Cultural diversity maintains a significant role in healthcare delivery in Australia. An individual’s cultural and ethnic background can affect beliefs and perceptions of health or illness. Furthermore, history and traditions influence potential risk factors which then impact health outcomes depending on the health service provision available. This report seeks to compare the influential factors of historical events and health policy on two diverse cultural groups such as Aboriginal and Torres Strait Islanders and Chinese Australians.
Aboriginal and Torres Strait Islander Australians
The Aboriginal and Torres Strait Islander cultural group consists of 798,400 people or approximately 3.3 percent of the total Australian population (Australian Bureau of Statistics, 2018). They occupy various territories throughout Australia, with one-third living in major cities, and another quarter in Inner Regional Australia. The population has historically been vulnerable and disadvantaged from a public healthcare perspective due to significant disparities in healthcare delivery.
Historical and Current Events
The origins of the Aboriginal people in Australia stretch back for as long as 120,000 years. This population lived in the Torres Straits and eventually mainland Australia, through a semi-nomadic lifestyle. The colonisation of Australia that started in the 19th century led to significant social disruptions which negatively impacted health behaviour due to control and attitudes towards health. Indigenous populations were forced unto unfavourable land where their lifestyle, culture, and traditions were either controlled or restricted.
Disruption of social networks caused eradication of cultural identity that is psychologically protective, without which positive health behaviours cannot be promoted. Racism and discrimination led to long-term physical and psychological abuse which has a profound trans-generational impact on the Aboriginal people. Historical events encouraged risk health behaviours such as tobacco smoking and alcohol abuse. Loss of liberty, fairness, and life have led to circumstances of significant social and economic disparity that causes to risk behaviour detrimental to health status (Waterworth, Pescud, Braham, Dimmock, & Rosenberg, 2015).
The transition from an active hunter-gatherer lifestyle to a Western sedentary habits and high caloric diet without proper preventive care has had serious impacts on the population health. Social determinants significantly impact the health status of Aboriginal people.
Despite some progress in recent years, only 47% of Aboriginal and Torres Strait Islander people have completed full secondary education and were employed. Reported incomes range between $150 and $799 weekly, which is lower than the $400 and $1249 range of non-indigenous populations (HealthInfoNet, 2017). The current state of social determinants is causing severe health issues for the population as life expectancy is almost ten years shorter than that of non-indigenous populations.
Poor employment and lack of education are creating barriers to access to healthcare, unhealthy lifestyles, and violence or stress. Aboriginal people have high rates of heart disease, diabetes, cancer, and respiratory disease as the leading causes of death (Australian Human Rights Commission, 2014). Furthermore, the populate maintains increasing rates of chronic diseases and experience common occurrences of otitis and trachoma which impact the quality of life.
There is poor access to primary health care and increasing rates of STDs, largely due to unavailability of medical facilities or lack of culturally-competent care that leaves numerous health problems undiagnosed and untreated. Substance abuse and unhealthy behaviours such as consistent alcohol and tobacco use are evident as well (Aboriginal and Torres Strait Islander Social Justice Commissioner, 2005).
Health Care Policies and Service Provision
Significant inequalities exist between Aboriginal and Torres Strait Islander peoples and non-indigenous Australians when concerning health status and provision. The 1989 National Aboriginal Health Strategy (NAHS) is the primary health policy articulated by the Australian government which recognised Aboriginal health disparities and strived towards creating a rights-based framework.
In 1997, the Aboriginal and Torres Strait Islander Health Framework Agreements were signed between all Commonwealth, state, and community governments focusing on establishing partnerships in healthcare provision for the population. In the 21st century, a wide variety of agreements and frameworks were developed by the Australian government, dedicating significant resources towards Aboriginal healthcare. This led to significant reforms with first Aboriginal medical services being established, large investments into rural hospitals, promoting the culturally-competent practice, and introducing Aboriginal stakeholders into the healthcare delivery system (Australian Government, 2013).
Despite such investment, dedication, and commitments by various Australian government and health organisations for over two decades, the effectiveness of health policy and service provision has only seen incremental improvement. Despite outlining commitments, they have not been activated or set within a designated time-frame to be achieved, leading to a lack of accountability. Furthermore, commitments and frameworks have not been adequately funded to implement these aspects into practice.
Finally, while a holistic and culturally-competent approach to Aboriginal healthcare is emphasised in every framework, there have been limited attempts to develop practical health programs focusing on the context of this population’s health setting and status (Aboriginal and Torres Strait Islander Social Justice Commissioner, 2005). A more recent approach has focused on establishing partnerships with Indigenous people to determine their needs and utilise evidence-based decisions when creating a policy to drive healthcare delivery. Providing a voice for the Indigenous populations is vital to establishing culturally sensitive and effective service provision (Australian Government, 2013).
Chinese-Australians are one of the most overlooked populations in the country, with a staggering 5.6% (over 1.2 million) of Australian residents identified as having Chinese heritage (Australian Bureau of Statistics, 2017). This population contributes significantly to the cultural diversity of Australia. However, from a health perspective, Chinese-Australians like many minorities face certain risks due to socio-cultural determinants and underutilisation of medical services.
Historical and Current Events
Chinese immigration began in the early 19th century when many migrant workers came to the country attracted by gold rushes and other work in Australian colonies. Significant Chinese presence was established in many cities as communities bonded together. The Australian government strictly controlled Asian immigration in the following century. There were strict entry policies such as a dictation test, and heavy tax was levied on Chinese minors.
Race-based policies and attitudes were prevalent in the country until 1973 (Kwai, 2018). Since Chinese belong to a category of visible minorities, they have felt permanently marginalised to this day. Trends in politics and society have led to negativism and discrimination.
In the past 30 years, the number of Chinese migrants has increased significantly. Families arrive not just from mainland China but Malaysia, Singapore, Hong Kong, and surrounding Indochina region. Many of the Chinese migrants maintain their culture regarding health, such as family, herbal drugs, belief in supernatural, and traditional medical methods. The population tends to distrust native Australian practitioners and prefers someone from their culture.
Furthermore, there are significant language barriers and cultural stigma for utilisation of mental health services (Queensland Health, n.d.). In light of recent nationalistic politics, some discrimination is evident as well against minorities such as Chinese-Australians.
Health Care Policies and Service Provision
Chinese-Australians continue to remain relatively secluded in their communities. As many as 2% of the total Chinese-Australian population are first-generation migrants, deeply embedded in culture and language. This leaves them vulnerable to negative treatment outcomes due to barriers to access. Delayed diagnoses and uncoordinated care are an inherent consequence of language barriers. In turn, the Chinese migrant community lacks the necessary support and information important for health literacy and maintenance (Hyatt et al., 2017). For the Chinese-Australian community, this has resulted in increased rates of improperly treated cancer and chronic cardiovascular conditions.
Unfortunately, very little research and focus have been given towards Asian minorities health in Australia. General research has been conducted highlighting that migrants remain a vulnerable population due to underutilisation of healthcare services. Certain segments of the population such as women and elderly require aid, interpreter services, and de-stigmatisation of using official healthcare systems. The National Health Strategy has included a goal to measure health status and health service utilisation for minorities, but no significant measures have been taken.
Both Aboriginal and Torres Strait Islander peoples, as well as Chinese-Australians, share similar risk factors. These include increased rates of preventable and transmittable diseases such as STDs, long-term chronic conditions, and evidence of substance abuse. These risk factors occur due to poor health literacy and service utilisation that has been driven by cultural and historical factors. Social influences such as racism, discrimination, and lack of culturally competent care (interpreters or tribe inclusion) have played a role in deferring both populations. As a result, health management remains at a relatively poor level relying on community and traditional medical services.
Due to the much shorter history and limited exposure, it could be argued that Aboriginal and Torres Strait Islander peoples have been more impacted regarding social and health disparities. History of colonisation led to hundreds of years of oppression, racism, and encouragement of risk health behaviours from Aboriginal populations. The negative impact is extensive and transgenerational, with many similar patterns continuing to the modern day. Furthermost, this greater impact is evident through health policy. While general health promotions have positively impacted all other ethnic and cultural groups in recent Australian history, in statistics such as infant mortality or service utilisation, the Aboriginal population continues to lag behind in almost every aspect.
There are some similarities and differences as to how both cultures responded to these events and impacts. As evident, both populations demonstrated trends of underutilising health services due to potential discrimination and lack of culturally-competent support services. As mentioned before, the Aboriginal populations began to engage in high-risk behaviours prompted by white colonists, while being forced into special settlements.
Meanwhile, Chinese immigrants created their own unique communities within cities and attempted to withstand racism through unity. Chinese-Australians attempted to continue health management through traditional practices and cultural, medicinal approaches. On the other hand, while Chinese immigrants isolated themselves in a way, in recent years, Aboriginal leaders have actively engaged in guiding Australia’s health policy for the betterment of their minority population.
Health outcomes remain similar for both cultures as populations struggle to achieve the level of health service utilisation for proper management and prevention of diseases. Chronic conditions such as diabetes and cardiovascular diseases, as well as cancer, remain prevalent at relatively high rates for both populations. This is due to lack of or extremely delayed diagnoses which do not allow for participation in viable treatment options.
Health policy has targeted the populations differently. Very little focus has been given to the Chinese-Australian community and their health status, despite being a larger percentage of the country’s population than Aboriginal and Torres Strait Islander people. In fact, most health policies and frameworks in Australia divide populations into indigenous and non-indigenous categories. As a result, health outcomes for Chinese-Australian populations depend very little on Australian health policy, but rather the approach to medicine in China which is brought by other migrants.
Meanwhile, health policy towards Aboriginal populations promises improved health outcomes as enormous amounts of resources are concentrated on addressing the health concerns of this population and forming vital partnerships. Aspects such as improving health literacy, removing access barriers, and implementing viable methods of disease management for Indigenous people is gradually having positive effects in reducing disparities and improving social determinants which may beneficially improve health outcomes.
This report demonstrates that culture and history have significant long-term impacts on health outcomes of two distinct and diverse populations. Aboriginal and Torres Strait Island people, as well as Chinese Australians, are both vital cultural groups in Australia’s society, collectively including over 9% of the country’s population. However, their historical status as minorities, facing racism, discrimination, and oppression has led to social disadvantages. One critical consequence is underutilisation of health services due to social and cultural barriers. This results in poor disease management and health outcomes. However, national health policy and partnership frameworks have aimed to reduce disparities.
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