Assessment On Urban and Regional Aboriginal Men in SE QLD/Northern NSW

1. Executive Summary

The Aboriginal Torres/Strait Islanders are considered to be disadvantaged when it comes to their health needs being met. A needs assessment is defined as a process that identifies and prioritizes needs in a community in order to inform programs, policies, and services aimed at addressing those health needs (AIF, 2022). This needs assessment focused on the unmet health need of Aboriginal Torres Islander men in Southeast Queensland / Northern New South Wales. This was executed through the use of primary data and secondary data. Secondary data was collected from grey literature while Primary data was collected from interviews. Through the use of the Basic Priority Rating and analysis of the different needs categories, Rheumatic heart disease was identified as the health issue with the highest priority. The determinants of Rheumatic heart disease were identified and recommendations for program focus were developed.

• Community Profile

Doomadgee is a town located in the Gulf of Carpentaria approximately 140km from the Northern Territory border and 93km west of Burketown. The town is mostly an Aboriginal community The Australian Bureau of Statistics (ABS,2021) estimated the population of Doomadgee was 1,387. Of these 1238 were Aboriginal and/or Torres Strait Islander people, 50.1% were male and 49.9% were female. The median age was 22 years old. The town consists of 283 Aboriginal and/or Torres Strait Islander families. The average number of people per household

was estimated at 4.6 persons and 1.5 persons per bedroom. The estimated median personal weekly income was 332, Families was 840 and Household was 1032 (ABS, 2016).

Analysis and description of the data

1. Methods
   • Data collection, analysis

This needs assessment was carried out through the utilization of primary and secondary data. Primary data was collected through qualitative research methods. Qualitative methods are most appropriate for answering why observations are not made for issues, assessing complex multi-component interventions, and focusing on intervention improvement. (Busetto, Wick Gumbinger, 2020). Data was collected from literature reviews and the use of focus groups. The participants were selected on a criterion selection basis. The participants selected were males who identified as Aboriginal Torres/strait islanders who lived In urban areas. The qualitative data were analyzed and the data was transcribed and a thematic analysis was applied.

Ethical Considerations

The participants were given consent forms to read and sign voluntarily before the open-ended interviews began. Participants were provided with oral and written information about the study and how the interviews would be carried out. They were assured that their responses were fully confidential and at any time they felt uncomfortable or did not want to answer they were free to do so. The identities of the participants were not recorded to maintain confidentiality as there was no information accessible to anyone else except for the researcher.

1. Needs assessment
   • Normative

Aboriginal men suffer greater health inequalities compared to non-aboriginal men ( Australia Health, 2018 ). The Australian institute of health states that Aboriginal people experience the burden of disease at 2.3 times greater than non-indigenous people. The death rate of Aboriginal people in NSW from 2003 to 2007 was 950 deaths per 10 000 (Australia Health, 2011). The article mentions that Aboriginal men die early from chronic diseases such as cardiovascular disease, respiratory disease, cancer, etc. ( NSW Health, 2015/2020). Vos et al, 2009 estimate that cardiovascular disease contributes 23% of the excess burden of disease for Aboriginal people compared to non-aboriginal people. In the period from 2011 to 2015, there were 338 new cases of Acute rheumatic fever in Queensland. Of these 83% were Indigenous Australians and 26% were in the 15-24 age group. The health info net states that there in 2016-2018 the crude CVD hospitalization rate was 19% per 1000 for males ( AIHW, 2017)

Diabetes is considered a major health problem for Aboriginal and Torres Strait Islander men. Diabetes deaths for Aboriginal Torres and Strait Islander men were 7.5 times more common than in non-Aboriginal men. This was more prevalent in Aboriginal men aged 35 -54 years as they died at a rate 21 times more than non-Aboriginal men (User, 2015). The National Aboriginal and Torres Strait Islander Social survey carried out in the period 2018-2019 discovered that the proportion of people with diabetes was highest in the Northern Territory thus 11% followed by Queensland with 8.7%. The survey included that the self-reported prevalence of diabetes was 13 % for males. The crude hospitalization rates for 2015-17 were 4 per 1000 for males and there was a higher rate in males from 35 years old. Diabetes was the second leading cause of death among Aboriginal people in NSW and Qld in 2020. The WHO defines mental health as a state of social and emotional well-being in which individuals can cope with the normal stress of life and realise4 their potential (Thomas, 2013). In the NSW population health survey that was carried out in 2010, 26% of aboriginal Adults were calculated to have very high psychological distress than non-Aboriginal adults.

• Perceived

The health issues that were discussed as health needs by the Participants were Mental health, Disease, Chronic Disease, and Injury. An interviewee expressed that aboriginal men are often blamed without understanding their cultural history. He indicated that Aboriginal people often get targeted for no reason. This, therefore, impacts their mental health and sense of well-being. To help with this issue there is a need for strong community leaders that will help guide them with mental health issues. The participants mentioned that most of the community members have no knowledge of the services that are being offered to them. The participants mentioned that Aboriginal men barely access healthcare services as they would want men to attend to their needs instead of a woman and that cultural protocol is not recognized. Another issue mentioned was that aboriginal men are not into preventative health

• Expressed

Access to healthcare continues to be a significant problem for Aboriginal and Tress Strait Islander people in general. There are various factors that influence access to healthcare by Aboriginal and Torres/Strait Islander men and these include cultural factors, Ignorance of Healthcare services, and historical pasts (Health, 2015). In the Aboriginal and Torres Strait Islander health survey carried out In 2018-19, 31% of Indigenous adults with high or very high levels of psychological distress had visited a health professional about their distress. Of these 28% were male. in the period of 2017 -18 10.6?cessed Medicare Benefits schedule subsidized mental health care services. ( Access to mental health services, 2022). Two interviews mentioned that aboriginal people have no knowledge of some health services, such as dental health services. One expressed that aboriginal men do not take preventative health measures. They do not engage with health services when they find themselves relatively healthy.

The health system lacks a holistic approach. Aboriginal men prefer to be attended to by men specifically. Spiritual needs are often overlooked by non-aboriginal people. There Is no aboriginal doctor or services in Wollombi. Aboriginals are not present in the health system.

• Relative

Indigenous or Aboriginal/Torres Strait Islander men in the Kimberley were chosen as the comparative population group. Kimberley has two major hospital facilities located in Broome and Kununurra. These then support the smaller regional services in Derby, Fitzroy Crossing, Halls Creek, and Wyndham. The health program's key areas offered were Alcohol and drug programs, Healthy lifestyles, Sexual Health, and Spiritual Health programs. The Broome health campus has facilities that include public dental surgery, an Acute psychiatric unit, and renal services (Hospital Services Kimberly, 2022). The aboriginal population in Kimberley is approximately 45% of the region's population. The Kimberly 2018 health profile indicated that 5% of males self-reported Diabetes, 5.8% heart disease,28% injury and12.8% self-reported mental health problems (Kimberley Health Profile Planning and Evaluation Unit, 2018) In the period of 2016-2020 in Western. In Australia, the rate of Rheumatic heart disease in males aged 45 years to 64 years was 92.0 per 10 000 population (AIHW, 2016)

• Analyzing Needs and Determining Priorities
  • Identify health needs

This needs assessment enabled the identification of the health needs of Aboriginal Torres/Strait Islander men. The normative needs that were identified by the literature were Mental health, Chronic Disease (including Rheumatic fever, and respiratory disease), Diabetes, and Obesity. The perceived needs that were identified through focus groups were Mental Health, Alcohol and drug abuse, Diabetes, and Injury. These perceived needs that were discussed during the interview supported the grey literature. Expressed needs Identified were Mental health, Dental Heath, and diabetes. In the relative needs section mental health, Rheumatic heart disease, Injury, and Oral Health.

• Prioritize issues/problems

In order to prioritize the most significant health issue, a basic priority rating is implemented. The basic priority rating model applies a defined problem or issue to a set of criteria that the size and seriousness of the problem, and the effectiveness of potential intervention The resulting process then produces a quantifiable value of each problem being analyzed thus providing a basis for priority setting (D S,1990). This process was implemented on the health needs that were identified in the assessment for Aboriginal and Torres/Strait Islander men, Rheumatic heart disease was identified with the highest priority as this was evident in the needs categories. the second highest priority health need was Mental health.

• Identify and analyze the determinants of your need with the highest priority

As identified by the basic priority rating and by the analysis of the perceived at expressed needs, Rheumatic heart disease was the most significant health issue. Rheumatic heart disease is more prevalent in young Indigenous men. (Haynes et al, 2021). Rheumatic heart disease and acute rheumatic fever are predominately associated with social that include overcrowded housing, low education, and poor nutrition (Coffey, Ralph Krause, 2018).

in the period 2014 to 2015, 20% of Indigenous Australians reported living in overcrowded housing. A higher proportion of this percentage was in Remote areas. During the same period, 7.6% of indigenous Australians reported they did not have access to facilities for washing clothes and bedding and 6.7% did not have access to facilities for preparing food. Transport is another important determinant of Rheumatic heart disease as it provides access to healthcare services. Having limited or no public transport options significantly affects the capacity to access health care, particularly for patients with chronic health conditions (Teng et al. 2014).

• Recommendations for Program Focus

For the improvement and management of Rheumatic heart disease in Aboriginal Torres/Strait Islander men. To action this the social, economic, and environmental determinants should be improved. The first strategy would be to propose Holistic health services. Implementing Indigenous workers in health care facilities across all professions. This strategy will also encourage more Indigenous men into the health sector. This will improve the number of Indigenous men who will visit health services.

The second Strategy would be to have a Healthy Sanitary Home Initiative run by community members. The program will comprise healthy practices that include washing clothes and bedding, reducing overcrowding in homes, removing wastewater safely, Reducing the impact of dust, and removal of hazards that cause trauma.

The last strategy would be Early Prevention. Communities at higher risk will seek medical care when they have a sore throat and skin sores. The healthcare teams will be encouraged to maximize Medicare Benefits. This will be beneficial as appropriate treatment as the link between group A Streptococcus is interrupted thus reducing the development of ARF.

• Conclusion

In this needs assessment, the unmet health needs of Aboriginal Torres Strait Islander men were identified. A couple of health needs were identified across all the needs categories. The priority basic system indicated rheumatic heart disease as the most significant health issue. The recommendations for Program focus were based on social, economic, and environmental determinants. The strategies identified for this health issue were implementing a Holistic approach to health services, a healthy Sanitary home initiative, and an early prevention strategy.

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