Closing The Gap: A Government Strategy For Health Equity In ATSI

The Goals of Closing the Gap Initiative

Closing the Gap is a government strategy formed in 2006 with a goal to bringing equity in health matters between the indigenous and non-indigenous Australians. It also aimed at reducing child mortality, increasing life expectancy, improve employment outcomes, education and easy access to early childhood education. This policy was agreed upon by the Australian governments so at to bring equality in health matters for the Aboriginal and Torres Strait Islanders (ATSI) for until 2030 (Australian Indigenous Healthinfornet, 2018). Tom Calma, the ATSI Social Justice Commissioner, in 2005 produced the Social Justice Report 2005 that demanded equality for the indigenous population in life expectancy from the government. The close the gap campaign started as National Indigenous Health Equality Campaign. Different organisations came together to form they campaign, they include Human Rights and Equal Opportunity Commission, Australian Indigenous Doctor’s Association (AIDA), National Aboriginal Community Controlled Health Organization (NACCHO), Oxfam Australia, Australians for Native Title and Reconciliation, and Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATINaM). It also involved other about 40 ATSI health organizations.

The Council of Australian Governments (COAG) has laid down strategies to oversee the progress of this policy. They include close the gap life expectancy by 2031, halve the gap in child mortality by 2018 and have the gap in employment by 2018. On yearly basis, the Prime Minster and close the gap steering committee releases reports to the Parliament that gives the progress in these targets and also give recommendations to the government. According to Rosenstock et al. (2013), the indigenous Australians suffer greater mortality, disability and morbidity (high rates of renal diseases, diabetes, impaired vision, mental health complications, CVDs and incidents of intentional injury). These inequalities were the motivation to bring equity and social justice to the society. Wahliquist (2018) thinks that the Closing the gap have abandoned their long term goal of installing parity between the indigenous and the indigenous Australians and are now favouring short term political demands. The report that showed the 10 year review has indicated that political and bureaucratic changes has brought to a standstill the progress of the indigenous people (Wahliquist, 2018).

Judy is suffering from Type 2 Diabetes which is among the major global health concerns. Research attributes the increase in diabetes among the aboriginal population to genetic, environmental, biological and lifestyle risk factors (Leung, 2016). Aboriginals historically live in a transport, accommodation, health and food supply equilibrium and sustainable ecosystem. With the modern civilization, their health and social status are changing with respect to where they live, either rural or urban areas. The aboriginals are disadvantaged when factors like mobility, access to health and food supply are considered in relation to education and education levels. Modernization has corrupted their traditional hunting, harvesting and fishing culture, making them rely on processed food of low dietary quality due to their financial incapability. According to Reeves et al. (2014), the aboriginals are three times more like to contract type 2 diabetes than the non-indigenous generation. It is also diagnosed at younger ages for the ATSI. Diabetes leads to poor life quality. Some of the risk factor for the type 2 diabetes are poor diet, obesity, inactivity, socioeconomic factors, age, stress, and history of diabetes in the family. Judy has a leg ulcer and she has to be dressed up which indicates that she is not living a life that she could wish to. For the genetically susceptible people, type 2 diabetes is attributed to the autoimmune destruction of the pancreatic beta cells (Hill et al. 2017)

The History of Closing the Gap

To manage diabetes, a close communication, relationship and teamwork between the patient and healthcare provider is required. The community nurses visit Judy on daily bases not only to dress her wound but also to check on her diabetes status. They also provide an intensive diabetes self-management education, which is very vital for the control of diabetes other than the normalization of blood pressure, blood glucose and lipids. It is clear that indigenous population with low income, low literacy levels would be difficult to reach them or even participate in self-management education. According to Lopez and Grant (2012), the self-management education is mostly effective when administered with cultural sensitive support. For better results to me achieved, these community nurses, therefore have to be conversant with the social and cultural nuisance of the people. The community nurses help to determine the patients at risk care and also solve any shortcomings to administration of the care to the patient. These nurses work on a program based on solving problems on a more flexible way rather than offering a routine set of services. Lopez and Grant (2012) refer to these community as patient navigators and claim that they are capable of providing a range of services than just patient coaches. They can coordinate and offer both clinical and non-clinical services and also offer education and support needed for the patient to comply with the therapies prescribed.

According to Clark and Utz (2014), the long term complications due to diabetes are cardiovascular diseases, blindness, stroke, hypertension, lower limp amputations, renal diseases neuropathy and premature death. An individual’s social determinants include the person, his social, environmental and cultural networks. The physical environmental factors affecting diabetes patients may include transport, healthy diet and safety in the neighbouring environment. When an individual with diabetes has inadequate access to these factors, stand among the disadvantaged population as they have limited access to the required resources for their condition. Lack of god transport hinders access to healthcare. Insecurity in an area leads to health disparities in the sense that it contributes to few businesses and also leads to unemployment and therefore reduced access to food, health facilities and outdoor activities (Rashid et al. 2009). Research by Scicchitano et al. (2014) shows a relationship between access to healthy diet and positive health outcomes for diabetic individuals. None of these factors is a problem to Judy. If there were security issues with Judy’s neighbourhood, the community nurses would reconsider visiting her. If there was a problem with transport, the nurses would find difficulties in visiting Judy. It is not stated about the supply of quality diet but since Judy has two children who frequently visit her, I assume that they are stable enough to provide their mother with the right nutritious diet. Zheng et al. (2012) think that economic factors such as employment, level of education and family economic status affect health status. Education increases socioeconomic stability and therefore improved health status. Low income and those living in remote rural areas may lack primary and speciality clinicians for those suffering from chronic illness which leads to compounded and worsened long term effects of these diseases (Behringer and Friedel, 2006). Individuals suffering from diabetes need social support which include individual (formal and informal) who support them emotionally and help in improving their health status (Strom and Egede, 2012). Judy received formal support from his children who frequently came to visit her. This gave her the satisfaction that her family cares and supports her. The community nurses also paid visit to Judy. She was content that the community recognises her.

Type 2 Diabetes and ATSI Population

According to Marles et al. (2012), the Aboriginal Medical Service is a body whose responsibility is to offer cheap and accessible health care to the ATSI and have been doing so for over 40 years. This body built and is run by the aboriginal people so as to offer holistic and culturally based health care to those living in both rural and metropolitan places. This care helps the locals in self-actualization and also in achieving their life objectives (Weightman, 2013). The AMS also provides services like provision of community support, primary medical care, special needs programs and advocacy. The Aboriginal Liaison Officer (ALO) liaises and communicates with the ATSI on their needs on health support and how to access the disabled and the aged in the society. The ALO establishes a conducive rapport on the community level so that the aboriginals can freely express their grievances and concerns on the services offered to the disabled and aged. They offer social, emotional and cultural support to the disabled and aged. They also liaise with the patients and their families concerning the well-being of the patient. Apart from the above duties, the ALO acts as a link between the hospital and the aboriginal society. The ALO and the AMS main objective is to ensure that the locals live healthy. It is their duty to take care of the aboriginals and this is the reason as to why they referred to Judy.

The closing the gap policy was formed by the aboriginal and Torres Strait Islander people with the aim of achieving equality as far as health matters for the indigenous people is concerned. The indigenous population is more susceptible to chronic diseases due to social, economic, environmental and educational factors. According to history, the indigenous people depend on harvesting, hunting and fishing but due to the increasing civilization their culture has been brainwashed. Due to their economic status, they cannot afford a nutritious diet and therefore infections come in. They are also unable to access roper healthcare which make it difficult to get the required treatment and services. Their mortality rate is also low as compared to the non-indigenous generation. The Australians together with the government therefore saw the need to improve the health of the ATSI by setting policies that would improve their health.

References

Australian Indigenous HealthinfoNet. 2018. History of Closing the Gap. Retrieved from: https://healthinfonet.ecu.edu.au/learn/health-system/closing-the-gap/history-of-closing-the-gap/

Behringer B. and Friedell, G. H. 2006.  Appalachia: where place matters in health. Prev Chronic Dis. 2006; 3:A113.

Community Nurses and Diabetes Management

Clark, M. L. and Utz, S. W. 2014. Social determinants of type 2 diabetes and health in the United States. World Journal of Diabetes, Vol. 5, No. 3, pp. 296-304. Doi:  10.4239/wjd.v5.i3.296

Hill, K., Ward, P., Grace, B. S. and Gleadle, J. 2017. Social disparities in the prevalence of diabetes in Australia and in the development of end stage renal disease due to diabetes for Aboriginal and Torres Strait Islanders in Australia and Maori and Pacific Islanders in New Zealand. Journal of Public Health, Vol. 17, pp. 802

Leung, L. 2016. Diabetes mellitus and the Aboriginal diabetic initiative in Canada: An update review. Journal of Family Medicine and Primary Care, Vol. 5, No. 2, pp. 159-265. Doi: 10.4103/2249-4863.192362

Lopez, L. and Grant, R. 2012. Closing the Gap: Eliminating Health Care Disparities among Latinos with Diabetes Using Health Information Technology Tools and Patient Navigators. Journal of Diabetes Science and Technology, Vol. 6, No. 1, pp. 196-176. Doi: 10.1177/193229681200600121

Marles E., Frame, C. & Royce M. 2012. The Aboriginal Medical Service Redfern–improving access to primary care for over 40 years. The NCBI, Vol. 41, No. 6, pp. 433-436.

Millis, N. F. & White, D. O. 2017. The Australian Society for Microbiology. Retrieved from: https://www.theasm.org.au/about-us/general/

Reeve, R. Church, J., Haas, M., Bradford, W. & Viney, R. 2014. Factors that drive the gap in diabetes rates between Aboriginal and non-Aboriginal people in non-remote NSW. Australian and New Zealand Journal of Public Health Vol. 38, No. 5

Rashid, J. R., Spengler, R, F., Wagner, R, M., Melanson, C., Skillen, E. L., Mays, R, A., Heurtin-Roberts, S. & Long, J, A. 2009. Eliminating Health Disparities through Trans disciplinary Research, Cross-agency Collaboration, and Public Participation. Am J Public Health. 2009;99:1955–1961.

Scicchitano P., Cameli, M., Maiello, M, Modesti, P. A., Muiesan N. L. and Novo S. Nutraceuticals and dyslipidaemia: Beyond the common therapeutics. J Funct Foods. 2014;6:11–32

Strom, J. L. and Egede, L. E. 2012. The impact of social support on outcomes in adult patients with type 2 diabetes: a systematic review. Curr Diab Rep. 2012; Vol.12, pp. 769–78

Rosenstock, A., Mukandi, B., Zwi, A. B. and Hill, P. S. 2013. Closing the Gaps: competing estimates of Indigenous Australian life expectancy in the scientific literature. Australian and New Zealand Journal of Public Health, Vol. 37, No. 4, pp. 356-364

Wahlquist, C. 2018. Closing the Gap health goals ‘effectively abandoned’ for political reasons. Retrieved from: https://www.theguardian.com/australia-news/2018/feb/08/closing-the-gap-health-goals-effectively-abandoned-for-political-reasons

Weightman, M. 2013. Aboriginal Medical Service (AMS): NACCHO health news: The role of Aboriginal Community Controlled Health Services in Indigenous health. Retrieved from: https://nacchocommunique.com/tag/aboriginal-medical-service-ams/

Zheng H and George, L. K. 2012. Rising U.S. income inequality and the changing gradient of socioeconomic status on physical functioning and activity limitations, 1984-2007. Soc Sci Med. 2012; Vol. 75, pp. 2170–2182