ABORIGINAL AND TORES ISLANDER HEALTH AND CULTURAL SAFETY

1. Pre-Invasion Health Status of the Community-

   The Indigenous population in Australia has worse health than the non-Indigenous population. Chronic illnesses include diabetes, chronic renal disease, cardiovascular disease, and respiratory disorders are more common in Indigenous Australians. In a nationwide poll, 24% of Indigenous Australians said their health was fair or poor, compared to 45% who said it was excellent or very good (Dokis, 2011).

   The health of Australia's Indigenous population has suffered greatly as a result of government policies. Indigenous peoples' health and well-being have suffered greatly as a result of policy decisions made by the federal, state, and territory governments, churches, and other institutions since colonisation of Australia up till the present. Because of unfair policies that redistribute authority and assets unevenly, there are substantial health disparities between Indigenous and non-Indigenous people. The health levels, patterns, and trends of indigenous populations vary (Ring, 2003). The unacceptable disparities in health that exist in modern countries between indigenous and non-indigenous populations are a common issue. Durie has provided an overview of the causes of these differences and suggested a wide range of measures to enhance the health of Native Americans.

    

   Background of the Current Health status of the Community-

   Indigenous Australians' health was harmed by colonisation in a number of ways, including population decrease, incarceration, social marginalisation, political oppression, and land dispossession. According to an analysis of data from the “Australian Bureau of Statistics (ABS) health survey, social determinants (work and hours worked, highest non-school qualification, level of schooling completed, adequate housing, and household income) account for about one-third (34%) of the health gap between Indigenous and non-Indigenous Australians, and "health risk factors" (risky alcohol consumption, high blood pressure, overweight and obesity status, inadequate fruit and vegetable consumption, physical inactivity, and smoking) account for less than one-fifth (19%) of the gap (Feerick, 2004)”.

   One of the most significant pieces of legislation in Australian history was the Assimilation Policy of 1961, which aimed to effectively embrace Indigenous Australians into the broader Australian society. State and federal ministers developed the plan during the 1961 Native Welfare Conference (Brown, 2009). Regardless of their level of aboriginality, it said that all Australians were expected to live as members of a vital Australian community and eventually catch up to other Australians in terms of standard of living. This meant being an Australian citizen in the same sense as other Australians, with the same rights and advantages, and with the same obligations and traditions.

   The health of the Aboriginals has been impacted by the assimilation policies, which have a direct effect on a number of socioeconomic factors. The health of Indigenous Australians is significantly worse than that of non-Indigenous Australians due to factors such as lack of proper nutrition, inadequate education, poor housing and sanitation, low incomes, and exclusion from the workforce.

   One such element that has been impacted by these policies is unemployment. Low income and unemployment have been connected to unfavourable health outcomes (Brown, 2009). These elements have been directly impacted by the assimilation policies, which has an effect on Aboriginal health.

    

   Critically Analysis of the Assimilation Policy of 1961

   The policy's intention to grant them equitable access to hospital and mainstream medical services that had previously been denied to them, advancements were thwarted by pervasive racism, disputed assimilation theories, and the government's breakthroughs on its commitments5. This has established a legacy of mistrust and worry that still negatively affects Indigenous health in the modern era.  The goal of the policy was to grant Aboriginal Australians equal rights. It was described as a policy expecting all Aboriginals and part-Aborigines to achieve the same standard of living, rights, and privileges, accepting the same responsibilities, adhering to the same customs, and being influenced by the same ideas, hopes, and loyalties as other Australians at the 1961 Conference on Aboriginal (Affairs Australian Law Reform Commission, 2023). The policy, in spite of its good intentions, had a negative impact on Indigenous Australians that was substantial. Their identity and emotional and physical health were impacted. Because white society did not view Indigenous people as equals, the policy's attempt to integrate Indigenous Australians into white society did not succeed in improving their quality of life.

   There was a significant negative influence on the health of Indigenous Australians. In general, they experience greater health issues and are more susceptible to conditions including diabetes, liver disease, and glaucoma3. Because of the effects of colonisation, the health statistics for the Indigenous community now clearly reflect their current state of health. In conclusion, the Assimilation Policy of 1961 has had a major detrimental influence on the health status of Aboriginal people, despite its intended goal of integrating them into Australian society. The differences in health outcomes between Indigenous and non-Indigenous Australians are still a direct result of these effects.

    

   The 1961 Assimilation Policy and the current state of health among Indigenous Australian men and women

   • Racism's effects on the mental health and identities of Australian Indigenous men participating in sport

   The complex issue of racism in sports has a profound effect on Australian Indigenous men's identity and mental health. It can take many different forms, such as vilification, harassment, or discrimination by players towards other players or from spectators towards players. The negative impacts of racism on the mental health and wellness of Indigenous Australians, including psychological discomfort, stress, and depression, have been established. According to a study, removing discrimination on a daily basis could cut the amount of psychological anguish experienced by adults who are Aboriginal and Torres Strait Islander by half (Kiely, 2014). Furthermore, racism may result in fewer people engaging in beneficial pursuits like social sports. This may worsen mental health conditions and have an effect on Indigenous men's identities in sports. Their mental health may suffer as a result of their ongoing exposure to racism, which can cause them to feel alienated and lose their identity.

    

   Additionally, racism may indirectly contribute to a rise in the use of alcohol and drugs as stress relievers, which may worsen the mental health of those who use them. Between 6.9% and 97% of people identified as racist, and general bad mental health and poor general health perception were the most common health outcomes linked to racism (MacLeod and Newall, 2022). Moreover, racism-related experiences can cause stress and psychological anguish, both of which have a negative impact on one's physical health. For example, long-term stress brought on by racism can raise the risk of obesity, heart disease, gestational diabetes, and other perinatal health issues.

    

    

   • Indigenous Australian Pregnant Women: Racism affects their physical health and the wellbeing of their unborn child

   The unborn child is not exempt from the effects of racism. Research has linked adverse effects on children's mental health and socio-emotional wellbeing (SEWB) to experiences of racism among mothers. This implies that racism's impacts may begin to affect Indigenous Australians' health before birth.

   Likewise, Indigenous women may be discouraged from accessing essential healthcare or participating in cultural practises during pregnancy if they fear judgement or child protection interventions. Their physical health is impacted, but it also shatters the cultural continuity that is essential to their well-being and the well-being of their offspring. Racism in the medical field has a negative impact on the Aboriginal workforce, reduces the availability of equitable services, and results in worse health outcomes (Hwee Teo and HT Ling, 2020). Aboriginal women perceive a great deal of discrimination in maternity care settings, and the significance of their traditional practises around birthing is frequently overlooked (Priest et al., 2011). While efforts to address health disparities and enhance midwives' cultural competency have brought Aboriginal content into educational programmes, little is known about how this content is used in clinical settings. This study involved re-interviewing midwives who had previously finished their university-based midwifery programme, which aimed to improve cultural safety and understanding of Aboriginal people in health care (Thackrah et al., 2021). The Indigenous midwives proposed campaigns to raise awareness and debunk prejudices because they had firsthand experience with racism and were sensitive to its many manifestations. It is obvious that in order to raise awareness of institutional racism and promote proper responses in healthcare settings, more emphasis needs to be placed on it in educational initiatives.

   In summary, racism has a serious negative influence on the physical well-being of pregnant Indigenous Australian mothers and their unborn children. Improving the health outcomes of patients requires addressing racism in healthcare settings.

   • Australian Indigenous Men and Women: During the COVID-19 pandemic, racism affected their health and well-being when they interacted with medical professionals.

   Indigenous Australian men and women already experience health inequities, which have been made worse by the COVID-19 pandemic. During this time, racism—a substantial health determinant—has had an even greater negative influence on their health and wellness.

   For Indigenous Australians, racism at the interpersonal, institutional, or systemic levels has a substantial negative influence on their health outcomes and ability to obtain healthcare services (Jones et al., 2021). This is especially worrisome during a pandemic, when prompt and fair access to medical care is essential.

   Racism can breed mistrust and anxiety, which keeps Indigenous Australians from getting medical assistance when they need it (Ruiz et al., 2022). Delays in diagnosis and treatment can have a negative impact on health outcomes. For example, in the COVID-19 pandemic, this could lead to postponed viral testing or treatment.

   Furthermore, racism has a detrimental effect on the Indigenous health workforce's capacity to attract, recruit, retain, and take on leadership roles. This may result in Indigenous patients receiving care that is not culturally safe, which would worsen their health and wellbeing.

   Moreover, exposure to racism is linked to detrimental effects on mental health, such as psychological distress, stress, and depression. These consequences are probably made worse by the pandemic's additional stress.

    

    

   Reflection

   I have a strong commitment as a health professional to provide Indigenous Australians access to care that is safe for their culture. I am aware of the trauma Assimilation Policies have inflicted on multiple generations and the effects it has had on their general health and welfare (West et al., 2010). I am committed to supporting "Closing the Gap," as I am aware that it is a top priority for the Australian government.

   I shall implement the five Cultural Safety principles as described by M?ori Scholar I. Ramsden in 2002 in my work. These tenets are:

   Understanding: I'll make an effort to comprehend the political, social, and historical factors influencing the health of Indigenous Peoples.

   Respect: I promise to uphold the cultural identities, values, and beliefs of Indigenous Peoples.

   Shared Meaning: To guarantee shared understanding and decision-making in healthcare, I will collaborate with Indigenous Peoples.

   Safe Services: I'll make sure there is no racism, discrimination, or bias in the healthcare system.

   Reflective Practise: I will always be aware of my own cultural identity, prejudices, and potential effects on my work.

   Recognising the value of family, community, partnership, and cooperation in healthcare decision-making is, in my opinion, a necessary component of providing holistic care (Franklin & Gkiouleka, 2021). I will therefore always respect the preferences of my Indigenous clients and include them in their treatment plans.

   Racism violates norms of conduct and is a factor in determining health. In line with Ahpra's stance on racism, I will notify the proper authorities right away if I see racist behaviour occurring in the workplace (Hickey et al., 2019). In addition, I will fight against discriminatory practises and encourage cultural safety education among my peers on behalf of my Indigenous Australian customers and coworkers.

   In conclusion, my mission as a Registered Nurse or Midwife working with Australian Indigenous Peoples is to respect their distinct cultural identities and attend to their individual health needs while delivering culturally safe care. By doing this, I intend to help close the gap in health outcomes for Indigenous Australians and improve their quality of life.

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