Medical Science Assessment

Systematic literature review

Abstract

Background: The health care inequalities refers to the potential aspects that are related to health care like access and availability that fails to give health equity to the people of the nation. The health care inequalities exist between the Indigenous and non- Indigenous people of different nations on a broader level.

Aim: The main aim of this study was to analyse the health care inequalities among people of the nation.

Design: The design of this study was a systematic literature review in which various articles were searched using databases and selected using inclusion and exclusion criteria.

Method: The methodology is that the selected articles were then analysed for various aspects like the risk of bias, findings of the study, design of the study and limitations that helped in a better screening of the information. Results: The results were obtained on the basis of the findings from the studies that helped in shaping the topic of inequalities in health care.

 Conclusion: The conclusion drawn is that there exists a huge level of health care inequalities between Indigenous and non- Indigenous people of the nation mainly because of the racial discrimination and other social factors like no housing, low income, low employment rates among them and no access to affordable health care services.

Keywords- health inequalities, health care services, disadvantaged people, “Aboriginal and Torres Strait Islander people of Australia”, health disparities, discrimination

Introduction

Health inequality refers to the systematic difference in the health status of different population groups (World Health Organisation, 2020). This difference in health is observed in different communities of people like Indigenous groups of people and non- Indigenous groups of people. These are avoidable and preventable difference in the health of people that goes against the principle of social justice. The health inequality exists due to the social determinants of health and is also because of the socially determined by circumstances. These situations cause a disadvantage in people and also cause limited opportunities for living longer and healthier. The inequality in health care services is due to low access, less availability and many more reasons. The people who have no access or have limited access to health care services are especially from the remote areas of the nation who do not get an advantage of the health care services (Taylor & Guerin, 2019). This makes them the victim of inequality of health care services and this has a negative impact on their physical health and mental health. The inequality in the health care system is also due to income inequality that exists in the comparison groups that is, in different groups of people. Health inequalities do exist to some extent in every health care system of different nations (Martinson & Reichman, 2016). There is an assumption in the medical practice that health equity can be provided when people are able to access medical care easily and quickly. The “Aboriginals and Torres Strait Islander people” are one of the most disadvantaged people in terms of health care services because they live in rural areas and they do not have access to easy and affordable medical care. There are many socioeconomic factors such as housing, low employment, low education and low income that restrict them to have access to affordable medical care services. There are many health care services in Australia that are not delivered through the public sector like dental care services so the private sector does not make it affordable for such disadvantaged people of Australia. The inequalities in health care have been a major concern for the government of different nations so they have made some efforts like Australian government proposed ‘Closing the gap” which aims to diminish the health care disparities between “Indigenous and non- Indigenous people of Australia” (Altman, 2018).

Objectives

The main objective is to analyse the inequalities in health care among different groups of people.

Methods

The method adopted for the search on "inequalities in health care" is a systematic literature review. This is a review of a clearly formulated question that makes use of a systematic and explicit method that would help in identification, selection and critically appraising the relevant research (Liao et al., 2017). This also helps in the collection and analysis of the data that is collected from various studies that are a part of this review. The systematic literature review is done using different articles which have either quantitative data or qualitative data or has a mixed design that is both qualitative and quantitative data.

For this systematic literature review, the journal articles will be searched on various databases like MEDLINE, EMBASE, CINAHL and PubMed. These databases are searched thoroughly because they are the source of authentic and relevant articles that are published after thorough research. The articles from other sources like the WHO website and other websites for relevance on this topic are also searched. The search strategy adopted was to use relevant keywords along with the use of the Boolean operators, truncation and wildcard. The search terms used are inequalities AND health care, health care services OR health care AND inequality, disadvantaged people AND health care access, health care AND inequality*, ATSI AND health care access, ATSI OR disadvantaged people AND health care disparity.

The selection of articles was done using inclusion and exclusion criteria. The inclusion criteria were the articles that were published from 2012- 2019 were selected and the articles that were in the English language were only selected. This year bracket was selected so that recent information can be processed for the selected topic. The exclusion criteria were that the articles which did not match the topic or which contained information that was not relevant to the topic were excluded. The articles in a language other than English were also not selected. After the application of exclusion criteria, inclusion criteria and removal of duplicate articles, the total number of articles selected was six. These abstract of these six articles were read thoroughly for checking their relevancy. The selected articles had a mixed methodology that is were both qualitative design and quantitative design. This helped in selecting the best articles that had both types of data that is qualitative data and quantitative data both. The process of article selection is explained through the PRISMA chart diagram below:

Prisma flow chart

The data collection method for various journal articles was done using both inclusion and exclusion criteria. The data analysis was performed together that is the results of different articles were analysed together. The characteristics of the study were analysed along with the qualitative and quantitative information that the articles had.

Results

The results of different studies are presented in the form of the table given below:

Findings

The findings of different studies have been analysed as per the individual papers. The individual paper was read for the findings section for drawing an appropriate conclusion. Paper 1 states that Indigenous people of almost all the countries are the victim of health care inequalities. These are the most disadvantaged people because of their social determinants of health like poor housing, poor educational opportunities, low income and discrimination due to which they are unable to access easy and affordable health care services. The ATSI people of Australia are amongst the most disadvantaged ones because of the above-mentioned reasons and they are also known to have health disparity measured in the terms of dental health (Yap et al., 2018). The findings of the second article reveal that racial discrimination is one of the biggest causes of health care inequalities that is majorly suffered by Indigenous people of Australia. The fear of facing racism and discrimination does not allow these people to access health care services which further leads to inequalities in health care. The findings of the third article reveal that there is a significant gap in health care services that are provided to “Indigenous and non- Indigenous people” of different countries and this was drawn on the basis of self- reported dental health of the participants. This study analysed the health status through dental care which represented the health care inequalities that are experienced by “Indigenous people” of different countries. This health disparity in terms of access to services is explained by article 4 which states that the main reason for this gap in access to health care service is the demographic reason and socio-economic reason. The findings of article five state that the low level of emphasis when talking about health care inequalities is given to structural factors, organizational factors and social factors as compared to racism. This has a direct impact on the view of inequality in health care (Hicken et al., 2018).

Discussion

 The inequalities in health care are still a major concern in many countries like Australia despite governmental efforts like "Closing the gap" and other movements. This is because of some factors like racism, discrimination, social factors like housing, employment opportunities, low income and educational opportunities. The health care inequality exists between “Indigenous and non- Indigenous people of different countries”. This health care disparity is highly prevalent in Australia due to the lower rates of health care access among ATSI people. They do not have access to health care services that are affordable and discrimination-free which makes it impossible for them to access such services. This stud majorly analysed the national survey data and concluded that the health care inequalities need to be addressed to diminish the health disparities between “Indigenous and non- Indigenous people” of the nation.

Reflective review

Entrepreneur project in this report is based on the empathy field research using an appropriate entrepreneurial process. The entrepreneur business was of making a children’s play room beside the main theatre in Adelaide Town Hall so that the parents of small children can enjoy the movie whilst their children are also are safely playing and enjoying themselves. This innovative business concept consists of various stages of the entrepreneurial process that are ideation, prototype and test. This reflective essay focuses on the journey as an entrepreneur in this project. It includes reflection and analysis of existing theories and concepts that are based on ‘entrepreneurial traits, skills and processes’ in light of the personal experience.

There are four main stages of an entrepreneurial process they are innovation that is the generation of a business idea, second is identification of a market opportunity, third is the information search and the fourth stage is development of the service and product (Malecki, 2018). As an entrepreneur, I focused on the innovative business concept so that a lot of customers can be attracted towards the additional service that will be provided by the theaters. The process of engagement with the real users that is the real human beings who come to watch a movie changed the direction that the prototype took (Vecco, 2020). This prototype model was built keeping the humans in mind and their needs of the children so that the prototype can be tested and then rework can be done on same. The empathy field work was carried out for the couples who comes to enjoy a movie but are forced to leave midway because of the children who make noise and do not allow their parents to have a leisure time. When I started approaching people with the unfinished work, I realized more about the nature of work and made some amendments as per the review of these people.

The rough prototype was accepted by many and their positive reviews helped me to work harder for this innovative business concept.  This was an innovative business concept to increase the viewers that is to include the ones who have small children. This was a human- centered approach that was carried out collaboratively with the child care service provided by one of the renowned organization in Australia. as an entrepreneur that was a great experience because I learnt a lot about the child care services and the needs of children that makes them feel entertained and satisfied. The most interesting part of lean- start up process was when I finally started to work with my idea and collected the potential resources so that the whole idea could be well executed. A successful entrepreneur is the one who has good set of skills and attributes like who is open minded, creative, determined and is a self- starter. One should be confident and must have strong people skills to be a successful entrepreneur (Mohamed & Mustaffa, 2018). I definitely lacked some of these skills but my strength was my confidence, open mindedness and the strong people skills. the feedback of people on rough prototype helped me in shaping my work and finishing it as per the needs of the customers. The idea of a sound- proof glass slide door was given by some people and this is one of the strongest value proposition that this play room for children offers to the parents. This entrepreneurial process is highly different from that of a traditional approach of entrepreneurs as this is based on an innovative idea and I wanted to meet the customer’s need along with carrying out empathy field research. The traditional entrepreneurial approaches mainly focus on the money- making and business ideas but this one relies on an innovative idea that will be preferred by the couples having small children (Wu, Chen & Pan, 2019). It gives the parents ‘me time’ and this leisure time is too costly to be missed by them. Thus, it is expected that they will avail this kind of service and a positive feedback from them will motivate me for bringing up such innovative ideas.

The first thing that assists an entrepreneur in leading is the strong purpose that expresses their vision. The failure of innovation may lead to risk of losing ground to rival companies thus an entrepreneur must know when to innovate (Hseih, Parker & van Praag, 2017). Resources plays a very important role especially when an entrepreneur is working using a collaborative approach like an entrepreneur must build on strength using an advantage of the talent pool. I cultivated this idea and used the already existing resources to build a new one. The major focus on achieving the purpose is on the customers thus I used the same customers who come to watch a movie but used empathy field research for the customers that helped me with the execution of innovative business concept. In order to this entrepreneurial project forward I would take a feedback from the parents and would build a mini theatre for the small children where they will be able to watch movies and this will be highly beneficial for the business. This will be done only after I will develop some of the lacking entrepreneurial skills in me and after learning about the feedback response from the customers (Pathak, 2019). The children will be safe and be entertained at the same time along with allowing parents to keep an eye on their children.

The conclusion drawn is that as an entrepreneurial process this was a great experience and everything worked smoothly. There were many learning experiences and the issues faced enhanced the learning as an entrepreneur. This approach of entrepreneurship was much better than the traditional approach and this also enabled the development of skills and attributes that helped in the overall process. The customer’s feedback on the innovative idea was well incorporated and this resulted in the development of better system for both the children and their parents.

Reflective review

Entrepreneur project in this report is based on the empathy field research using an appropriate entrepreneurial process. The entrepreneur business was of making a children’s play room beside the main theatre in Adelaide Town Hall so that the parents of small children can enjoy the movie whilst their children are also are safely playing and enjoying themselves. This innovative business concept consists of various stages of the entrepreneurial process that are ideation, prototype and test. This reflective essay focuses on the journey as an entrepreneur in this project. It includes reflection and analysis of existing theories and concepts that are based on ‘entrepreneurial traits, skills and processes’ in light of the personal experience.

There are four main stages of an entrepreneurial process they are innovation that is the generation of a business idea, second is identification of a market opportunity, third is the information search and the fourth stage is development of the service and product (Malecki, 2018). As an entrepreneur, I focused on the innovative business concept so that a lot of customers can be attracted towards the additional service that will be provided by the theaters. The process of engagement with the real users that is the real human beings who come to watch a movie changed the direction that the prototype took (Vecco, 2020). This prototype model was built keeping the humans in mind and their needs of the children so that the prototype can be tested and then rework can be done on same. The empathy field work was carried out for the couples who comes to enjoy a movie but are forced to leave midway because of the children who make noise and do not allow their parents to have a leisure time. When I started approaching people with the unfinished work, I realized more about the nature of work and made some amendments as per the review of these people.

The rough prototype was accepted by many and their positive reviews helped me to work harder for this innovative business concept.  This was an innovative business concept to increase the viewers that is to include the ones who have small children. This was a human- centered approach that was carried out collaboratively with the child care service provided by one of the renowned organization in Australia. as an entrepreneur that was a great experience because I learnt a lot about the child care services and the needs of children that makes them feel entertained and satisfied. The most interesting part of lean- start up process was when I finally started to work with my idea and collected the potential resources so that the whole idea could be well executed. A successful entrepreneur is the one who has good set of skills and attributes like who is open minded, creative, determined and is a self- starter. One should be confident and must have strong people skills to be a successful entrepreneur (Mohamed & Mustaffa, 2018). I definitely lacked some of these skills but my strength was my confidence, open mindedness and the strong people skills. the feedback of people on rough prototype helped me in shaping my work and finishing it as per the needs of the customers. The idea of a sound- proof glass slide door was given by some people and this is one of the strongest value proposition that this play room for children offers to the parents. This entrepreneurial process is highly different from that of a traditional approach of entrepreneurs as this is based on an innovative idea and I wanted to meet the customer’s need along with carrying out empathy field research. The traditional entrepreneurial approaches mainly focus on the money- making and business ideas but this one relies on an innovative idea that will be preferred by the couples having small children (Wu, Chen & Pan, 2019). It gives the parents ‘me time’ and this leisure time is too costly to be missed by them. Thus, it is expected that they will avail this kind of service and a positive feedback from them will motivate me for bringing up such innovative ideas.

The first thing that assists an entrepreneur in leading is the strong purpose that expresses their vision. The failure of innovation may lead to risk of losing ground to rival companies thus an entrepreneur must know when to innovate (Hseih, Parker & van Praag, 2017). Resources plays a very important role especially when an entrepreneur is working using a collaborative approach like an entrepreneur must build on strength using an advantage of the talent pool. I cultivated this idea and used the already existing resources to build a new one. The major focus on achieving the purpose is on the customers thus I used the same customers who come to watch a movie but used empathy field research for the customers that helped me with the execution of innovative business concept. In order to this entrepreneurial project forward I would take a feedback from the parents and would build a mini theatre for the small children where they will be able to watch movies and this will be highly beneficial for the business. This will be done only after I will develop some of the lacking entrepreneurial skills in me and after learning about the feedback response from the customers (Pathak, 2019). The children will be safe and be entertained at the same time along with allowing parents to keep an eye on their children.

The conclusion drawn is that as an entrepreneurial process this was a great experience and everything worked smoothly. There were many learning experiences and the issues faced enhanced the learning as an entrepreneur. This approach of entrepreneurship was much better than the traditional approach and this also enabled the development of skills and attributes that helped in the overall process. The customer’s feedback on the innovative idea was well incorporated and this resulted in the development of better system for both the children and their parents.

Paper 1

Paper 2

Paper 3

Paper 4

Paper 5

Risk of bias

The methodology is a survey of people from Brazil, New Zealand and Australia for estimating health inequality of “Indigenous and non- Indigenous people”. High risk of bias because people were randomly selected.

The methodology is an analysis of data from the 2014 Australian General Social Survey that is used to assess the hypothesis formed. The risk of bias is medium because of the assessment of the hypothesis.

The methodology adopted is using a nationally representative survey of New Zealand, Australia and Canada. There is a high risk of bias in the study because this concentrates on the age and sex of participants.

The methodology adopted in the national survey of Australia which is based on self- reported data on health care utilization. This creates a high risk of bias because the data is self- reported which cannot be relied on.

The methodology adopted is a review of the medical systems' contribution to health disparities. This is a review of current knowledge on inequality and bias in the health care system that leads to inequalities in health care.

Study design

Quantitative design

Quantitative design

Quantitative design

Cross-sectional study

Qualitative design

Synthesis of results

The findings of this study state that irrespective of the country, “Indigenous people” were the victim of health inequality which was measured in terms of oral health (Schuch et al., 2017).  the magnitude of inequality was great and they remain untreated for the longest period of time.

The findings of this study state that one of the reasons for the barrier to health care which results in inequalities is racial discrimination and this was not found to be strongly associated with the only low-status group of people (Bastos et al., 2018). Racial inequalities contribute to health care inequalities in Australia.

The findings of this study state that the oral health of all the “Indigenous people” of all three countries was fair/ poor as self- reported by them as compared to “no- Indigenous people of all three countries”. This concludes that there exists health care inequalities between “Indigenous and non- Indigenous people of Canada”, Australia and New Zealand(Jamieson et al., 2016).

The findings of this study state that there are high rates of health care inequalities and health status inequalities in the utilization of health care services which is due to demographic reasons and socio-economic reasons (Jankovic et al., 2018). This should have significant implications for the health policymakers as they should ensure equal care for the people living in this country.

The findings of this study state that as per the modified social-ecological model there has been growth in the knowledge of cognitive and psychological processing that judge the bias and racism (Spencer & Grace, 2016). There have been decreased emphasis on the structural, organisational and social factors that contribute to inequalities in health care.

Limitations

There were age restrictions for becoming a participant in Australia.

The assessment of individual-level data was done that does not include all the potential aspects.

This study is secondary data analysis which does not allow them to have all the areas of interest under study.

This is a cross-sectional study design that is known to limit the casual interpretation of the findings of the study and this has self- reported data on health care which affects the reliability of the data.

The limitation of this study is that it has reviewed the limited information from the secondary sources that are insufficient to draw a conclusion.