Who is an Aboriginal/Torres Strait Islander person?
An Aboriginal and/or Torres Strait Islander person is someone who:
- Is of Aboriginal and/or Torres Strait Islander descendant.
- Identifies as an Aboriginal and/or Torres Strait Islander person.
- Is recognised as an Aboriginal and/or Torres Strait Islander person by the community in which they live/have lived.
Describe the needs of Aboriginal and Torres Strait Islanders as compared to the rest of the Australian population
Across remote, regional and urban areas, Aboriginal and Torres Strait Islander peoples encounter similar problems, but at different degrees and for different reasons.
These include:
- access to transport
- access to services (complicated by past experiences, trauma etc; language barriers; privacy/family/community politics)
- availability of services
- wait times, which can interfere with accessibility and availability of services
- cost of services
Describe the Aboriginal definition of health
“Aboriginal health means not just the physical well-being of an individual but refers to the social, emotional and cultural well-being of the whole Community in which each individual is able to achieve their full potential as a human being thereby bringing about the total well-being of their Community.”
Describe how different healthcare professionals support the Aboriginal definition of health
- Connection to body
- Connection to mind and emotions
- Connection to family and kinship
- Connection to community
- Connection to culture
- Connection to country
- Connection to spirit, spirituality, and ancestors
These are informed by historical and social determinants.
The aboriginal definition of health which encompasses:
- the presenting problem
- the patient’s community
- surrounding culture and environment
- the broader context they exist within
is addressed by different healthcare professionals. Specialists will not have scope to look beyond or help with anything more than the presenting problem, while GPs have more scope to observe the effect of community.
ACCHOs are equipped to consider all these factors.
In general better outcomes are observed when community-controlled institutions or initiatives are empowered to serve their communities.
aka self-determination
Describe how history has shaped Aboriginal and Torres Strait Islander health outcomes
- Policies such as dispossession of land and a ban on culture/practices/customs/language/kinship lead to
- loss of employment opportunities, impacted further by stolen wages, reliance? on welfare
- housing and lack of adequate facilities, leading to overcrowding, and worsened by lack of access to clean water, health hardware and sanitation, overall leading to increased risk of ill-health e.g. trachoma and scabies
- forced transition to “Western” diet and rations, changed food preferences and loss of culture and connection
- removal of children from families, leading to family and transgenerational trauma and loss of identity. Family and transgenerational trauma leads to loss of trauma and connection
- racism and segregation in general, which leads to inadequate care provision, lack of access to services i.e. hospitals leading to late stage presentation, and the physical and mental effects of racism (as experienced with NT intervention)
All these factors lead to poorer health outcomes.
Lateral violence has a compounding effect, exacerbating the factors that arise from historical policies towards Aboriginal and Torres Strait Islander people, as well as also having a direct impact on health outcomes.
Describe how cultural continuity is a protective factor
Connection to culture and community reduces the rate/risk of suicide. It is thus a protective factor.
Provide some examples of health disparities
Aboriginal and Torres Strait Islander children are 8.5% more likely to have otitis media but only 6% more likely to have a myringotomy.
Reasons include remoteness and lack of access to services, low SES, lack of private insurance, and waiting times.
Similarly, rates of coronary procedures for those admitted with ACS are lower in Aboriginal and Torres Strait Islander populations, and although the gap on the face of it seems to be decreasing, it appears that the “non-Indigenous” population is utilising these services less.
Describe general transplant conditions
- Age: Age range considered suitable for transplantation has steadily increased.
- Comorbidities: Conditions or combinations of conditions that would result in an unacceptably high risk of mortality or morbidity.
- Behavioural risk factors: Ongoing substance abuse is generally considered contraindications to transplantation.
- Inability to adhere with complex medical therapy: Chronic cognitive or neuropsychiatric deficits without a capable carer.
Describe the closing the gap program
COALITION OF PEAKS
The Coalition of Peaks consists of over 80 Aboriginal and Torres Strait Islander community-controlled peak bodies and members across Australia.
Closing the Gap Program in General Practice
- Annual health check encouraged.
- Better access to allied healthcare.
- Cheaper medications (PBS listed items).
- Access to care coordinators and transport.
- Funds for private specialists and expensive imaging (e.g., MRI).
- GPs encouraged to see patients regularly.
Describe CtG in clinical practice
- Annual health check encouraged.
- Better access to allied healthcare.
- Cheaper medications (PBS listed items).
- Access to care coordinators and transport.
- Funds for private specialists and expensive imaging (e.g., MRI).
- GPs encouraged to see patients regularly.
Provide some examples of CtG pharmaceutical programs
The Closing the Gap PBS Co-payment Program is available to Aboriginal and
Torres Strait Islander people of any age who are registered with Medicare, and in the opinion of a prescriber or Aboriginal Health Practitioner (AHP):
- would experience setbacks in the prevention or ongoing management of a condition if the person did not take the prescribed medicine; and
- are unlikely to adhere to their medicines regimen without assistance through the program.
The Program applies to prescriptions for PBS General Schedule medicines only.
Other pharmaceutical programs
Specific PBS for Aboriginal and Torres Strait Islander people
- Antifungal creams
- Terbinafine
- Ciprofloxacin ear drops
- Nicotine patches
- Folic acid, magnesium, iron and thiamine
- Paracetamol and aspirin
- Invermectin
- Antivirals (e.g. COVID)
Describe the role of the doctor
Improving Aboriginal and Torres Strait Islander health requires
more than ‘treating everyone the same’
- Be aware of inequalities in healthcare
- Cultural awareness
- Working alongside Aboriginal and Torres Strait Islander people
- Knowledge of preventative activities unique to Aboriginal and Torres Strait Islander people
- Knowledge of the programs available to Aboriginal and Torres Strait Islander people
