Aboriginal or Torres Strait Islander Australians

The purpose of this report is to evaluate the accessibility, acceptability and availability of public health care services among Aboriginal or Torres Strait Islander of Australia. Despite improvements in health technology and the high quality of health services in Australia, this group continues to suffer health inequities. This is evident from high rate of chronic disease among Indigenous Australians. The disparities in health among non-indigenous and indigenous Australians arise from many factors including the difference in socioeconomic status, cultural beliefs, and geographical locations. This is evident from high rate of chronic disease among indigenous Australians. This report explores the barrier to the accessibility of adequate health care services and recommends solutions to improve acceptability of public health care services. Aboriginal and Torres Strait Islander people were the first inhabitants of Australia. They have distinct culture and social tradition separate from general population of Australia. The estimated population of Aboriginal and Torres Strait Islander people was 669,900 or 3% of the total population, the majority of whom resided in New South Wales and Queensland (Australian Bureau of Statistics, 2011). They experience health inequity and poor health outcome due to their low socioeconomic status, psychosocial risk factors, poor standard of living and poor geographical location (Markwick, et al., 2014). Structural determinants of health relate to geographical accessibility, income status and affordability and acceptability factors that act as major barriers in access to health services for indigenous people (Germov, 2014, p. 76). Availability of health service means presence of appropriate health care resource relevant to the needs of the population. Equity of access is dependent on income and cultural setting of diverse population groups (Gulliford et al., 2016). Although the standard of health services in Australia is excellent, however the distribution of service is not uniform throughout Australia. As indigenous Australians resides in remote locations, the number of specialist physician decreases due to remoteness (Larkins et al., 2015). In urban areas too, the public health service are concentrated in those areas where people of high socio-economic status resides (Violà ¡n et al., 2014). Economic disadvantage among Aboriginal and Torres Strait Islander people is another cause of inaccessibility to health care services (Aspin et al., 2012, pp. 73-75). The unaffordability of health care services has led to high prevalence of health complex disease conditions such as kidney failure, circulatory disease and its associated comorbidity. For example study by (McDonald, 2013, pp. 170-173) revealed that current health disadvantage like kidney problem is linked to social disadvantage among indigenous Australians. The cultural sensitivity of a population is a crucial indicator for determining the level of availability and accessibility of health (Purnell, 2014). It also has impact on health promotion and screening activities (Chalmers et al., 2014, p. 111). Many factors inhibit the acceptability of health services. Firstly, due to their cultural beliefs, indigenous Australians have different concepts and understanding of illness (Thompson et al., 2013, p. 473). Due to lack of awareness and poor knowledge about disease and their morbidity, they avoid primary level of treatment and many chronic disease are diagnosed at later stage of disease (Frey et al., 2013, pp. 519-529). Secondly, reluctance to engage in care because of cultural beliefs has impact on the relation between indigenous people and health professionals. For example culture act as a barrier in effective communication between indigenous patients and health care providers. Such patients are more inclined to traditional method of curi ng disease than depending on scientific health service. Even if they access the service, they have little knowledge about diagnostic process and disease. This leads to conflict between as the expectation of health care providers and patient differs significantly (Dell’Arciprete et al., 2014). Hence instead of approaching health care service, they seek spiritual interventions. This attitude significantly affects the availability and accessibility of preventive health care service (Hunt et al., 2015, pp. 461-467). Lack of cross cultural communication influences the accessibility and acceptability of health service (Germov, 2014). The accessibility and acceptability of care is related to social acceptance of health service according to consumer’s cultural preferences. Many people have different tradition beliefs which act as a barrier in accepting health care service (Dillip et al., 2012). This is evident from the fact many aboriginals reported lack of trust in mainstream health care service because they felt their cultural preferences were not taken into account. Many times language act as a barrier between proper health discussion among indigenous Australians and non-indigenous health professionals (Shahid et al., 2013). Cross cultural miscommunication occurs when health professionals do not understand concerns or gestures of patients and the thought patterns of indigenous people. Due to this gap, therapeutic relationship is compromised and Aboriginal groups do not accept the available health service (Dell’Arciprete et al., 2014). Unavailability of care also occurs due to discrimination of indigenous groups on the basis of their race and poor social position. Racial discrimination significantly lead to deleterious health outcome in indigenous Australians (Cunningham & Paradies, 2013).   Health professional behaviour such as racist attitude, unwelcome comment and evil treatment also influences the indigenous people ability to access and accept mainstream health services (Price & Dalgleish, 2013). Many indigenous patients wanted health professionals to respect their personal choice, cultural preference and autonomy in receiving. But conflict arose due to lack of cultural awareness among health professionals leading to poor patient-physician relationship (Artuso et al., 2013, pp. 193). The health status of a population depends on physical availability of health service structure, their organization and functioning. In case of Aboriginal and Torres Islander people, health service is not uniformly distributed in their area (Willis et al., 2016).  Even if a health service is available, there is shortage of adequate medical staffs to treat disease and illness. Lack of transport is also a factor that hinders their access to care (Nilson et al., 2014, pp. 3394-3405). Due to remoteness of location, many professionals do wish to come to this area and with low-skilled physicians, the overall health outcome among this group is very poor (Durey & Thompson, 2012). Social justice principle is the key to address inequities in health due to social position. This principle enables giving high priority to socially disadvantaged group irrespective of their financial instability.   The uptake can be improved by following the principle of access, equity, rights and participation in social justice (Germov, 2014). After analysing the factors associated with lack of accessibility of mainstream health services in Aboriginal and Torres Islander people, the recommended ways to improve public health services includes the following: The first step is making affordable and high quality service available locally in the area of Aboriginal and Torres Islander people. Arrangement should be made for proper transport facilities to increase the pace of receiving care. Exhibiting flexibility in health care delivery is also important so that the process do not seem burdensome to indigenous groups (Paniagua, 2013). This also follows the right of equality according to social justice principle and by this step health service is distributed to needy person even if they do not the capability to pay for the costly service (Germov, 2014). Health care system also needs to address the cultural incompetence in medical staff through enhancing cultural awareness and developing holistic model of care (Kirmayer, 2012, p. 149). It is necessary to engage more number of indigenous health professionals to promote delivery of culturally safe care. This strategy promotes greater participation amongst Aboriginal and Torres Strait Islander peo ple and therefore reflects social justice principles (). Health care staff should adopt cultural competence strategy such as understanding of cross-cultural communication style and providing treatment in such a way that their cultural obligation is not denied (Douglas et al., 2014). The disparities in health outcome between indigenous and non-indigenous Australians occur due to lack of accessibility and acceptability of health care services and poor socioeconomic status, cultural beliefs, structural barriers and lack of cross-communication skills. The report brought into focus different issues that act as barrier in seeking care and provided recommendation to improve health care delivery. The main focus should be on adopting culturally appropriate health care service to enhance indigenous people’s trust on medical services.   Artuso, S., Cargo, M., Brown, A., & Daniel, M. (2013). Factors influencing health care utilisation among Aboriginal cardiac patients in central Australia: a qualitative study.  BMC Health services research,  13(1), 1, p. 193. Aspin, C., Brown, N., Jowsey, T., Yen, L., & Leeder, S. (2012). Strategic approaches to enhanced health service delivery for Aboriginal and Torres Strait Islander people with chronic illness: a qualitative study.  BMC Health services research,  12(1), 1, pp. 73-75. Australian Bureau of Statistics. (June 2011). Estimates of Aboriginal and Torres Strait Islander Australians, June 2011. Abs.gov.au. 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