Week 14 ~ Aboriginal Health ~ PBL J

Education

MINIMUM EDUCATIONAL ATTAINMENT ACHIEVED, PERSONS 18 YEARS AND OVER BY INDIGENOUS STATUS - 2008

(a) Includes Year 10/11 and basic vocational qualifications. (b) Includes Year 12 and skilled vocational qualifications. Sources: ABS 2008 National Aboriginal and Torres Strait Islander Social Survey and 2008 Survey of Education and Work

HIGHEST EDUCATIONAL ATTAINMENT ACHIEVED, INDIGENOUS PERSONS 18 YEARS AND OVER - 2008

Employment - Raph

• In 2010, 202,700 indigenous people in labour workforce (this represents 56% of population) • 18% unemployed (36,600)• 46% employed (166,100)• Participation in labour workforce declines with remoteness

• Unemployment gap between indigenous and non-indigenous people 12.6%• In 2009, 63% of indigenous employees at lower salary levels while only 4.8% at upper salary level

Schemes to Help• Public Calling• Making it Our Business• Aboriginal Employment Strategy• Community Development Employment Projects

Socioeconomic status - Hannah

HousingTaken from ‘Australia’s Health 2010’

There is strong evidence that low socioeconomic status is associated with poor health and increased risk factors

Overcrowding◦ 14% of Aboriginal dwellings were considered ‘overcrowded’ in

2006◦ This corresponds to 27% of the population living in overcrowded

conditions◦ Factors affecting overcrowding were

Remoteness Aboriginal community housing

Poor quality◦ Shelter◦ Safe drinking water◦ Adequate waste disposal◦ Houses in remote areas tended to be in the poorest condition◦ 31% of Aboriginal community houses needed repair or

replacement

HousingImplications for health & wellbeing:

Consider:1/3 of the Indigenous health gap is due to

disabilityNon-communicable disease accounts for 70%

of the observed health gap◦ Mental health◦ Chronic respiratory disease

Asthma – 1.5 times as likely to have it as non-Indigenous Australians

COPD

27% of Aboriginal and Torres Strait Islander people reported having a respiratory disease in 2004

Communicable disease

Transport (Access to health Services)Remoteness: 26% Ind v 2% N/IMed Practitioners: 281/100k v 312 metro.Specialists: 29 v 114/100k78% of communities > 78k from hospital

50% > 25k from Community Health Centre

Vehicular access/ability: 60% Ind v 85% N/I

Remote = 48% Ind (? N/I)

Transport (Access to Health Services)“transport difficulty” (getting from A to

B)◦12% Ind v 4% N/I

Reference: http://www.aihw.gov.au/access-to-health-services-indigenous/

Discrimination (1)

What is it and what are the facts?

•Refers to self-reported situations/places in which the person received unfair or racist treatment.

•Major contributing factor to poor Abs. health as studies have shown it to be directly associated with various adverse health conditions.

•In 2008, 27% of Indigenous adults (aged 15 years and over) reported experience of discrimination in the previous 12 months. Most commonly experienced in the:

general public (11%), police/security personnel/courts of law (11%), at work or when applying for work (8%).

•More specifically, discrimination was more common among those who:Have even displaced from their natural families 45% compared to 26%Are unemployed 41% compared tp those who are employed 25%.Had a disability or long-term health condition 32% compared to those without disability 22%.

Discrimination (2)

Effect of discrimination:•Recent research suggests that experiencing racism and discrimination can negatively affect areas of wellbeing such as mental and physical health

•Indigenous Australians who had experienced discrimination were: More likely to report higher levels of psychological distress (44% compared

with 26%), Be in fair/poor health (28% compared with 20%). More likely to engage in binge drinking (42% compared with 35%) To have recently used illicit substances (28% compared with 17%)

•These victims of discrimination were less likely to trust the police, their local school, their doctor and/or hospital and other people in general. Problems?

Need for changeHas adverse impacts on health + hinders equal access to healthcare.

•Improving community awareness•Strengthening political will•Improve cultural competence among healthcare workers•Health service redesign to facilitate optimal access to BOTH Aboriginal AND Torres Strait Islanders.

Cultural IdentityDifficulty with measurement: criteria developed in consultation with ATSI peoples:

• Connectedness to country• Culture and identity• Resilience• Leadership• Role/Structure/Routine• Feeling Safe• Vitality

Improvements in these areas promotes the cultural identity of the Aboriginal and Torres Strait Islander Peoples

*Taken from Aus. Government: The Health and welfare of Australia’s Aboriginal and Torres Strait Islander people – an overview 2011

Cultural IdentityLanguage 11% ATSI peoples (>15y/o) speak LOTE at home

◦ 42% Rural / 2% Urban 40% possess some command of ATSI languages: remote >

urban > regionalCultural connectedness 73% <15y/o and 63% >15y/o involved in cultural events 2/3 identify with clan/tribe/group 25% ATSI peoples lived on tribal homelandsLeadership: 42% 3-14y/o spent time with elder 1 in 4: elders support weighs heavily on decisions to

complete schooling Stability & Routine: 78% in stable dwelling Informal learning in 0-14y/o ~94%

Implications for health: ◦Disease as a psycho-spirituo-socio-somatic

entity (Peck)◦Speculating on consequences:

Psychological trauma of abuse/discrimination

Psych. Distress 2x higher than non-Indigenous (33% vs. 16%)Maladaptive coping strategies escape mechanismsDepression as ‘learned helplessness’

Somatic disease associated with changes to living conditions:Changes to diet/activity levels Poor housing, sanitation

Removal from spiritual homeland

Changes to sense of meaning and purposeSubstance abuse as an

Disconnection from traditional social structures

Role models? Compliance with western lifestyle? Joblessness rate?Lack of TRUST in authority: police, schools, doctors, hospitals

Leadership/role/structure

'Community capacity’- readiness of population, with good leadership, community togetherness, to deliver sustainable environment for health and wellbeing to its members. Strong communities = stable family structures, inter-generational care and social networks = improved health outcomes. Negatively impacting associated with one-parent families, child protection, unsafe communities & criminal justice system.

Aboriginal people and Torres Strait Islanders assert that maintaining close connections with ancestral country is a prerequisite for good health.Structure surrounding community participation in caring for land is associated with superior health outcomes.

If elders, cultural leaders are actively engaged in health education and role model, re-orient health promotion messages so they are culturally appropriate, greater acceptance from the population.

And Rebecca will be reflecting