, legal and cultural significance which were designed in consultation with the Indigenous peoples that have established indigenous and non-indigenous relations with ‘governments using treaties and treaty-making as part of a wider approach to developing a better relationship with and addressing the socio-economic problems of indigenous peoples’ (Brennan et al. 2005, p.99).
In Australia there are no such treaties and often the commonwealth and state governments have a different belief in how the gap in life expectancy can be overcome to that of many indigenous Australians. This can be seen through the use of policies relating to indigenous affairs. A health impact assessment of the current governments Northern territory Emergency Response (NTER) points out that the Aboriginal understanding of health as having five dimensions ‘cultural, spiritual, social, emotional and physical-within which are a number of layers that reflect historical, traditional and contemporary influences on health’ (O’Mara 2010,p.547). It is needed that Indigenous people have greater control over these dimension of their daily lives in order for the indigenous disadvantage to be improved (Maddison 2009). However the summary of findings from the assessment conclude that because of the lack of consultation with the Aboriginal communities and ignoring of cultural elements, the NTER is unlikely to be effective in its aim of ‘improving physical health and improving the social and environmental determinants of health’ as ‘The HIA predicts that improvements in physical health may be outweighed by negative impacts on the psychological health, spirituality, and cultural integrity of a high proportion of the Aboriginal population in prescribed communities’ (Australian Indigenous Doctors’ Association and Centre for Health Equity Training 2010, p.65).
There is an evidence base around the relationship between social detriments and psychological and physical health, with implications on health, through the addressing of those social detriments. Within indigenous communities outside Australia, social factors of cultural significance have and continue to be address through consultations with Governments. It is in these countries that statistics show improvements in life expectancy of the Indigenous population. Were as in Australia were this type of consultation and cultural consideration is absent in Governments initiatives and policies the gap in life expectancy in Australia continues to be a constant burden of Australian indigenous peoples. With the NTER which like past policies also excludes indigenous peoples involvment, being the Governments latest attempt at overcoming the status of appalling health among Australian Aborigines, the gap can be expected to continue.
‘Asked about the government’s priorities, indigenous affairs minister Jenny Macklin said that there will be little progress made by spending money on indigenous health without first addressing the chronic social problems that have been eating away at Aboriginal society’ (Dart 2008, p.247).
Australian Bureau of statistics 2010, The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples, Canberra, Viewed 19 October 2010, http://www.abs.gov.au/AUSSTATS/abs@.nsf/lookup/437BB6CD9D0BCDB8CA2577300017FB8F?opendocument
Australian Indigenous Doctors’ Association and Centre for Health Equity Training, Research and Evaluation 2010, Health Impact Assessment of the Northern Territory Emergency Response , Canberra, viewed 19 October 2010 http://www.aida.org.au/viewpublications.aspx?id=3.
Banks, G 2007, Overcoming Indigenous Disadvantage in Australia, Australian Government Productivity commission, Canberra, viewed 19 October 2010, http://www.pc.gov.au/__data/assets/pdf_file/0009/64584/cs20070629.pdf
Brennan, S, Behrendt, L, Strelein, L & Williams, G 2005, Treaty, The Federation Press, Sydney, NSW.
Centres for Disease Control and Prevention 2010, Table 26. Life expectancy at birth, at 65 years of age, and at 75 years of age, by race and sex: United States, selected years 1900-2005, U.S, Viewed 19 October, http://www.cdc.gov/nchs/data/hus/hus08.pdf#026
Dart, J 2008, ‘Australia’s disturbing health disparities set Aboriginals apart’, Bulletin of the World Health Organization,vol.86, no.4, pp.245-247, viewed 5 October 2010, retrieved from Academic Search Premier database.
Eades, S 2000, ‘Reconciliation, Social Equity and Indigenous Health’, The Medical Journal of Australia, vol.172, viewed 8 October 2010, pp.468-469.
Healey, J (ed.) 2002, Aboriginal Disadvantage, The Spinney Press, NSW.
Maddison, S 2009, ‘Australia: Indigenous Autonomy Matters’, Development, vol.52, no. 4, pp.483-489, viewed 19 October 2010, retrieved from Academic Search Premier database.
McMurray, A & Param, R 2008, ‘Culture Specific Care for Indigenous People: A Primary Health Care Perspective’, Contemporary Nurse: A Journal for the Australian Nursing Profession, vol. 28, pp.165-172, viewed 22 October 2010, retrieved from Academic Search Premier database.
O’Mara, P 2010, ‘Health Impacts of the Northern Territory Intervention: After the Intervention Editorial’, The Medical Journal of Australia, vol .192, no.10, viewed 8 October 2010, pp.546-548, http://www.mja.com.au/public/issues/192_10_170510/oma10307_fm.pdf.
Statistics New Zealand Tatauranga Aotearoa 2008, New Zealand Life Tables: 2005-2007, New Zealand, Viewed 19 October 2010, http://www.stats.govt.nz/browse_for_stats/health/life_expectancy/NZLifeTables_HOTP05-07.aspx
Sweet, M 2003, ‘Carrying a Heavy Burden’, BMJ: British Medical Journal, Vol.327, no.7412, pp.414-414, viewed 5 October 2010, retrieved from Academic Search Premier database.
Wilkinson, R & Marmot, M (eds.) 2003, Social Determinants of Health The solid Facts, 2nd edn, WHO, Copenhagen, Viewed 23 October 2010, retrieved from http://www.euro.who.int/en/what-we-publish/abstracts/social-determinants-of-health.-the-solid-facts.
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